Background/Purpose: Fibromyalgia (FM), often disputed and challenged, has emerged as a clear cluster of symptoms and co-morbidities, characterized by subjective complaints without physical or biomarker abnormality. Areas of debate include classification, value of diagnostic label, tender point examination, and best clinical care setting. Recommendations in recent guidelines addressing these issues were examined for consistencies and differences.

Methods: Systematic searches from January 2008 to February 2013 of the US-American National Guideline Clearing House, the Scottish Intercollegiate Guidelines Network, Guidelines International Network and Medline for evidence-based guidelines for the management of FM were conducted. Inclusion criteria required that the guideline was commissioned by a scientific organisation, guideline group was interdisciplinary, systematic search strategy was outlined, criteria for classification of evidence and recommendations were stated and the process for establishing recommendations was outlined. Only guidelines addressing FM were accessed.

Results: The literature search yielded 24 citations (19 excluded for duplication, 1 without criteria for assigning evidence, 1 not scientific society commissioned) with three guidelines independently developed in Canada, Germany and Israel included. Recommendations concerning definition, classification, clinical diagnosis and general principles of care were based predominantly on expert consensus, with limited literature evidence. All three countries justified the need for guidelines based on high FM prevalence, controversies surrounding diagnosis/management, reduced health-related quality of life and high health care costs with unanimity for the following parameters: FM was defined by the 1990 ACR classification criteria; FM should be clinically diagnosed by a typical cluster of symptoms, following a composite history, physical examination, and selected laboratory tests, to exclude another somatic disease; diagnosis confirmation with 2010 ACR diagnostic criteria if desired; importance of assigning a diagnostic label; education regarding the nature of the disorder to include a biopsychosocial model, planned treatment strategy and expected outcome; recognition that FM is a continuum disorder; coexistence with another medical (e.g.) rheumatic condition and mental disorder. Differences between guidelines were reflected in the concept of FM as representing a clinical construct of pain and other symptoms, a functional somatic syndrome, or a central hypersensitivity syndrome identified by each, tender point examination replaced by examination for soft tissue tenderness by 2, care in the primary care setting by 2, and 1 discouraging focus on a triggering event.

Conclusion: Guidelines from three continents showed remarkable consistency regarding the clinical concept of FM, acknowledging the need to provide confidence in a clinical diagnosis, importance of assigning a diagnostic label, and acceptance that FM is neither a distinct rheumatic nor mental disorder, but a cluster of symptoms spanning a broad range of medical disciplines.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/recommendations-for-the-classification-and-diagnosis-of-fibromyalgia-syndrome-provided-by-independently-developed-evidence-based-interdisciplinary-guidelines-spanning-three-continents/