ACR Fibromyalgia Diagnostic Criteria

Aka: ACR Fibromyalgia Diagnostic Criteria, ACRFDC, Widespread Pain Index, Fibromyalgia Symptom Severity Score, Fibromyalgia Diagnosis

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II. Background

  1. Replaces Tender Points in the diagnosis of Fibromyalgia as of 2010
  2. Updated in 2016 by ACR, adding 4 of 5 regions criteria, simplified Part 2 of the Symptom Severity Score
  3. See Fibromyalgia for the AAPT Diagnostic Criteria

III. Criteria: Widespread Pain Index (WPI)

  1. In the past 7 days, where have you had pain or tenderness (one point for each location, out of 19 possible)
    1. Neck
    2. Upper Back
    3. Chest or Breast
    4. Abdomen
    5. Lower Back
    6. Left jaw
    7. Left Shoulder
    8. Left upper arm
    9. Left lower arm
    10. Left hip or buttock
    11. Left upper leg
    12. Left lower leg
    13. Right jaw
    14. Right Shoulder
    15. Right upper arm
    16. Right lower arm
    17. Right hip or buttock
    18. Right upper leg
    19. Right lower leg

IV. Criteria: Symptom Severity Score (out of 12 possible)

  1. Part 1: Rate each of the following three symptoms, for the past 6 months
    1. Rating scale
      1. Points 0: No problem
      2. Points 1: Slight or intermittent
      3. Points 2: Moderate (considerable problems)
      4. Points 3: Severe (pervasive, life altering)
    2. Questions
      1. Fatigue
      2. Trouble thinking or remembering (cognitive symptoms)
      3. Waking up tired or unrefreshed
  2. Part 2: Assign one point for each symptom that has been bothersome over the last 6 months
    1. Headache
    2. Lower Abdominal Pain or cramps
    3. Depressed mood

V. Interpretation: ACR Diagnostic Criteria for Fibromyalgia (all three must be present)

  1. Symptom Duration of 3 months or more
  2. Generalized pain affects at least 4 of 5 body regions
    1. Left Shoulder or arm
    2. Right Shoulder or arm
    3. Neck or back
    4. Left hip or leg
    5. Right hip or leg
  3. Widespread Pain Index and Symptom Severity Score Composite (see criteria above)
    1. Widespread Pain Index >=7 AND Symptom Severity Score >=5 OR
    2. Widespread Pain Index >=4 AND Symptom Severity Score >=9 OR

VI. References

  1. Wolfe (2016) Semin Arthritis Rheum 46(3): 326 [PubMed]
  2. Wolfe (2010) Arthritis Care Res 62(5): 600-10 [PubMed]

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