ACR Fibromyalgia Diagnostic Criteria
The American College of Rheumatology
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.
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
||% of FMS
| Numbness and Tingling
| Leg Cramps
| Depression (Major Depression)
Arthritis and Rheumatism. Vol. 33, No. 2 (February 1990)