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The American College Of Rheumatology Preliminary Bibliography


The 2010 criteria addressed a number of problems with the 1990 criteria.

Intended Population

Patients suffering from Fibromyalgia/ Wide spread pain

Method of Use

The TPE is eliminated in this criteria. A physical examination item, replaced by the widespread pain index (WPI), a 0-19 count of the number of body regions reported as painful by the patient. In addition, the 2010 criteria assessed on a 0-3 severity scale a series of symptoms that were characteristic of fibromyalgia: fatigue, non-refreshed sleep, cognitive problems, and the extent of somatic symptom reporting. The items were combined into a 0-12 Symptom Severity (SS) scale. Finally, the Widespread Pain Index (WPI) and SS-scales could be combined into a 0-31 fibromyalgianess scale, a second measure of polysymptomatic distress or FM severity (3). The criteria committee considered that the diagnosis of a symptom severity disorder should require more than an ‘augenblick’ diagnosis. Instructions, a criteria worksheet, and a patient pain location report are available on-line as an aid to ACR2010 assessments (


W. Häuser, F. Wolfe. Diagnosis and diagnostic tests for fibromyalgia (syndrome)Reumatismo, 2012; 64 (4): 194-205

Wolfe F1, Clauw DJ, Fitzcharles MA, Goldenberg DL, Katz RS, Mease P, Russell AS, Russell IJ, Winfield JB, Yunus MB. The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. Arthritis Care Res (Hoboken). 2010 May;62(5):600-10.


Recent Related Research (from Pubmed)


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Developed in 1993

The ACR20 is a composite measure defined as both improvement of 20% in the number of tender and number of swollen joints, and a 20% improvement in three of the following five criteria: patient global assessment, physician global assessment, functional ability measure [most often Health Assessment Questionnaire (HAQ)], visual analog pain scale, and erythrocyte sedimentation rate or C-reactive protein (CRP).

ACR50 and ACR70 are the same instruments with improvement levels defined as 50% and 70% respectively versus 20% for ACR20.

The ACR20 was revised in 2007 and the Hybrid ACR Response Measure, combining the ACR20, ACR50, ACR70 and a continuous score of the mean improvement in ACR core set measures, was proposed as a better definition of response to treatment in Rheumatoid Arthritis (RA) clinical trials.

Physician Assessment Form © 1999, American College of Rheumatology.

Felson DT, Anderson JJ, Boers M, Bombardier C, Chernoff M, Fried B, Furst D, Goldsmith C, Kieszak S, Lightfoot R, et al. The American College of Rheumatology preliminary core set of disease activity measures for rheumatoid arthritis clinical trials. The Committee on Outcome Measures in Rheumatoid Arthritis Clinical Trials. Arthritis Rheum. 1993 Jun;36(6):729-40 (PubMed Abstract)

Felson DT, Anderson JJ, Boers M, Bombardier C, Furst D, Goldsmith C, Katz LM, Lightfoot R Jr, Paulus H, Strand V, et al. American College of Rheumatology. Preliminary definition of improvement in rheumatoid arthritis. Arthritis Rheum. 1995 Jun;38(6):727-35 (PubMed Abstract)

Felson DT, Anderson JJ, Lange ML, Wells G, LaValley MP. Should improvement in rheumatoid arthritis clinical trials be defined as fifty percent or seventy percent improvement in core set measures, rather than twenty percent? Arthritis Rheum. 1998 Sep;41(9):1564-70 (Full text article)

American College of Rheumatology Committee to Reevaluate Improvement Criteria. A proposed revision to the ACR20: the hybrid measure of American College of Rheumatology response. Arthritis Rheum. 2007 Mar 15;57(2):193-202. Erratum in: Arthritis Rheum. 2007 Dec 15;57(8):1574 (Full text article)