Diagnostic Accuracy of ACR 2010 Preliminary Diagnostic Criteria in the Diagnosis of Fibromyalgia Among Chronic Backache
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ORIGINAL ARTICLE
Diagnostic Accuracy of ACR 2010 Preliminary Diagnostic Criteria in the Diagnosis of Fibromyalgia Among Chronic Backache Patients Vikas Saxena1,3 · Pavan Pradhan2 · Kulbhushan Tyagi1 Received: 10 January 2020 / Accepted: 23 July 2020 / Published online: 30 July 2020 © Indian Orthopaedics Association 2020
Abstract Background Chronic backache remains among common causes of attendance in orthopaedic, pain and neurology clinics and requires a detailed workup for the management of these patients. As per literature, fibromyalgia contributes to a significant number of chronic backache patients but in clinical practice, it remains a diagnosis of exclusion in the absence of definitive diagnostic workup. We need to evaluate the diagnostic accuracy of ACR 2010 preliminary diagnostic criteria for the diagnosis of fibromyalgia among chronic backache patients for use in primary and speciality care. Methods The patients with chronic backache (> 3 months) attending the orthopaedic OPD were screened by the principal investigator by ACR 1990 tender point and ACR 2010 preliminary diagnostic criteria for the diagnosis of fibromyalgia. Symptoms severity assessment was done by the Fibromyalgia severity score by the principal investigator or resident doctors trained by the principal investigator. Results Approximately 47% of patients didn’t satisfy the American College of Rheumatology 1990 criteria but could be diagnosed as a case of fibromyalgia by ACR 2010 new case definition: (WPI ≥ 7 and SS ≥ 5) or (WPI ≥ 3–6 and SS ≥ 9). Discussion The patients with chronic back pain along with marked symptoms variability need consideration of Fibromyalgia for possible diagnosis especially in the absence of secondary cause for these symptoms. ACR 2010 diagnostic criteria seem compelling and effective for the diagnosis of fibromyalgia among patients with chronic back pain. Keywords Fibromyalgia · Preliminary diagnostic criteria · Fibromyalgia severity score (FS) · American college of rheumatology (ACR)
Introduction Chronic backache is an important cause of morbidity at orthopaedic, neurology, and pain clinics. Despite numerous peer-reviewed published studies on the prevalence or incidence of low backache, there is little consensus regarding it’s epidemiology and risk factor [1, 2]. 60–70% of the people suffer from low backache in their life and 7–10% of these become chronic and lead to a major economic burden on health care [3, 4]. These patients may or may not have * Vikas Saxena [email protected] 1
Department of Orthopaedics, Government Institute of Medical Sciences, Greater Noida, India
2
Department of Orthopaedics, BRD Medical College, Gorakhpur, India
3
A 601, Stellar MI Legacy, Zeta 1, Greater Noida 201308, India
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a structural cause of a backache. A large subset of these patients may have associated somatic, cognitive and affective dysfunctions which are often overlooked, and can lead to misdiagnosis and treatment failure. In clinical practice, it is observed that widespread musculo
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