WHAT IS FIBROMYALGIA

Fibromyalgia Syndrome

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

Arthritis and Rheumatism, Vol. 33, No. 2, Feb 1990, F. Wolfe, et al.

Fibromyalgia Syndrome Symptoms

Arthritis and Rheumatism, Vol. 33, No. 2, Feb 1990, F. Wolfe, et al.

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