The American College of Rheumatology Preliminary Diagnostic Criteria for Fibromyalgia and Measurement of Symptom Severity
The American College of Rheumatology Preliminary Diagnostic Criteria for Fibromyalgia and Measurement of Symptom Severity
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DOI：
10.1002/acr.20140
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发表时间：
2010-05-01
影响因子：
4.7
通讯作者：
Yunus, Muhammad B.
中科院分区：
文献类型：
--
作者：
Wolfe, Frederick;Clauw, Daniel J.;Yunus, Muhammad B.
目标。为纤维肌痛的临床诊断制定简单、实用的标准，这些标准适用于初级和专科护理，不需要进行压痛点检查，并为纤维肌痛的典型症状提供严重程度的分级。我们对829名先前诊断为纤维肌痛的患者和对照组进行了一项多中心研究，使用医生的体检和面谈检查，包括广泛性疼痛指数(WPI)，这是一种衡量身体疼痛区域数量的指标。使用随机森林和递归分区分析来指导纤维肌痛的病例定义的发展，制定标准，并构建症状严重性(SS)量表。在研究进行时，大约25%的纤维肌痛患者不符合美国风湿病学会(ACR)1990年的分类标准。最重要的诊断变量是WPI和认知症状、清醒睡眠、疲劳和躯体症状数量的分类量表。将分类量表相加，形成SS量表。我们结合SS量表和WPI推荐了一个新的纤维肌痛病例定义：(WPI>；=7和SS>；=5)OR(WPI 3-6和SS>；=9)。这一简单的纤维肌痛临床病例定义正确地将88.1%的病例按ACR分类标准分类，并且不需要体检或压痛点检查。SS量表可以评估目前或以前有纤维肌痛的人以及那些没有应用标准的人的纤维肌痛症状严重程度。在对症状变异性明显的患者进行纵向评估时，它将特别有用。
Objective. To develop simple, practical criteria for clinical diagnosis of fibromyalgia that are suitable for use in primary and specialty care and that do not require a tender point examination, and to provide a severity scale for characteristic fibromyalgia symptoms.Methods. We performed a multicenter study of 829 previously diagnosed fibromyalgia patients and controls using physician physical and interview examinations, including a widespread pain index (WPI), a measure of the number of painful body regions. Random forest and recursive partitioning analyses were used to guide the development of a case definition of fibromyalgia, to develop criteria, and to construct a symptom severity (SS) scale.Results. Approximately 25% of fibromyalgia patients did not satisfy the American College of Rheumatology (ACR) 1990 classification criteria at the time of the study. The most important diagnostic variables were WPI and categorical scales for cognitive symptoms, unrefreshed sleep, fatigue, and number of somatic symptoms. The categorical scales were summed to create an SS scale. We combined the SS scale and the WPI to recommend a new case definition of fibromyalgia: (WPI >= 7 AND SS >= 5) OR (WPI 3- 6 AND SS >= 9).Conclusion. This simple clinical case definition of fibromyalgia correctly classifies 88.1% of cases classified by the ACR classification criteria, and does not require a physical or tender point examination. The SS scale enables assessment of fibromyalgia symptom severity in persons with current or previous fibromyalgia, and in those to whom the criteria have not been applied. It will be especially useful in the longitudinal evaluation of patients with marked symptom variability.