Wolfe Frederick, Fitzcharles Mary-Ann, Goldenberg Don L, Häuser Winfried, Katz Robert L, Mease Philip J, Russell Anthony S, Jon Russell I, Walitt Brian
National Data Bank for Rheumatic Diseases and the University of Kansas School of Medicine, Wichita, Kansas.
Mary-Ann Fitzcharles, MBChB, McGill University Health Center, Montreal, Quebec, Canada.
Arthritis Care Res (Hoboken). 2016 May;68(5):652-9. doi: 10.1002/acr.22742.
The American College of Rheumatology (ACR) 2010 preliminary fibromyalgia diagnostic criteria require symptom ascertainment by physicians. The 2011 survey or research modified ACR criteria use only patient self-report. We compared physician-based (MD) (2010) and patient-based (PT) (2011) criteria and criteria components to determine the degree of agreement between criteria methodology.
We studied prospectively collected, previously unreported rheumatology practice data from 514 patients and 30 physicians in the ACR 2010 study. We evaluated the widespread pain index, polysymptomatic distress (PSD) scale, tender point count (TPC), and fibromyalgia diagnosis using 2010 and 2011 rules. Bland-Altman 95% limits of agreement (LOA), kappa statistic, Lin's concordance coefficient, and the area under the receiver operating curve (ROC) were used to measure agreement and discrimination.
MD and PT diagnostic agreement was substantial (83.4%, κ = 0.67). PSD scores differed slightly (12.3 MD, 12.8 PT; P = 0.213). LOA for PSD were -8.5 and 7.7, with bias of -0.42. The TPC was strongly associated with both the MD (r = 0.779) and PT PSD scales (r = 0.702).
There was good agreement in MD and PT fibromyalgia diagnosis and other measures among rheumatology patients. Low bias scores indicate consistent results for physician and patient measures, but large values for LOA indicate many widely discordant pairs. There is acceptable agreement in diagnosis and PSD for research, but insufficient agreement for clinical decisions and diagnosis. We suggest adjudication of symptom data by patients and physicians, as recommended by the 2010 ACR criteria.
美国风湿病学会（ACR）2010年纤维肌痛初步诊断标准要求由医生确定症状。2011年经调查或研究修改后的ACR标准仅采用患者自我报告。我们比较了基于医生的（MD）（2010年）和基于患者的（PT）（2011年）标准及标准组成部分，以确定标准方法之间的一致程度。
我们前瞻性地研究了ACR 2010年研究中514例患者和30名医生的先前未报告的风湿病诊疗数据。我们使用2010年和2011年的规则评估广泛疼痛指数、多症状困扰（PSD）量表、压痛点计数（TPC）以及纤维肌痛诊断。采用布兰德-奥特曼95%一致性界限（LOA）、kappa统计量、林氏一致性系数以及受试者工作特征曲线（ROC）下面积来衡量一致性和辨别力。
MD和PT诊断一致性较高（83.4%，κ = 0.67）。PSD评分略有差异（MD为12.3，PT为12.8；P = 0.213）。PSD的LOA为-8.5和7.7，偏差为-0.42。TPC与MD（r = 0.779）和PT PSD量表（r = 0.702）均密切相关。
在风湿病患者中，MD和PT纤维肌痛诊断及其他指标之间存在良好的一致性。低偏差分数表明医生和患者测量结果一致，但LOA值较大表明存在许多差异较大的配对。在研究中诊断和PSD方面存在可接受的一致性，但在临床决策和诊断方面一致性不足。我们建议按照2010年ACR标准的建议，由患者和医生对症状数据进行判定。
