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ACR 2016 Fibromyalgia Diagnostic Criteria

by Will Gregory | May 26, 2020 | in Rheumatology

The 2010/2011 ACR guidance document suggested replacing the tender point score with a questionnaire based solution to picking up a potential fibromyalgia diagnosis. The adoption of this has been slow and the physical assessment nature of the tender point score still has some merit in some cases. We switched soon after the 2011 paper and the 2016 update has made the criteria quicker to perform and more patient friendly.

The corona virus pandemic mandated switch to telephone and video consults should be the end of the use of the trigger point score and full adoption of the preferentially recommended diagnostic criteria. Whilst we'd usually get this completed by the patient in the wait room when we used to do face-to-face, the ability to complete over the phone has been successfully trialed with good clinician and patient feedback.

What is needed to sustain the change?

Widespread adoption of the 2016 ACR fibromyalgia diagnostic criteria across the the rheumatology and msk assessment pathways. Ability to use this over the phone (or video) during the appointment or, perhaps preferentially, over the internet pre-appointment.

What is your region?

North West

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edited on Jul 13, 2020 by Kyle Beacham
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Elizabeth MacPhie May 27, 2020

Hi Will
thanks for sharing

We've been using this questionnaire within our community pain setting and agree that the real value is getting patients to fill it in and the challenge is how we do this with remote appts. I'm slightly nervous about sending it out to new patients ahead of their initial assessment as the assumption is being made that the diagnosis if FM and often the question we're being asked as rheumatologist is that the diagnosis is secure and "nothing else" is being missed..... We're using the AttendAnywhere platform for our video consultations and would be great to share a PROM such as this through that platform and get the patient to complete at the appropriate time during the consultation but not aware that this is possible.

I'm thinking this could also apply to completing BASDAI, though we're keen to get these pushed out to patients to complete ahead of appts...….

Is there any restriction with regards to the license for the FM questionnaire?

Lizzy MacPhie

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Will Gregory May 28, 2020

Hi Lizzy,
Agree re: issues with sending ACR 2016 FDC out in advance of appointment.
Our Trust have opted for AccuRx and it does have a function to text patients the questionnaire during the consult (once agreed it's needed). A bit clunky as sending out a .pdf and then talking through the responses, but better than a blanket "send to all" prior to appointment. (prior to texting Q option had been talking through the questions without sending .pdf and that seems to work well too).

Yes, sending BASDAI pre-appointment is a much clearer decision.

I'm optimistically assuming no license restriction for FM questionnaire as it is ACR-developed and ACR-badged (source article states no funding for the project, which is promising). Searched for a while and not been able to find the answer on a number of sites inc. OMERACT. There is a nice review of the what, why, how, but no clear info on license https://www.mdpi.com/2077-0383/9/4/1219/pdf

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Carol McCrum May 27, 2020

Hi Will and Lizzy
One of the challenges which has been discussed locally is the need expressed on Pain Management pathways to have the reassurance of the diagnosis of fibromyalgia made by a rheumatologist, along with their exclusion of other conditions before being accepted onto the pathway.

Is there adequate evidence or clinical confidence in a screening /diagnosis strategy /model that could reduce the need for a Consultant Rheumatologist assessment for many of these people with suspected FMS or non-inflammatory wide spread pain problems- any thoughts would be great.
Thank you for your comments

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Elizabeth MacPhie May 28, 2020

Hi Carol
I feel it fair to comment that there is much debate amongst the rheumatology community as to whether we should "see" FM patients. We had quite a heated discussion about this at our GIRFT review. Many argue that with this being a non-inflammatory condition it shouldn't be seen in rheumatology clinics. My personal view is that often our input is needed to ensure "something else" isn't being missed or to provide assurance that the diagnosis is correct.

I'm aware that there is a group working on some criteria to support Primary Care with making the diagnosis and would welcome this approach and our support with challenging cases

hope that helps to provide some clarity as to what our role is
Lizzy


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Greta McLachlan Jun 12, 2020

Status labels added: Guidance, Information Sharing, Patient Activation, Virtual Consulting, Horizon 1

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Kyle Beacham Jul 13, 2020

Status labels removed: Guidance, Information Sharing, Patient Activation, Virtual Consulting

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