Review Article

Classification and Clinical Diagnosis of Fibromyalgia Syndrome: Recommendations of Recent Evidence-Based Interdisciplinary Guidelines

Table 4

Comparison of the recommendations of the Canadian, German, and Israeli guidelines on the clinical diagnosis of FMS.

ā€‰CanadaGermanyIsrael

History of a typical cluster of symptomsDiffuse body pain that has been present for at least 3 months, with symptoms of fatigue, sleep disturbance, cognitive changes, mood disorder, and other somatic symptoms to variable degreeChronic widespread pain and fatigue (physical and/or mental) and sleeping problems/unrefreshed sleepPresence of pain in muscles, joints, connective tissues, various areas of the upper and lower limbs, neck, shoulders, and upper and lower back
Typical symptoms of sleep disturbances, difficulty falling asleep, frequent awakening during the night, disturbed sleep patterns, and unrefreshing sleep
Chronic fatigue complaints throughout the day
Difficulties with concentration and memory

ExclusionOther illness explaining the symptomsSomatic disease sufficiently explaining the symptoms; the diagnosis of a mental disorder does not exclude the diagnosis of FMSOther disorders explaining the symptoms have been ruled out. FMS may develop in coexistence with additional disorders, be they somatic, inflammatory, psychiatric, or otherwise

Recommended methods
for exclusion of a somatic disease
Complete physical examination
Full blood count, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), creatine phosphokinase (CPK), and thyroid stimulating hormone (TSH)
Obtaining history of pharmacological agents used
Complete physical examination
Complete blood count, C-reactive protein (CRP), serum calcium, creatine phosphokinase (CPK), and thyroid stimulating hormone (TSH)
Complete physical examination
Complete blood count, renal function tests (creatinine and urea), serum calcium and phosphorous levels, liver function tests, creatine phosphokinase (CPK), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), thyroid stimulating hormone (TSH) and vitamin D

Further tests Any additional laboratory or radiographic testing should depend on the clinical evaluation in an individual patient that may suggest some other medical conditionOnly in case of clinical hints pointing at a somatic diseaseAt the discretion of the physician performing the evaluation, based on clinical hints pointing at a somatic disease. (low threshold for serological tests e.g., ANA and RF)

Tender point examinationSpecific tender point examination is not required, but examination of soft tissues for generalized tenderness should be doneFacultativeNo requirement to document number of tender points; however, assessment of tenderness recommended as part of physical examination

Screening for mental disordersMental disorder can be expected in three quarters of persons with FMSRecommendedRecommended

Diagnostic criteriaAmerican College of Rheumatology (ACR) 2010 preliminary diagnostic criteriaACR 1990 classification criteria or ACR 2010 modified diagnostic criteria
AWMF criteria
Clinical diagnosis, based on above evaluation