ACR Fibromyalgia Diagnostic Criteria

Fibromyalgia is a distinctive syndrome which can be diagnosed with clinical precision. It may occur in the absence (primary fibromyalgia) or presence of other conditions such as rheumatoid arthritis or systemic lupus erythematosus (concomitant fibromyalgia). It is rarely secondary to another disease, in the sense that alleviation of the associated disease also cures the fibromyalgia. It may be confidently diagnosed in patients with widespread musculo-skeletal pain and multiple tender points.

The American College of Rheumatology
1990 Criteria for the Classification of Fibromyalgia

History of widespread pain has been present for at least three months
Definition: Pain is considered widespread when all of the following are present:

  • Pain
  • in both sides of the body
  • Pain
  • above and below the waist In addition, axial skeletal pain (cervical spine, anterior chest, thoracic spine or low back pain) must be present. Low back pain is considered lower segment pain.

Pain in 11 of 18 tender point sites on digital palpation
Definition: Pain, on digital palpation, must be present in at least 11 of the following 18 tender point sites:

  • Occiput
  • (2) - at the suboccipital muscle insertions.
  • Low cervical
  • (2) - at the anterior aspects of the intertransverse spaces at C5-C7.
  • Trapezius
  • (2) - at the midpoint of the upper border.
  • Supraspinatus
  • (2) - at origins, above the scapula spine near the medial border.
  • Second
  • rib (2) - upper lateral to the second costochondral junction.
  • Lateral
  • epicondyle (2) - 2 cm distal to the epicondyles.
  • Gluteal
  • (2) - in upper outer quadrants of buttocks in anterior fold of muscle.
  • Greater
  • trochanter (2) - posterior to the trochanteric prominence.
  • Knee
  • (2) - at the medial fat pad proximal to the joint line.

Digital palpation should be performed with an approximate force of 4 kg. A tender point has to be painful at palpation, not just "tender."

Illustration of Tender Points

Fibromyalgia Syndrome Symptoms
Condition % of FMS Symptoms
Muscular Pain 100
Fatigue 96
Insomnia 86
Joint Pains 72
Headaches 60
Restless Legs 56
Numbness and Tingling 52
Impaired Memory 46
Leg Cramps 42
Impaired Concentration 41
Nervousness 32
Depression (Major Depression) 20

Arthritis and Rheumatism. Vol. 33, No. 2 (February 1990)

Obesity Link to Fibromyalgia
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