New guidelines for the diagnosis of fibromyalgia

Heymann, Roberto E.; Paiva, Eduardo S.; Martinez, José Eduardo; Helfenstein, Milton; Rezende, Marcelo C.; Provenza, Jose Roberto; Ranzolin, Aline; Assis, Marcos Renato de; Feldman, Daniel P.; Ribeiro, Luiz Severiano; Souza, Eduardo J.R.

doi:10.1016/j.rbre.2017.07.002

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Original articles • Rev. Bras. Reumatol. 57 (suppl 2) • 2017 • https://doi.org/10.1016/j.rbre.2017.07.002 linkcopy

New guidelines for the diagnosis of fibromyalgia

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objective To establish guidelines based on scientific evidence for the diagnosis of fibromyalgia.

Material and methods Evidence collection was performed based on 9 questions regarding the diagnosis of fibromyalgia, structured using the Patient, Intervention or Indicator, Comparison and Outcome (P.I.C.O.), with searches in the main, primary databases of scientific information. After defining the potential studies to support the recommendations, they were graded according to evidence and degree of recommendation.

Keywords:
Fibromyalgia; Pain; Diagnosis; Diagnostic criteria; Guidelines

Question	Strategy	Result
1. Are the 1990 ACR criteria essential for the diagnosis of FM?	Fibromyalgia AND (ACR OR American College of Rheumatology) AND (sensitiv[Title/Abstract] OR sensitivity and specificity[MeSH Terms] OR diagnos[Title/Abstract] OR diagnosis[MeSH:noexp] OR diagnostic* [MeSH:noexp] OR diagnosis,differential[MeSH:noexp] OR diagnosis[Subheading:noexp])	Retrieved: 283 Selected: 5
2. Is widespread pain essential for the diagnosis of FM?	((Fibromyalgia AND Pain AND widespread AND (sensitiv[Title/Abstract] OR sensitivity and specificity[MeSH Terms] OR diagnos[Title/Abstract] OR diagnosis[MeSH:noexp] OR diagnostic* [MeSH:noexp] OR diagnosis,differential[MeSH:noexp] OR diagnosis[Subheading:noexp])) OR (Fibromyalgia AND Pain AND specificity[Title/Abstract])))	Retrieved: 382 Selected: 6
3. Should tender points be considered in the diagnosis of FM?	(tender point* OR pressure OR pain threshold) AND Fibromyalgia AND (sensitiv[Title/Abstract] OR sensitivity and specificity[MeSH Terms] OR diagnos[Title/Abstract] OR diagnosis[MeSH:noexp] OR diagnostic* [MeSH:noexp] OR diagnosis,differential[MeSH:noexp] OR diagnosis[Subheading:noexp])	Retrieved: 588 Selected: 13
4. Are sleep disorders, fatigue disorders and cognitive disorders also considered?	(sleep OR fatigue OR mental disorders OR cognitive OR cognition OR stress) AND Fibromyalgia AND (sensitiv[Title/Abstract] OR sensitivity and specificity[MeSH Terms] OR diagnos[Title/Abstract] OR diagnosis[MeSH:noexp] OR diagnostic* [MeSH:noexp] OR diagnosis,differential[MeSH:noexp] OR diagnosis[Subheading:noexp])	Retrieved: 1419 Selected: 6
5. Can the 2010 criteria be considered in the diagnosis of FM?	Fibromyalgia AND (sensitiv[Title/Abstract] OR sensitivity and specificity[MeSH Terms] OR diagnos[Title/Abstract] OR diagnosis[MeSH:noexp] OR diagnostic* [MeSH:noexp] OR diagnosis,differential[MeSH:noexp] OR diagnosis[Subheading:noexp]) Limits: published in the last 3 years Sort by: PublicationDate	Retrieved: 659 Selected: 7
6. Is thermography indicated in the diagnosis of FM? Note: use in complex pain, almost nothing on FM	(Fibromyalgia AND (thermography OR temperature OR thermo test OR capillaroscopy OR heat OR hot OR cold OR sensory OR thermal OR somatosensory) OR (thermograph* OR telethermography) AND (pain OR trigger OR tender))	Retrieved: 857 Selected: 10
7. When should we request polysomnography for the diagnosis of FM? Note: the question of sleep complements	Fibromyalgia AND (Polysomnography* OR Circadian Rhythm)	Retrieved: 62 Selected: 4
8. Is the diagnosis of FM a diagnosis of exclusion? Note: The answer to this question can naturally arise with the other answers	Fibromyalgia AND (exclu* OR differential)	Retrieved: 766 Selected: 7
9. Should we assess mood disorders in patients with FM? How?	(Mood Disorders OR depression OR depressive) AND Fibromyalgia AND (sensitiv[Title/Abstract] OR sensitivity and specificity[MeSH Terms] OR diagnos[Title/Abstract] OR diagnosis[MeSH:noexp] OR diagnostic* [MeSH:noexp] OR diagnosis,differential[MeSH:noexp] OR diagnosis[Subheading:noexp])	Retrieved: 617 Selected: 9

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