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In this issue of The Journal Dr. Wolfe and colleagues introduce 2 new and different protocols (there have been many prior versions) to identify what they call “fibromyalgianess”1,2. In what ways are the new proposals unhelpful? Dilution (the inclusion of milder cases changes prognosis); inconsistency (multiple diagnostic strategies identify different patients); loss of specificity [later criteria sets lose information and fail to discriminate symptoms of rheumatoid arthritis (RA), fibromyalgia (FM), systemic lupus erythematosus (SLE), and osteoarthritis (OA)]; and loss of the ability to recognize FM concurrent with other diseases. Statistical approaches are used that do not make most efficient use of the information available. More fundamental is the continuing distraction from the obligation to accurately identify the origins of pain and choose appropriate treatments3.The odyssey was not without purpose or logic. FM has been described as a spectrum disorder. But there are 2 quite separate spectra. One is a continuous spectrum expressing severity, with FM separated from lesser chronic pain by arbitrary cutpoints. The other is better described as a palette of characteristic symptoms, found to be associated with FM however defined. Many of these statistically significant associations were found in the 1990 Classification Criteria study4. Sleep disturbance, fatigue, morning stiffness > 15 minutes, paresthesias, anxiety, headache, prior depression, irritable bowel syndrome, sicca symptoms, urinary urgency, dysmenorrhea history, and Raynaud’s phenomenon are all listed in Table 6 of the 1990 paper. Because symptoms other than widespread pain were not embedded in the Criteria, the statistical strength of the association of these and other symptoms associated with FM could be tested independent of the 1990 Criteria. Other links were added later, including cognitive problems (“Fibrofog”)5, “dizziness,” jaw pain6,7, and low abdominal pain. If this symptom profile … Address correspondence to Dr. H.A. Smythe, 2 Heathbridge Park, Toronto, Ontario M4G 2Y6, Canada. E-mail: hasmythe{at}rogers.com

Unhelpful Criteria Sets For “Diagnosis” and “Assessment of Severity” of Fibromyalgia