The American College of Rheumatology is introducing new diagnostic criteria to update the 1990 set for fibromyalgia. Diagnosis had been made based on the presence of widespread pain in all four body quadrants for at least three months and on results of the tender point test, in which light pressure is applied to 18 points around the neck, shoulder, chest, hip, knee, and elbow regions to check for pain. However, confusion often prevented primary-care clinicians from performing the test correctly, and fluctuating pain could skew the results, leading to underdiagnosis.

The new criteria will standardize diagnosis by means of a widespread pain index score, involving 19 areas on the body, and a symptom severity score (Arthritis Care Res [Hoboken]. 2010;62:600-610).

A final score of seven or more pain areas and a symptom severity score of at least five points, or three to six pain areas and a symptom severity score of at least nine points, will indicate fibromyalgia.