A Comparative Evaluation of the 2011 and 2016 Criteria for Fibromyalgia

Abstract

Objective: In 2016, a revised version of the 2010 American College of Rheumatology fibromyalgia (FM) criteria and the 2011 self-report (survey) FM criteria were published. The 2016 criteria preserved the distinction between physician and patient criteria, but made the individual criteria items identical, added a "generalized pain" criterion, and changed ascertainment and scoring methods, among other changes. In this study, we evaluated diagnostic differences relating to 2016 changes.

Methods: We used the National Data Bank for Rheumatic Diseases and evaluated 16,987 participants with painful rheumatic disorders using the 2011 and 2016 methodologies.

Results: There were 4731 patients (27.9%) who satisfied the 2011 criteria and 4077 (24.0%) the 2016 revision. This resulted in agreement in 96.2% of cases and disagreement in 3.9%. All disagreements occurred in the 4731 2011-positive cases who failed to meet the 2016 criteria. This result came about because 654 (13.8%) of the 2011-positive cases failed to meet the new generalized pain requirement. When using the approximate polysymptomatic distress diagnostic method, diagnostic misclassification ranged between 7% and 13%.

Conclusion: The 2016 FM criteria further refined and increased the usefulness of symptom-based diagnosis of FM by excluding patients with regional pain syndromes. However, these changes, useful as they are, underscore the social construction of symptom-based diagnosis and the inherent limitations in reliability and validity associated with FM criteria.

Keywords: EPIDEMIOLOGY; FIBROMYALGIA; PAIN.