Department of Internal Medicine I, Klinikum Saarbrücken gGmbH, Saarbrücken, Germany.
Clin J Pain. 2010 Jul-Aug;26(6):505-11. doi: 10.1097/AJP.0b013e3181d92a6c.
OBJECTIVES: The survey and the Association of the Medical Scientific Societies in Germany (AWMF) criteria had been developed to overcome problems associated with tender point criterion of the American College of Rheumatology (ACR) (lacking validation for clinical diagnosis, inconsistent use by rheumatologists, and nonrheumatologists) for the clinical diagnosis of fibromyalgia syndrome (FMS). We compared the concordance between these 3 criteria. METHODS: Consecutive patients of different clinical settings referred for the evaluation of chronic widespread pain or management of established FMS diagnosis were assessed by medical history, a complete physical examination including tender points, and questionnaires [self-constructed symptoms questionnaire, regional pain scale (RPS), Patient Health Questionnaire (PHQ 9 and 15)]. FMS according to AWMF-criteria was diagnosed by the history of widespread pain (axial and all 4 extremities), the symptoms sleep disturbances, fatigue, and feeling of swelling or stiffness of the hands or feet or face (Numeric rating scale >or=1/10 each symptom) and the exclusion of somatic diseases sufficiently explaining the symptoms. FMS according to survey criteria was diagnosed by regional pain scale score >or=8 and fatigue score >or=6/10 on a visual analogue scale. RESULTS: Out of 310 patients, 292 could be analysed. AWMF and ACR were concordant in 86.6%, AWMF and survey criteria were concordant in 78.8% and survey and ACR-criteria were concordant in 79.5% of the cases. DISCUSSION: AWMF, survey, and ACR criteria were moderately concordant. As AWMF and survey criteria do not require tender point examination, these criteria can be used by nonrheumatologists for the clinical diagnosis of FMS.
目的:调查和德国医学科学协会(AWMF)标准的制定是为了克服美国风湿病学会(ACR)的压痛标准相关问题(缺乏临床诊断验证、风湿病学家和非风湿病学家不一致使用以及),用于纤维肌痛综合征(FMS)的临床诊断。我们比较了这三个标准之间的一致性。
方法:不同临床环境的连续患者因慢性广泛疼痛的评估或既定 FMS 诊断的管理而被转诊,通过病史、包括压痛点的完整体检以及问卷(自我构建的症状问卷、区域疼痛量表(RPS)、患者健康问卷(PHQ9 和 15))进行评估。根据 AWMF 标准诊断 FMS 是通过广泛疼痛的病史(轴和所有 4 个四肢)、症状睡眠障碍、疲劳、手部或脚部或面部肿胀或僵硬的感觉(每个症状的数字评定量表>或=1/10)以及排除足以解释症状的躯体疾病。根据调查标准诊断 FMS 是通过区域疼痛量表评分>或=8 和疲劳评分>或=6/10 在视觉模拟量表上。
结果:在 310 名患者中,有 292 名可以进行分析。AWMF 和 ACR 标准在 86.6%的病例中一致,AWMF 和调查标准在 78.8%的病例中一致,调查和 ACR 标准在 79.5%的病例中一致。
讨论:AWMF、调查和 ACR 标准具有中等一致性。由于 AWMF 和调查标准不需要压痛检查,因此这些标准可由非风湿病学家用于 FMS 的临床诊断。
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