Wolfe Frederick, Egloff Niklaus, Häuser Winfried
From the National Data Bank for Rheumatic Diseases and University of Kansas School of Medicine, Wichita, Kansas, USA; Department of General Internal Medicine, Division of Psychosomatic Medicine, Inselspital, Bern University Hospital, University of Bern; Department of Clinical Research, University of Bern, Bern, Switzerland; Department of Internal Medicine 1, Klinikum Saarbrücken; Department of Psychosomatic Medicine and Psychotherapy, Technische Universität München, Munich, Germany.F. Wolfe, MD, National Data Bank for Rheumatic Diseases, and University of Kansas School of Medicine; N. Egloff, MD, Department of General Internal Medicine, Division of Psychosomatic Medicine, Inselspital, Bern University Hospital, and Department of Clinical Research, University of Bern; W. Häuser, MD, Department of Internal Medicine 1, Klinikum Saarbrücken, and Department of Psychosomatic Medicine and Psychotherapy, Technische Universität München.
J Rheumatol. 2016 Sep;43(9):1743-8. doi: 10.3899/jrheum.160153. Epub 2016 Jul 1.
Widespread pain is no longer required for fibromyalgia (FM) diagnosis according to the American College of Rheumatology (ACR) 2010 preliminary diagnostic criteria and its 2011 modification, but its absence may be of concern. We investigated whether the widespread pain definition was satisfactory and the consequences of having a small number of painful regions or of not satisfying the widespread pain criterion.
We studied 5011 patients who satisfied the 2011 criteria. FM was identified using the Widespread Pain Index (WPI) and the Symptom Severity Scale (SSS): WPI ≥ 7 and SSS ≥ 5 or WPI 3-6 and SSS ≥ 9. Widespread pain was 4 quadrants plus axial pain, according to the 1990 ACR FM criteria.
There were 4700 patients (93.8%) who satisfied the ACR 1990 widespread pain criterion. Using a new strict definition for 5 pain regions based on the WPI sites, a modified widespread pain criterion requiring 4 of 5 regions identified 98.8% of criteria-positive patients. Patients without widespread pain or those in the low WPI/high SSS group had milder FM and no evidence of increased psychological or physical distress.
In usual clinical and epidemiological studies, the 2011 and 2010 criteria work well, but are not as effective in patients with asymmetrical or regional pain who do not satisfy a widespread pain criterion. A ≥ 4-pain region widespread pain definition will eliminate regional pain false-positives and will identify 98.8% of current 2011 cases. Future revisions of the 2010/2011 criteria should consider incorporating the ≥ 4-region requirement to avoid misclassification.
根据美国风湿病学会（ACR）2010年初步诊断标准及其2011年修订版，纤维肌痛（FM）诊断不再需要广泛性疼痛，但无广泛性疼痛可能令人担忧。我们调查了广泛性疼痛的定义是否令人满意，以及疼痛区域数量少或不满足广泛性疼痛标准的后果。
我们研究了5011名符合2011年标准的患者。使用广泛性疼痛指数（WPI）和症状严重程度量表（SSS）来确定FM：WPI≥7且SSS≥5或WPI 3 - 6且SSS≥9。根据1990年ACR FM标准，广泛性疼痛是指4个象限加轴向疼痛。
有4700名患者（93.8%）符合ACR 1990年广泛性疼痛标准。基于WPI部位对5个疼痛区域采用新的严格定义，一个要求5个区域中有4个区域的修订广泛性疼痛标准识别出了98.8%的符合标准阳性患者。没有广泛性疼痛的患者或处于低WPI/高SSS组的患者FM症状较轻，且没有证据表明心理或身体痛苦增加。
在常规临床和流行病学研究中，2011年和2010年标准效果良好，但对于不符合广泛性疼痛标准的不对称或局部疼痛患者效果不佳。一个≥4个疼痛区域的广泛性疼痛定义将消除局部疼痛假阳性，并能识别出98.8%的当前2011年病例。2010/2011年标准的未来修订应考虑纳入≥4个区域的要求，以避免错误分类。
