Abstract
Fibromyalgia syndrome (FMS) is a chronic illness characterized by widespread pain and other clinical and emotional symptoms. The lack of objective markers of the illness has been a persistent problem in FMS research, clinical management, and social recognition of the disease. A critical historical revision of diagnostic criteria for FMS, especially those formulated by the American College of Rheumatology (ACR), was performed. This narrative review has been structured as follows: Introduction; historical background of FMS, including studies proposing and revising the diagnostic criteria; the process of development of the ACR FMS diagnostic criteria (1990 and 2010 versions); revisions of the 2010 ACR FMS diagnostic criteria; the development of scales based on the 2010 and 2011 criteria, which could help with diagnosis and evaluation of the clinical severity of the disease, such as the Polysymptomatic Distress Scale and the FMS Survey Questionnaire; relationships of prevalence and sex ratio with the different diagnostic criteria; validity and diagnostic accuracy of the ACR FMS criteria; the issues of differential diagnosis and comorbidity; the strength and main limitations of the ACR FMS criteria; new perspectives regarding FMS diagnosis; and the impact of the novel findings in the diagnosis of FMS. It is concluded that despite the official 2010 FMS diagnostic criteria and the diagnostic proposal of 2011 and 2016, complaints from health professionals and patients continue.
Highlights
Fibromyalgia syndrome (FMS) is conceptualized as a chronic disorder characterized by widespread and persistent non-inflammatory musculoskeletal pain
In spite of the 1990 American College of Rheumatology (ACR) criteria being replaced by the 2010 criteria and later diagnostic proposals being made, in clinical settings, the majority of health professionals continue to employ digital palpation, in which controlling the level of pressure exerted is difficult, and do not systematically apply any of the criteria proposed by the ACR [58,79,86,87]
In many cases the FMS diagnosis is fundamentally based on the exclusion of other similar diseases; in spite of that practice not being recommended because of its lack of precision and the high possibility of misdiagnosis
Summary
Fibromyalgia syndrome (FMS) is conceptualized as a chronic disorder characterized by widespread and persistent non-inflammatory musculoskeletal pain. The majority of FMS patients usually show predominantly negative affect, including neuroticism, alexithymia, and catastrophizing [3,4,5] and impaired health-related quality of life [6]. The prevalence of FMS is estimated at 2%–4% in the general population, being more frequent in women than in men (see later) [2]. The prevalence in Spain is around 2.4% in the general population [7] (see Figure 1 for prevalence in different countries). As reported by the 2016 EPISER study (prevalence of rheumatic diseases in the adult population in Spain), carried out by the Spanish Society of Rheumatology and published in 2019, the prevalence of FMS in Spain is around 2.45% [8]. UUssuuaallllyy,, tthhee ddiiaaggnnoossiiss ooff FFMMSS mmaayy ttaakkee yyeeaarrss ttoo bbee ccoommpplleetteedd,, wwiitthh ppaattiieennttss vviissiittiinngg sseevveerraall mmeeddiiccaall ssppeecciiaalliissttss iinn tthhaattttiimmee..In this context, the development of objective and reliable diagnostic criterIina itshoisf pcroinmteaxryt, imthpeodrteavnecleopfomr eimntporofvoinbgjecFtMivSe raensedarrcehliaabnlde udnidagernsotastnidc icnrgitoefritaheisdiosfeapsrei.mTahriys rimevpieowrtaonfcFeMfoSr icmritperroiaviinsgfoFcMusSerdesoenaracdhualntsdwuinthdeFrMstaSn, dniontgthoef tpheeddiaistreiacspe.oTphuilsatrieovnie. w of FMS criteria is focused on adults with FMS, not the pediatric population
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