Classification and Clinical Diagnosis of

Fibromyalgia Syndrome:
Recommendations of Recent
Evidence-Based Interdisciplinary
Guidelines*
Journal Reading
Isma Resti Pratiwi, S.Ked
I11111029
Supervisor
dr. Iqbal Lahmadi, Sp.PD
*Mary-Ann Fitzcharles,1 Yoram Shir,2 Jacob N. Ablin,3
Dan Buskila,4
Howard Amital,5 Peter Henningsen,6 andWinfried
Huser6,7

Introduction
2010
classificatio
n of ACR
Fibromyalgi
a
Syndrome
Somatic &
psychologic
al symptoms

Benefits/har
m for
diagnosing
FMS
The
classification
(rheumatic,
neurologic,
psychological
disorder?)
Tender
point
examinatio
n

Compare the
recommendati
on define
and diagnose
FMS

Material and Methods

1. Search of Literature
2. Inclusion Criteria
1. Guideline was commissioned by a scientific
organisation.
2. Guideline group was interdisciplinary and included at
least the specialties rheumatology, pain medicine,
and psychiatry or psychosomatic medicine or clinical
psychology.
3. A systematic search strategy was outlined.
4. Recognized criteria of classification evidence and
recommendationswere used.
5. The formal process for establishing recommendations
(Delphi exercise, panel conference) was outlined.

3. Analysis of Guidelines

Results
Three of these met the inclusion criteria:
The 2012 Canadian Guidelines for the
diagnosis and management of fibromyalgia
syndrome, the guidelines of the Association
of the Scientific
Medical Societies in Germany (AWMF) on
the definition, pathophysiology, diagnosis,
and treatment of fibromyalgia syndrome,
The Israeli guidelines for the diagnosis and
treatment of fibromyalgia syndrome

Results

The differences between

guidelines -1
German and Canadian used ACR 2010 as the
basic preliminary criteria
German guidelines recommended the use of the
fibromyalgia survey questionnaire
Canadian and German: FMS can be diagnosed
by primary care physician without having to
refer to specialist
All three guidelines: FMS can coexist with a
diagnosis of another somatic disease (e.g.,
inflammatory arthritis, osteoarthritis) or of a
mental disorder (e.g., depression)

The differences between

guidelines -2
All three guidelines recommended that the diagnostic
label FM or FMS should be communicated to the
patients
Canadian guideline discouraged excessive focus on a
triggering event (physical/psychological traumatic event)
which could compromise patient care
German guideline suggestion:
Symptoms are not caused by organic disease
persistent in nearly all patient
Total relief is seldom achieved
Symptoms do not lead to disablement
Most patient could adapt to the symptoms,
Goal of treatment: quality of life and maintenance of
function
Self-management strategies should be improved

The Comparisons between Guidelines

The Comparisons between Guidelines

Discussion -1
Consistency between 3 FMS guidelines FMS is
neither a distinct rheumatic disease nor a
mental disorder but a syndrome defined by a
typical cluster of symptoms
It can be diagnosed by primary care
physicians by medical history, PE, and laboratory
(to exclude other somatic diseases)
A tender point examination is not obligatory for
diagnosing FMS
Subject to variable interpretation and which reflects
an overall reduction in pain threshold, has at times
been inappropriately used to establish a diagnosis
of FMS.

Discussion -2
The use of the (modified) ACR 2010
diagnostic criteria which do not
require tender point examination, is
recommended for clinical diagnosis, but
should not preclude a thorough physical
examination
The concept of FMS, remains a work in
progress with many current unanswered
clinical and pathophysiologic questions.

Conclusion
The cluster of symptoms that we today recognize
as FMS has been described in the literature for over
200 years, with the specific diagnostic label of FMS
introduced at the end of the 20th century
The recent evidence-based interdisciplinary
guidelines developed in Canada, Germany, and
Israel should give healthcare professionals
confidence to positively diagnose this
condition, avoid excessive testing and medical
consultation, and facilitate patient care by
emphasis on appropriate patient education and
active patient participation in healthcare plan.

THANK YOU!

Table 1. Fibromyalgia survey questionnaire.

Huser W, Jung E, Erbslh-Mller B, Gesmann M, Khn-Becker H, et al. (2012) Validation of the Fibromyalgia Survey
Questionnaire within a Cross-Sectional Survey. PLoS ONE 7(5): e37504. doi:10.1371/journal.pone.0037504
http://journals.plos.org/plosone/article?id=info:doi/10.1371/journal.pone.0037504