Fibromyalgia: do not give up the tender point count too easily: comment on the article by Wolfe et al.

摘要

We read with interest the article by Wolfe et al (1) and the editorial by Wolfe (2), published recently in Arthritis Care & Research, introducing new diagnostic criteria for the fibromyalgia syndrome. These preliminary diagnostic criteria (including a widespread pain index [WPI] >=7 and a symptom severity [SS] scale score of >=5, or a WPI of 3-6 and an SS scale score of >=9) raise important concerns. First, the new criteria are intended to get rid of the tender point examination introduced in 1990 by the American College of Rheumatology (ACR) (3). Abandoning an intrinsic requirement for physical examination in favor of indices and scales carries the risk of discarding the "laying on of hands" and a careful clinical examination altogether. Indeed, the physician who regards the tender point examination as cumbersome may think the same of a thorough rheumatologic and neurologic examination and limit the clinical encounter to a structured interview. Yet, multifocal pain has a broad differential diagnosis, relying on careful history taking and clinical examination.