Performance of the American College of Rheumatology 2016 criteria for fibromyalgia in a referral care setting, 2019, Lawrence et al

Andy

Andy

Retired committee member
Abstract
The American College of Rheumatology (ACR) 2016 criteria for fibromyalgia (FM) is recommended for use in primary and referral setting. However, neither the ACR 2016 nor its predecessor ACR 2010 criteria have been validated in a referral setting. We hypothesized that the presence of higher comorbidities in the referral care setting may affect the performance of the ACR 2016.

All patients referred to a tertiary care hospital with widespread pain for more than 3 months were screened using (1) the ACR 2016 criteria and (2) by a blinded expert physician (using ACR 1990 criteria). Using the ACR 1990 as reference standard, the sensitivity and specificity were calculated. Also, concomitant depression (BPHQ: Brief Patient Health Questionnaire), anxiety disorder (GAD7: Generalized Anxiety Disorder-7) and alexithymia (TAS-20: Toronto Alexithymia Scale-20) were screened for using standardized instruments. Other central sensitization syndromes were also screened clinically.

Of 147 patients (132 females; median age 36 [30–45] years, median symptom duration 4 [1–6] years), 112 met the ACR 1990 criteria while 93 met the ACR 2016 criteria. There was disagreement between the two criteria in 47 patients. The sensitivity and specificity of ACR 2016 were 71% and 60%, respectively. Patients diagnosed by ACR 2016 criteria alone, had higher GAD7 scores than those diagnosed by the ACR 1990 alone. However, BPHQ and TAS-20 did not differ between the groups. Patients diagnosed by the ACR 2016 criteria had a greater odds (OR 5.2 CI 1.3–21.7, p = 0.022) of having concomitant restless leg syndrome or post-traumatic stress disorder or chronic fatigue syndrome.

The sensitivity/specificity of the ACR 2016 in tertiary settings matched those found in previous primary care-based studies. Thus, the ACR 2016 criteria are valid for use in the tertiary setting. However, patients diagnosed by only the ACR 2016 criteria (and not by the ACR 1990) have high probability of having another concomitant comorbidity
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Paywall, https://link.springer.com/article/10.1007/s00296-019-04323-7
Sci hub, https://sci-hub.se/10.1007/s00296-019-04323-7
 
Thank you for posting @Andy

One thing from the abstract that strikes me:
The sensitivity and specificity of ACR 2016 were 71% and 60%, respectively
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What other disease get an acceptable diagnosis that has a sensitivity and specificity this low? Such test would not be acceptable for HIV.

I am calling on to @Jonathan Edwards to please tell us what the lupus diagnosis criteria S&S is comparable and whether this is acceptable considering that fibromyalgia is usually a diagnosis for life.

Disclaimer, I did not read the full paper.
 
Milo said:
Thank you for posting @Andy


What other disease get an acceptable diagnosis that has a sensitivity and specificity this low? Such test would not be acceptable for HIV.

I am calling on to @Jonathan Edwards to please tell us what the lupus diagnosis criteria S&S is comparable and whether this is acceptable considering that fibromyalgia is usually a diagnosis for life.

Disclaimer, I did not read the full paper.
Click to expand...

The whole study is meaningless. I don't see how you can talk of sensitivity and specificity when you are just comparing two sets of criteria - although the fact that they differ so much is certainly a clear indiction that one or other or both are pretty useless.

There is no comparison for lupus because there is only one set of criteria - so it is 100% specific and sensitive for itself.

What one really wants to know is how sensitive or specific the criteria are for some important biological feature of the illness. But you then have to decide which feature. There is no answer to any of this.It is just running around in circles.
 
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