Disparity Exists Between Criteria and Expert Diagnosis of Fibromyalgia

There is disconnect between the clinical-based and criteria-based diagnosis of fibromyalgia, according to a new study.

To reach this conclusion, the researchers compared the responses of 497 patients who completed the Multidimensional Health Assessment Questionnaire and the 2010 American College of Rheumatology preliminary diagnostic criteria for self‐administration during ordinary medical visits to a rheumatology clinic. All participants were diagnosed by rheumatology staff.

In all, 121 participants (24.3%) satisfied the fibromyalgia criteria, whereas 104 participants (20.9%) received a clinician International Classification of Diseases (ICD) diagnosis of fibromyalgia.

While the agreement between clinicians and criteria was 79.2%, the agreement beyond chance was only fair. Physicians did not identify 60 criteria‐positive patients (49.6%) and incorrectly identified 43 criteria‐negative patients (11.4%).

In a subset of 88 participants with rheumatoid arthritis, the agreement was considered slight to fair.

Women participants and participants with more symptoms but fewer pain areas were more likely to receive a clinician's diagnosis than to meet fibromyalgia criteria.

“There is considerable disagreement between ICD clinical diagnosis and criteria‐based diagnosis of fibromyalgia, calling into question ICD‐based studies,” the researchers concluded. “Fibromyalgia criteria were easy to use, but problems regarding clinician bias, meaning of a fibromyalgia diagnosis, and the validity of physician diagnosis were substantial.”

—Colleen Murphy

Reference:

Wolfe F, Schmukler J, Jamal S, et al. Diagnosis of fibromyalgia: disagreement between fibromyalgia criteria and clinician‐based fibromyalgia diagnosis in a university clinic [published online February 6, 2019]. Arthritis Care Res (Hoboken). https://doi.org/10.1002/acr.23731.