Diagnostic Considerations
In adults, diagnosis of fibromyalgia syndrome (FMS) is based on history, physical examination, laboratory study findings, and exclusion of other potential conditions.
In 1990, the American College of Rheumatology (ACR) defined 2 major diagnostic criteria for classifying FMS in adults. The first is a history of widespread pain for at least 3 months that involves both sides of the body above and below the waist. Specific areas include the cervical skeleton (eg, spine, anterior chest), the shoulders or buttocks (considered for each involved side), and the lower back (considered below the waist).
The second criterion requires pain on 11 of 18 defined tender points (TPs) upon digital palpation with approximately 4 kg per unit area of force. For a positive result, the patient must indicate that palpation is painful (see Physical Examination).
In 1985, Yunus and Masi first compared juvenile primary fibromyalgia syndrome (JPFS) with FMS in adults. [11] The 1990 criteria for adult FMS were found to be less sensitive to the events that occur in childhood FMS. Yunus and Masi proposed FMS criteria that are slightly different for children and adolescents. Their criteria take into consideration a more variable presentation, along with a dependence on adult input to make the diagnosis.
The ACR criteria for adults have not been validated in children; thus current diagnostic criteria for JPFS are based on the Yunus and Masi guidelines. [11]
By these criteria, a JPFS patient should have had 3 or more months of widespread musculoskeletal pain, with 5 or more well-defined TP sites. No other underlying medical conditions that could have caused the symptoms should be present, and routine laboratory test results should be in the normal range. In addition, at least 3 of the following 10 minor criteria (or associated symptoms) should be present (see History):
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Chronic anxiety or tension
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Fatigue
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Poor sleep
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Chronic headaches
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Irritable bowel syndrome
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Subjective soft tissue swelling
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Numbness
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Pain modulation by physical activities
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Pain modulation by weather conditions
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Pain modulation by anxiety or stress
Although children and adults with FMS experience similar symptoms, children seem to have more sleep disturbances. Compared with adults, children experience pain in fewer body areas (3 versus 5) and have fewer TPs (5 out of 11 versus 11 out of 18). Children have less lower back pain, hand pain, and paraspinal TPs; however, they experience ankle pain and increased pain associated with overactivity.
Go to Fibromyalgia and Rehabilitation and Fibromyalgia for complete information on these topics.
Other conditions to be considered include the following:
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Anterior chest wall syndrome
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Benign rheumatoid nodules
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Bursitis
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Dysautonomia
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Early spondyloarthropathy
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Growing pains
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Hypermobility syndrome
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Inflammatory bowel disease
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Malingering
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Multiple sclerosis
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Reflex sympathetic dystrophy
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Restless leg syndrome
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Tendinitis
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Thyroid disease
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Syndrome of multiple chemical sensitivities
Differential Diagnoses
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Illustration of 9 paired tender points identified in the 1990 statement of the American College of Rheumatology on fibromyalgia. They are as follows: (a) insertion of nuchal muscles into occiput, (b) upper border of trapezius, (c) muscle attachments to upper medial border of scapula, (d) anterior aspects of the C5–C7 intertransverse spaces, (e) second rib space 3 cm lateral to the sternal border, (f) muscle attachments to lateral epicondyle 2 cm below bony prominence, (g) upper outer quadrant of gluteal muscles, (h) muscle attachments just posterior to greater trochanter, and (i) medial fat pad of knee proximal to joint line.
