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Fibromyalgia
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==== 2010 American College of Rheumatology (ACR) Criteria ==== The new ACR criteria for fibromyalgia assesses: * [[#WPI|Widespread Pain Index]] (WPI), which replaces the older tender points assessment, and * [[#SS|Symptom Severity Score]] (SS), which assesses somatic symptoms other than pain<ref name="ACR2010" /> =====<span id="WPI">Widespread pain index===== There are 19 areas in the widespread pain index (WPI) in the newer ACR criteria.<ref name="masscfids" /><ref name="ACR2010" /> [[File:Widespread Pain Index Areas with numbers.svg|200px|thumb|right|'''WPI''' 19 areas of pain. Count 1 point for each area of pain present at least once a week.<ref name="Firdous2012" /><ref name="ACR2010" /><ref name="excerpt" /><br> Image source: [https://commons.wikimedia.org/wiki/File:Widespread_Pain_Index_Areas_with_numbers.svg#/media/File:Widespread_Pain_Index_Areas_with_numbers.svg Wikimedia Commons] by author Jmarchn. License: CC-by-sa-3.0.]] This '''Widespread Pain Index (WPI)''' is scored out of 19, and is one of the two required scores needed for a doctor to make a diagnosis of fibromyalgia, and is considered in combination with the SS score.<ref name="Firdous2012" /><ref name="ACR2010" /> =====<span id="SS">Symptom severity</span>===== The Symptom Severity score ranks each of the following groups of fibromyalgia symptoms on a scale of 0-3, giving a SS score out of 12: *[[Fatigue]] *[[Unrefreshing sleep|Waking unrefreshed]] *[[Cognitive dysfunction|Cognitive symptoms]] *Somatic (physical) symptoms in general (such as [[headache]], weakness, [[Gastrointestinal system|bowel problems]], [[nausea]], [[dizziness]], [[numbness]]/[[Paresthesia|tingling]], [[hair loss]], [[Dry eye syndrome|dry eyes]], [[Raynaud's syndrome|Raynaud's phenomenon]], painful urination, and more.<ref name="Firdous2012" /><ref name="ACR2010" /> [[File:WPI SS Fibro.JPG|600px|thumb|center|Table 2: '''SS''' scale score. Add a 4th column for Somatic (physical) symptoms in general (such as Headache, weakness, bowel problems, nausea, dizziness, numbness/tingling, hair loss, dry eyes, Raynaud's phenomenon, painful urination, and more)<ref name="Firdous2012" /><ref name="ACR2010" /> The patient ranks specific symptoms on a scale of 0-3. The numbers assigned to each column are added up, for a total of 0-12.<ref name="Firdous2012" /><br> Source: Jahan F, Nanji K, Qidwai W, Qasim R. Fibromyalgia Syndrome: An Overview of Pathophysiology, Diagnosis and Management. Oman Med J 2012 May; 27(3):192-195. doi: 10.5001/omj.2012.44 license: CC-BY-NC]] A fibromyalgia diagnosis is based on both the '''WPI''' score and the '''SS''' score either: *'''WPI''' of at least 7 and '''SS''' scale score of at least 5, ''or'' *'''WPI''' of at least 4 and '''SS''' scale score of at least 9 *with symptoms present for at least three months<ref name="Firdous2012" /><ref name="ACR-rev" /> The 2010 American College of Rheumatology (ACR) proposed diagnostic criteria for fibromyalgia<ref name="ACR2010" /><ref name="excerpt" /> was modified in 2011,<ref name="2016revision" /> with the modification being validated in 2013 and published in 2014.<ref name="prelim2010">{{Cite journal | last = Bennett | first = Robert M. | last2 = Friend | first2 = Ronald | last3 = Marcus | first3 = Dawn | last4 = Bernstein | first4 = Cheryl | last5 = Han | first5 = Bobby Kwanghoon | last6 = Yachoui | first6 = Ralph | last7 = Deodhar | first7 = Atul | last8 = Kaell | first8 = Alan | last9 = Bonafede | first9 = Peter| date = 2014 | title = Criteria for the diagnosis of fibromyalgia: validation of the modified 2010 preliminary American College of Rheumatology criteria and the development of alternative criteria| url = https://www.ncbi.nlm.nih.gov/pubmed/24497443|journal=Arthritis Care & Research|volume=66|issue=9 | pages = 1364–1373|doi=10.1002/acr.22301|issn=2151-4658|pmid=24497443|via=}}</ref> In September 2016, another revision was been made.<ref name="ACR-rev">{{Cite news |url =http://acrabstracts.org/abstract/2016-revisions-to-the-20102011-fibromyalgia-diagnostic-criteria/ | title = 2016 Revisions to the 2010/2011 Fibromyalgia Diagnostic Criteria - ACR Meeting Abstracts | last = | first = | date = Sep 28, 2016|work=ACR Meeting Abstracts|access-date=2018-08-09|archive-url=|archive-date=|language=en-US}}</ref> =====Take the online Fibromyalgia test ===== This [https://www.fibromyalgiaforums.org/get-help/online-fibromyalgia-test online test by fibromyalgiaforums.org] uses the ACR 2010 Criterion to help diagnose fibromyalgia. =====Tender point test phased out ===== The older 1990 criteria's tender point examination was replaced because men often do not seem to form the tender points needed for diagnosis.<ref name="men">{{Cite news |url =http://www.webmd.com/fibromyalgia/features/how-fibromyalgia-affects-men#2 | title = How Fibromyalgia Affects Men: Symptoms and Diagnosis|work=WebMD|access-date=2018-08-09|language=en-US}}</ref> The 2010 proposed criteria correctly diagnosed more men, with a female:male ratio of 2:1.<ref name="medscape">{{Cite web | last = Boomershine | first = Chad | date = Nov 4, 2017 | title = Fibromyalgia: Practice Essentials, Background, Pathophysiology| url = http://emedicine.medscape.com/article/329838-overview#a5 | website = Medscape | pages = |via=}}</ref> Tender point examination was also problematic because "considerable skill is needed to correctly check for a patient's tender points (i.e., digital palpation that is done with certain amount of applied pressure)", but this technique was not taught at most medical schools.<ref name="NBK279092" /><ref name="masscfids">{{Cite web | url = https://www.masscfids.org/8-resource-library/diagnosis/266-tender-points-might-no-longer-be-used-for-diagnosis-of-fibromyalgia#2 | title = Tender Points might no longer be used for diagnosis of Fibromyalgia | last = Proskauer | first = Charmian | date = Feb 5, 2011 | website = [[Massachusetts ME/CFS & FM Association]]|language=en-GB|archive-url=|archive-date=|access-date=2018-08-09}}</ref> :The new standards were designed to: :*eliminate the use of a tender point examination :*include a severity scale by which to identify and measure characteristic FM symptoms :*utilize an index by which to rate pain<ref name="masscfids" />
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