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Health Information Under the Microscope: Improving Diagnosis for Fibromyalgia

The American College of Rheumatology has proposed a new set of diagnostic criteria for fibromyalgia that includes common symptoms such as fatigue, sleep disturbances and cognitive problems, as well as pain. These new criteria were published in the journal Arthritis Care & Research.

Fibromyalgia is a chronic condition characterized by unexplained, widespread pain in the muscles, ligaments and tendons, as well as fatigue and multiple tender points — places on the body where slight pressure causes pain. It occurs in 2 to 4 percent of the U.S. population, but unfortunately, many people who suffer fibromyalgia symptoms don’t get a proper diagnosis, and as a result, don’t get the treatment they need.

Flawed Findings
The problem is that routine lab tests cannot detect fibromyalgia. Instead, a diagnosis is made using a tender point test, a physical exam that focuses on 18 points throughout the body. When light pressure is applied to these points, clustered around the neck, shoulder, chest, hip, knee and elbow regions, patients with fibromyalgia feel tenderness or pain.

“There are numerous shortcomings with these criteria,” says Robert S. Katz, MD, one of the authors of the new criteria and a rheumatologist at Rush University Medical Center. “They don’t take into account the importance of a number of common fibromyalgia symptoms, including significant fatigue, a lack of mental clarity and forgetfulness, sleep problems and an impaired ability to function doing normal activities.”

A More Definitive Diagnosis
The new criteria recognize that fibromyalgia is more than just body pain. According to Katz, fibromyalgia pain may fluctuate, which can affect the number of tender points. The tender point test also did not adequately measure symptom severity or the effectiveness of new treatments.

Under the new criteria, the tender point test is replaced with a widespread pain test — the results of which are determined by counting the number of areas on the body where the patient has felt pain in the past week — plus an assessment of symptom severity. The authors have also created a standardized, symptom-based diagnosis that ensures all doctors will use the same process to diagnose fibromyalgia.

“This is a big deal for patients who suffer symptoms but have had no diagnosis,” Katz says. “A definite diagnosis can lead to more focused and successful treatment, and reduce the stress of the unknown.”


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Please note: All physicians featured in Discover Rush Online are on the medical faculty of Rush University Medical Center. Some of the physicians featured are in private practice and, as independent practitioners, are not agents or employees of Rush University Medical Center.

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Under the Microscope: Improving Diagnosis for Fibromyalgia

   
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