The DOI matches its Crossref record; 24 of the 25 references it cites were found in a registry or an index, and 1 are not checked yet; 3 of the 14 sources its claims cite were checked for support.
The American College of Rheumatology Preliminary Diagnostic Criteria for Fibromyalgia and Measurement of Symptom Severity
Open accessAbstract
Objective: To develop simple, practical criteria for clinical diagnosis of fibromyalgia that are suitable for use in primary and specialty care and that do not require a tender point examination, and to provide a severity scale for characteristic fibromyalgia symptoms. Methods: We performed a multicenter study of 829 previously diagnosed fibromyalgia patients and controls using physician physical and interview examinations, including a widespread pain index (WPI), a measure of the number of painful body regions. Random forest and recursive partitioning analyses were used to guide the development of a case definition of fibromyalgia, to develop criteria, and to construct a symptom severity (SS) scale. Results: Approximately 25% of fibromyalgia patients did not satisfy the American College of Rheumatology (ACR) 1990 classification criteria at the time of the study. The most important diagnostic variables were WPI and categorical scales for cognitive symptoms, unrefreshed sleep, fatigue, and number of somatic symptoms. The categorical scales were summed to create an SS scale. We combined the SS scale and the WPI to recommend a new case definition of fibromyalgia: (WPI ≥7 AND SS ≥5) OR (WPI 3–6 AND SS ≥9). Conclusion: This simple clinical case definition of fibromyalgia correctly classifies 88.1% of cases classified by the ACR classification criteria, and does not require a physical or tender point examination. The SS scale enables assessment of fibromyalgia symptom severity in persons with current or previous fibromyalgia, and in those to whom the criteria have not been applied. It will be especially useful in the longitudinal evaluation of patients with marked symptom variability.
Verified 2026-10-22 · 1 reference not checked yet
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3 of 14 cited sources checked · 0 supported · 0 flagged · accuracy not yet measured
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“the importance of symptoms that had not been considered by the ACR Multicenter Criteria Committee became increasingly known and appreciated as key fibromyalgia features: for example, fatigue, cognitive symptoms, and the extent of somatic symptoms (4 -7).”
§ The American College of Rheumatology Preliminary Diagnostic Criteria for Fibromyalgia and Measurement of Symptom Severity > INTRODUCTION
What the sources say
- Partly supportedcites [4] 4. Mease P, Arnold LM, Choy EH, Clauw DJ, Crofford L, Glass JM, et al, for the OMERACT Fibromyalgia Working Group. Fibromyalgia syndrome module at OMERACT 9: domain con- struct. J Rheumatol 2009;36:2318 -29. sourceExperimental — accuracy not yet measured
The Introduction (page not provided) says the 1990 ACR criteria focused on widespread pain and tenderness, while patients also experience fatigue, cognitive dysfunction, and other symptoms. The Cognition section calls dyscognition a salient symptom. The paper does not identify the extent of somatic symptoms as a key feature in the same way, so that part of the claim is not supported. (LLM, conf=0.84)
- Partly supportedcites [5] 5. Choy EH, Arnold LM, Clauw DJ, Crofford LJ, Simon LS, Mar- tin SA, et al. Content and criterion validity of the preliminary core dataset for clinical trials in fibromyalgia syndrome. J Rheumatol 2009;36:2330 -4. sourceExperimental — accuracy not yet measured
The Introduction (page unavailable) lists fatigue and dyscognition (cognitive dysfunction) among the relevant fibromyalgia domains identified through earlier patient and clinician exercises. It does not identify the extent of somatic symptoms as a domain or establish the claimed progression in recognition of all three features. The Discussion (page unavailable) also says clinical-trial data were insufficient to require dyscognition in the core dataset. (LLM, conf=0.85)
- Not matchedcites [6] 6. Mease P. Fibromyalgia syndrome: review of clinical presen- tation, pathogenesis, outcome measures, and treatment. J Rheumatol Suppl 2005;75:6 -21.
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Not checked — no full text of the sourcecites [7] 7. Mease P, Arnold LM, Bennett R, Boonen A, Buskila D, Car- ville S, et al. Fibromyalgia syndrome. J Rheumatol 2007;34: 1415-25.
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes- Partly supported
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Approximately 25% of fibromyalgia patients did not satisfy the American College of Rheumatology (ACR) 1990 classification criteria at the time of the study.”
- Also stated in: § Characteristics of patients by fibromyalgia status. · plain
“Taken as a whole, these data show that approximately 25% of patients considered to have fibromyalgia by their physicians do not satisfy ACR classification criteria for fibromyalgia”
§ The American College of Rheumatology Preliminary Diagnostic Criteria for Fibromyalgia and Measurement of Symptom Severity > Abstract
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes- Rests on an assumption: The ACR 1990 classification criteria are a valid reference standard for identifying fibromyalgia cases.
- Also stated in: § Characteristics of patients by fibromyalgia status. · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“This simple clinical case definition of fibromyalgia correctly classifies 88.1% of cases classified by the ACR classification criteria”
§ The American College of Rheumatology Preliminary Diagnostic Criteria for Fibromyalgia and Measurement of Symptom Severity > Abstract
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes- Rests on an assumption: The ACR 1990 classification criteria are a valid reference standard for identifying fibromyalgia cases.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The most important diagnostic variables were WPI and categorical scales for cognitive symptoms, unrefreshed sleep, fatigue, and number of somatic symptoms.”
§ The American College of Rheumatology Preliminary Diagnostic Criteria for Fibromyalgia and Measurement of Symptom Severity > Abstract
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes- Rests on an assumption: Physician diagnosis of fibromyalgia is a valid way to identify fibromyalgia patients for the study.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Removing all of the muscle variables and the WPI resulted in a misclassification rate of 16.1% (Table 2).”
§ The American College of Rheumatology Preliminary Diagnostic Criteria for Fibromyalgia and Measurement of Symptom Severity > Misclassification rates and fibromyalgia classifiers.
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Using the short variable list (that never contains muscle pain or muscle weakness), the misclassification rate was 18.4%.”
§ The American College of Rheumatology Preliminary Diagnostic Criteria for Fibromyalgia and Measurement of Symptom Severity > Misclassification rates and fibromyalgia classifiers.
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Depending on the number of variables in the model (variable group) and whether the WPI was used as a continuous or a categorical variable, physician study variables misclassified fibromyalgia cases and controls at rates of 6.2-10.3%(Table 2).”
§ The American College of Rheumatology Preliminary Diagnostic Criteria for Fibromyalgia and Measurement of Symptom Severity > Misclassification rates and fibromyalgia classifiers.
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“However, for the count of patient-endorsed somatic symptoms, the physician somatic symptom scale, and the SS scale, prior fibromyalgia patients had scores that were somewhat closer to current fibromyalgia patients than to control subjects.”
§ The American College of Rheumatology Preliminary Diagnostic Criteria for Fibromyalgia and Measurement of Symptom Severity > Characteristics of patients by fibromyalgia status.
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Patients previously diagnosed by clinical criteria were more likely to be classified as prior fibromyalgia (38.3%) compared with patients previously diagnosed by the ACR classification criteria (18.9%;P Ͻ 0.001).”
§ The American College of Rheumatology Preliminary Diagnostic Criteria for Fibromyalgia and Measurement of Symptom Severity > Diagnosis and diagnostic methods.
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passes- Rests on an assumption: The ACR 1990 classification criteria are a valid reference standard for identifying fibromyalgia cases.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Figure 2A shows that the WPI and muscle tenderness were the most important variables in the classification of cases and noncases.”
§ The American College of Rheumatology Preliminary Diagnostic Criteria for Fibromyalgia and Measurement of Symptom Severity > Misclassification rates and fibromyalgia classifiers.
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passes
- It may state two separate claims as one. 30
- Probably not a substantial claim. 11
- The quote only partly states this claim. 1
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Subsequent studies as well as the data of this study showed the importance of (improved) quantitative measures of body pain (18 -22), and of the key variables that comprise the SS scale in characterizing fibromyalgia.”
§ The American College of Rheumatology Preliminary Diagnostic Criteria for Fibromyalgia and Measurement of Symptom Severity > DISCUSSION
What the sources say
- Not matchedcites [18] 18. Macfarlane GJ. Chronic widespread pain and fibromyalgia: should reports of increased mortality influence management? Curr Rheumatol Rep 2005;7:339 -41.
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Not matchedcites [19] 19. Moldofsky H. The significance of the sleeping-waking brain for the understanding of widespread musculoskeletal pain and fatigue in fibromyalgia syndrome and allied syndromes. Joint Bone Spine 2008;75:397-402.
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Partly supportedcites [20] 20. Hieblinger R, Coenen M, Stucki G, Winkelmann A, Cieza A. Validation of the International Classification of Functioning, Disability and Health core set for chronic widespread pain from the perspective of fibromyalgia patients. Arthritis Res Ther 2009;11:R67. sourceExperimental — accuracy not yet measured
The Discussion (page not available in our copy) says pain was the central topic reported by fibromyalgia patients, with 159 concepts linked to sensation of pain. That supports the importance of pain, but this qualitative focus-group study does not establish the importance of improved quantitative measures of body pain—the part to which this citation is attached. (LLM, conf=0.84)
- Not checked — no full text of the sourcecites [21] 21. Macfarlane GJ, Jones GT, Knekt P, Aromaa A, McBeth J, Mikkelsson M, et al. Is the report of widespread body pain associated with long-term increased mortality? Data from the Mini-Finland Health Survey. Rheumatology (Oxford) 2007; 46:805-7. source
- Not checked — no full text of the sourcecites [22] 22. Macfarlane GJ, Pye SR, Finn JD, Wu FC, Silman AJ, Bartfai G, et al. Investigating the determinants of international differ- ences in the prevalence of chronic widespread pain: evidence from the European Male Ageing Study. Ann Rheum Dis 2009; 68:690 -5. source
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- Not matched
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Prior and current fibromyalgia patients had similar distributions of somatic symptom counts (Figure 1B), while prior fibromyalgia had the WPI shifted somewhat to the left (Figure 1A).”
§ The American College of Rheumatology Preliminary Diagnostic Criteria for Fibromyalgia and Measurement of Symptom Severity > Characteristics of patients by fibromyalgia status.
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“When all of the patients were considered, WPI Ն7 performed about as well (83.6%) as physician diagnosis (84.1%) in the classification of fibromyalgia in phase 1, again with improvement in the phase 2 data.”
§ The American College of Rheumatology Preliminary Diagnostic Criteria for Fibromyalgia and Measurement of Symptom Severity > Misclassification rates and fibromyalgia classifiers.
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- Rests on an assumption: The ACR 1990 classification criteria are a valid reference standard for identifying fibromyalgia cases.
- Rests on an assumption: Physician diagnosis of fibromyalgia is a valid way to identify fibromyalgia patients for the study.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The tender point count (Figure 1D) demonstrates the clearest distinction between groups, followed by unrefreshed sleep (Figure 1C).”
§ The American College of Rheumatology Preliminary Diagnostic Criteria for Fibromyalgia and Measurement of Symptom Severity > Characteristics of patients by fibromyalgia status.
Strength:boosted· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In addition, in the comparison of ACR classification criteria-positive versus ACR classification criteria-negative cases (excluding prior fibromyalgia), the correct classification rates for phase 1 ran between 89.0% and 92.6%, with higher rates being obtained in phase 2 analyses.”
§ The American College of Rheumatology Preliminary Diagnostic Criteria for Fibromyalgia and Measurement of Symptom Severity > Misclassification rates and fibromyalgia classifiers.
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- Rests on an assumption: The ACR 1990 classification criteria are a valid reference standard for identifying fibromyalgia cases.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“ACR classification criteria were used in 63.6% of fibromyalgia diagnoses and clinical diagnosis was used in 36.4% of fibromyalgia diagnoses.”
§ The American College of Rheumatology Preliminary Diagnostic Criteria for Fibromyalgia and Measurement of Symptom Severity > Diagnosis and diagnostic methods.
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“We then applied recursive partitioning to the data and determined that values of the WPI Ն7 best identified fibromyalgia cases and values Յ6 best identified control cases according to their ACR classification criteria status.”
§ The American College of Rheumatology Preliminary Diagnostic Criteria for Fibromyalgia and Measurement of Symptom Severity > Misclassification rates and fibromyalgia classifiers.
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- Rests on an assumption: The ACR 1990 classification criteria are a valid reference standard for identifying fibromyalgia cases.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“There was a clear difference in clinical findings and symptom severity among the groups, the current fibromyalgia patients having the greatest symptom severity with prior fibromyalgia generally occupying the severity scale midpoint between current fibromyalgia and controls (Table 1).”
§ The American College of Rheumatology Preliminary Diagnostic Criteria for Fibromyalgia and Measurement of Symptom Severity > Characteristics of patients by fibromyalgia status.
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Using the same intermediate model but keeping muscle pain reduced the error rate to 14.0%, whereas removing the WPI but leaving all muscle pain and muscle tenderness variables resulted in a misclassification rate of 10.3%.”
§ The American College of Rheumatology Preliminary Diagnostic Criteria for Fibromyalgia and Measurement of Symptom Severity > Misclassification rates and fibromyalgia classifiers.
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“At the time of the study examination, 74.5% of patients who had been previously diagnosed with fibromyalgia satisfied the ACR classification criteria and 2.0% of controls satisfied the ACR classification criteria.”
§ The American College of Rheumatology Preliminary Diagnostic Criteria for Fibromyalgia and Measurement of Symptom Severity > Diagnosis and diagnostic methods.
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- Rests on an assumption: The ACR 1990 classification criteria are a valid reference standard for identifying fibromyalgia cases.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Among patients diagnosed as having fibromyalgia, 76.0% met ACR classification criteria compared with 74.5% in the first phase of the study.”
§ The American College of Rheumatology Preliminary Diagnostic Criteria for Fibromyalgia and Measurement of Symptom Severity > Phase 2 validation.
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The WPI, which strongly correlated with the tender point count and the SS scale, best identified patients diagnosed with the ACR classification criteria.”
§ The American College of Rheumatology Preliminary Diagnostic Criteria for Fibromyalgia and Measurement of Symptom Severity > DISCUSSION
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“We categorized the 315 patients into 3 groups based on prior diagnosis and current ACR classification criteria status: 42.2% with current fibromyalgia, 13.3% with prior fibromyalgia, and 44.4% who were neither current nor prior fibromyalgia patients.”
§ The American College of Rheumatology Preliminary Diagnostic Criteria for Fibromyalgia and Measurement of Symptom Severity > Phase 2 validation.
Strength:plain· not yet calibratedn = 315Tests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Although we omitted mood, it was correlated with the SS scale at 0.725 and with the components of the SS scale as follows: cognition 0.625, somatic symptoms 0.621, waking unrefreshed 0.619, and fatigue 0.612.”
§ The American College of Rheumatology Preliminary Diagnostic Criteria for Fibromyalgia and Measurement of Symptom Severity > DISCUSSION
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The validation sample was slightly different in the 2 phases (Figure 3), and criteria to identify ACR classification criteria cases worked slightly better in phase 2.”
§ The American College of Rheumatology Preliminary Diagnostic Criteria for Fibromyalgia and Measurement of Symptom Severity > Phase 2 validation.
Strength:plain· not yet calibratedn = 315Tests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“We categorized the 315 patients into 3 groups based on prior diagnosis and current ACR classification criteria status: 42.2% with current fibromyalgia, 13.3% with prior fibromyalgia, and 44.4% who were neither current nor prior fibromyalgia patients.”
§ The American College of Rheumatology Preliminary Diagnostic Criteria for Fibromyalgia and Measurement of Symptom Severity > Phase 2 validation.
Strength:plain· not yet calibratedn = 315Tests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In addition, it should be remembered that physician diagnosis only correctly classified 84.1% of cases, while the proposed diagnostic criteria, even with shift of definition, identified 82.6% of patients correctly (Table 5).”
§ The American College of Rheumatology Preliminary Diagnostic Criteria for Fibromyalgia and Measurement of Symptom Severity > DISCUSSION
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“The validation sample was slightly different in the 2 phases (Figure 3), and criteria to identify ACR classification criteria cases worked slightly better in phase 2.”
§ The American College of Rheumatology Preliminary Diagnostic Criteria for Fibromyalgia and Measurement of Symptom Severity > Phase 2 validation.
Strength:plain· not yet calibratedn = 315Tests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Missing data were rare: in phase 1, 81.7% of patients had no missing data, 12.8% had 1 missing data point, and 1.6% had 3-8 missing data points.”
§ The American College of Rheumatology Preliminary Diagnostic Criteria for Fibromyalgia and Measurement of Symptom Severity > Statistical methods.
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“The criteria required tenderness on pressure (tender points) in at least 11 of 18 specified sites and the presence of widespread pain for diagnosis.”
§ The American College of Rheumatology Preliminary Diagnostic Criteria for Fibromyalgia and Measurement of Symptom Severity > INTRODUCTION
What the sources say
- Not checked — no full text of the sourcecites [1] 1. Wolfe F, Smythe HA, Yunus MB, Bennett RM, Bombardier C, Goldenberg DL, et al. The American College of Rheumatology 1990 criteria for the classification of fibromyalgia: report of the Multicenter Criteria Committee. Arthritis Rheum 1990;33: 160 -72. source
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The study was approved by the Via Christi Institutional Review Board.”
§ The American College of Rheumatology Preliminary Diagnostic Criteria for Fibromyalgia and Measurement of Symptom Severity > Conflict of interest and ethics.
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“This signifies that the criteria set has been quantitatively validated using patient data, but it has not undergone validation based on an external data set.”
§ The American College of Rheumatology Preliminary Diagnostic Criteria for Fibromyalgia and Measurement of Symptom Severity > Abstract
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“the ACR classification criteria set such a high bar for diagnosis that there was little variation in symptoms among fibromyalgia patients”
§ The American College of Rheumatology Preliminary Diagnostic Criteria for Fibromyalgia and Measurement of Symptom Severity > INTRODUCTION
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim. It may state two separate claims as one.
In the paper
“the tender point count was rarely performed in primary care where most fibromyalgia diagnoses occurred, and when performed, was performed incorrectly (2)”
§ The American College of Rheumatology Preliminary Diagnostic Criteria for Fibromyalgia and Measurement of Symptom Severity > INTRODUCTION
What the sources say
- Not checked — no full text of the sourcecites [2] 2. Fitzcharles MA, Boulos P. Inaccuracy in the diagnosis of fibromyalgia syndrome: analysis of referrals. Rheumatology (Oxford) 2003;42:263-7. source
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“In phase 1, we enrolled 610 patients from 32 referring physicians between December 2, 2008, and April 30, 2009.We excluded 96 patients (15.7%) for one or more protocol violations.”
- Also stated in: § SUBJECTS AND METHODS · plain
“After exclusions, there were 514 subjects (mean 17 and median 20 per center).”
§ The American College of Rheumatology Preliminary Diagnostic Criteria for Fibromyalgia and Measurement of Symptom Severity > SUBJECTS AND METHODS
Strength:plain· not yet calibratedn = 514Tests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one. The quote only partly states this claim.
- Also stated in: § SUBJECTS AND METHODS · plain
In the paper
“Many physicians did not know how to examine for tender points and some simply refused to do so (3).”
§ The American College of Rheumatology Preliminary Diagnostic Criteria for Fibromyalgia and Measurement of Symptom Severity > INTRODUCTION
What the sources say
- Not checked — no full text of the sourcecites [3] 3. Buskila D, Neumann L, Sibirski D, Shvartzman P. Awareness of diagnostic and clinical features of fibromyalgia among fam- ily physicians. Fam Pract 1997;14:238 -41. source
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Examining physicians were each compensated $2,000 for their work in interviewing, examining, and completing study forms for 10 patients and 10 controls.The study authors received no compensation.”
- Also stated in: § Abstract · plain
“The authors received no compensation.”
§ The American College of Rheumatology Preliminary Diagnostic Criteria for Fibromyalgia and Measurement of Symptom Severity > Conflict of interest and ethics.
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
- Also stated in: § Abstract · plain
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Fibromyalgia subjects were slightly older than controls (mean Ϯ SD age 54.6 Ϯ 12.9 versus 52.3 Ϯ 12.2 years; P ϭ 0.035), but did not differ by the percentage of males (8.2% versus 9.0%; P ϭ 0.732), percentage of non-Hispanic whites (86.8% versus 85.9%; P ϭ 0.770), or education level (mean Ϯ SD 14.2 Ϯ 2.1 versus 14.3 Ϯ 2.2 years; P ϭ 0.517).”
§ The American College of Rheumatology Preliminary Diagnostic Criteria for Fibromyalgia and Measurement of Symptom Severity > Demographics.
Strength:plain· not yet calibratedn = 258Tests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Overall, these data show that patients who satisfy the ACR classification criteria can be identified with an acceptable rate of error by the use of the WPI alone, and with very slightly better results if muscle tenderness or muscle pain is assessed.”
§ The American College of Rheumatology Preliminary Diagnostic Criteria for Fibromyalgia and Measurement of Symptom Severity > Misclassification rates and fibromyalgia classifiers.
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- Rests on an assumption: The ACR 1990 classification criteria are a valid reference standard for identifying fibromyalgia cases.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The study sponsor placed no restrictions, offered no input or guidance on the conduct of the study, did not participate in the design of the study, see the results of the study, or review the manuscript or submitted abstracts prior to the submission of the paper.”
§ The American College of Rheumatology Preliminary Diagnostic Criteria for Fibromyalgia and Measurement of Symptom Severity > Abstract
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“The ACR classification criteria, rightly criticized for circularity (16), created a de facto case definition by imposing the 11 tender point rules on top of a crude definition of widespread pain (17).”
§ The American College of Rheumatology Preliminary Diagnostic Criteria for Fibromyalgia and Measurement of Symptom Severity > DISCUSSION
What the sources say
- Not checked — no full text of the sourcecites [16] 16. Cohen ML, Quintner JL. Fibromyalgia syndrome, a problem of tautology. Lancet 1993;342:906 -9. source
- Not checked — no full text of the sourcecites [17] 17. Macfarlane GJ, Croft PR, Schollum J, Silman AJ. Widespread pain: is an improved classification possible? J Rheumatol 1996;23:1628 -32.
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“As shown in Figure 3, the SS scale appropriately follows the definitions of ACR classification criteria-positive fibromyalgia, prior fibromyalgia, and non-fibromyalgia, suggesting that it can categorize fibromyalgia symptom severity.”
§ The American College of Rheumatology Preliminary Diagnostic Criteria for Fibromyalgia and Measurement of Symptom Severity > The SS scale and fibromyalgia diagnostic criteria.
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“However, it is clear that the ACR classification criteria are unable to provide a useful classification for the 25% of fibromyalgia cases we identified as prior fibromyalgia, something that can be somewhat ameliorated through the use of the SS scale.”
§ The American College of Rheumatology Preliminary Diagnostic Criteria for Fibromyalgia and Measurement of Symptom Severity > DISCUSSION
Load-bearingStrength:boosted· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The diagnostic criteria and SS scale we have proposed shift the fibromyalgia definition somewhat toward important symptoms: first, the criteria can be satisfied by a high level of symptoms if the WPI score is not high enough; second, fibromyalgia symptoms are accorded appropriate importance by the provision of the SS scale.”
§ The American College of Rheumatology Preliminary Diagnostic Criteria for Fibromyalgia and Measurement of Symptom Severity > DISCUSSION
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- Rests on an assumption: The case definition of fibromyalgia has changed somewhat with increasing recognition of the importance of cognitive problems and somatic symptoms, factors that were not even considered in the 1990 ACR classification criteria.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In this respect, fibromyalgia differs from rheumatoid arthritis or systemic lupus erythematosus, illnesses that do not involve diagnosis based on symptom severity, where patients continue to have their condition even though they may subsequently not meet diagnostic criteria.”
§ The American College of Rheumatology Preliminary Diagnostic Criteria for Fibromyalgia and Measurement of Symptom Severity > DISCUSSION
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
The paper relies on this without support.
The ACR 1990 classification criteria are a valid reference standard for identifying fibromyalgia cases.
“correctly classifies 88.1% of cases classified by the ACR classification criteria”
The paper relies on this without support.
Physician diagnosis of fibromyalgia is a valid way to identify fibromyalgia patients for the study.
“We required the fibromyalgia study patients to have a previous diagnosis of fibromyalgia.”
The paper relies on this without support.
The study sample of rheumatology patients and physicians is representative of primary and specialty care settings where the criteria are intended to be used.
“We recruited study physicians by selecting randomly from a list of 113 rheumatologists who were members of the ACR and who indicated an interest in participating in the study after an e-mail solicitation.”
The paper relies on this without support.
The ACR classification criteria have not been widely embraced in primary care.
“However, they have not been widely embraced in primary care.”
The paper relies on this without support.
The clinical diagnosis in primary care does not ordinarily involve a tender point count or an adequately executed tender count when performed.
“First, the clinical diagnosis in primary care does not ordinarily involve a tender point count or an adequately executed tender count when performed.”
The paper relies on this without support.
The case definition of fibromyalgia has changed somewhat with increasing recognition of the importance of cognitive problems and somatic symptoms, factors that were not even considered in the 1990 ACR classification criteria.
“Second, the case definition of fibromyalgia has changed somewhat with increasing recognition of the importance of cognitive problems and somatic symptoms, factors that were not even considered in the 1990 ACR classification criteria.”
The paper relies on this without support.
The central problem in fibromyalgia criteria is the absence of a gold standard or case definition.
“The central problem in fibromyalgia criteria is the absence of a gold standard or case definition.”
The paper relies on this without support.
The shift in the conceptualization of fibromyalgia that occurred in the clinic and in research studies provided no clear case definition.
“The shift in the conceptualization of fibromyalgia that occurred in the clinic and in research studies, however, provided no clear case definition.”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“The Symptom Severity Scale (SS) is a widely-used, two-part instrument that enables assessment of fibromyalgia-related symptoms over the past week.20”
From Mindfulness is associated with psychological health and moderates the impact of fibromyalgia (2019) · cites this paper as [20]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“The American College of Rheumatology (ACR) defines fibromyalgia (FM) as a common chronic illness of unknown aetiology characterised by widespread musculoskeletal pain of more than three months, with the presence of generalised sensitivity, pain and tenderness in specific regions.”
From Identifying mindfulness and acceptance as mediators between negative affect, functional disability and emotional distress in patients with fibromyalgia (2021) · cites this paper as [5]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“FM is considered an unresolvable primary chronic pain condition wherein evaluations of affective pain appear to be more susceptible to change after intervention than general evaluations of pain that include permanent sensory symptoms (Clauw, 2015, Wolfe et al., 1990, Wolfe et al., 2010).”
From Online ACT intervention for fibromyalgia: An exploratory study of feasibility and preliminary effectiveness with smartphone-delivered experiential sampling assessment (2022) · cites this paper as Wolfe et al., 2010
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“The majority of the included trials applied the ACR 1990 diagnostic criteria which are favorably disposed towards women [27].”
From Mindfulness- And acceptance-based interventions for patients with fibromyalgia - A systematic review and meta-analyses (2019) · cites this paper as [27]
Experimental — accuracy not yet measuredThe cited source says what the claim attributes to it.
In the citing paper
“Diagnoses were self‐reported and previously confirmed by a rheumatologist, according to the American College of Rheumatology (ACR) 2010 criteria (Wolfe et al. 2010); however, for online recruits, self‐reporting relied solely on patient affirmation.”
From Physical and Mental Health of Fibromyalgia Patients Following October 7th Attack and the Ensuing Military Conflict: A Cross-Sectional Analysis (2025) · cites this paper as Wolfe et al. 2010
The cited source says what the claim attributes to it.
In the citing paper
“Fibromyalgia (FM) is a chronic pain syndrome characterized by physical symptoms like fatigue, stiffness or insomnia, and psychological alterations such as anxiety or depression (de la Coba et al., 2020; Wolfe et al., 1990, Wolfe et al., 2010) that limits the life of people suffering from it.”
From Online ACT intervention for fibromyalgia: An exploratory study of feasibility and preliminary effectiveness with smartphone-delivered experiential sampling assessment (2022) · cites this paper as Wolfe et al., 2010
The cited source says what the claim attributes to it.
In the citing paper
“Diagnostic criteria were determined based on the American College of Rheumatology preliminary diagnostic criteria for FMS 52 , and participants provided results of a blood test completed within a year to confirm a normal complete blood count and inflammatory panel”
From Stanford Hypnosis Integrated with Functional Connectivity-targeted Transcranial Stimulation (SHIFT): a preregistered randomized controlled trial (2024) · cites this paper as [52]
The cited source says what the claim attributes to it.
In the citing paper
“Patients with FMS and pathological skin innervation (only distal, only proximal, and generalized reduction of IENFD) had a higher clinical Widespread Pain Index (WPI)53 compared with patients with normal skin innervation (P < 0.01; Fig. 4A).”
From Pain and small fiber pathology in men with fibromyalgia syndrome (2024) · cites this paper as [53]
In the citing paper
“The definition of PPPD paralleled work in other areas of medicine where functional disorders (e.g., the functional gastrointestinal disorders [25, 91] and fibromyalgia [93, 94]) were defined by their core physical symptoms and not associated psychological features.”
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Control-group percentage does not match its count
MinorThe reported 251 controls are 48.8% of the 514 phase 1 subjects, not 48.1%.
Reported 48.1 · recomputed 48.832685
“251 patients (48.1%) who were neither current nor prior fibromyalgia patients (control subjects)”
Table 5 omits the pain-index requirement from one diagnostic branch
MinorTable 5 labels SS ≥9 alone as sufficient in its second branch, while Table 4 also requires WPI 3-6. The Table 5 expression would include patients with WPI below 3 whom the stated criteria exclude.
“ACR 1990 classification criteria vs. diagnostic criteria ((WPI Ն7 AND SS Ն5) OR SS Ն9) 88.1 82.6 95.2 90.8”
“1) Widespread pain index (WPI) Ն7 and symptom severity (SS) scale score Ն5 or WPI 3-6 and SS scale score Ն9.”
Seven categorical patient scales are claimed but six are listed
MinorThe methods say patients completed seven categorical symptom scales, but the ensuing list names only six.
“Patients completed 7 categorical scales for symptoms over the past week”
“Symptoms were assessed using the following words: pain, fatigue, trouble with sleep, trouble with anxiety or depression, problems awaking unrefreshed, and overall severity of your arthritis or fibromyalgia problem.”
Patient symptom-count ranges differ
MinorThe methods define the patient somatic-symptom count as ranging from 0 to 56, but Table 1 labels the patient symptom count as ranging from 0 to 48.
“Patient symptom count (0-48) 22.9 Ϯ 8.8 18.2 Ϯ 8.4 9.7 Ϯ 8.4”
“We summed the positive replies to create a 0 -56 count of somatic symptoms scale.”
Citations
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Metadata
- Authors
- Wolfe, F., Clauw, D. J., Fitzcharles, M., Goldenberg, D. L., Katz, R. S., Mease, P., Russell, A. S., Russell, I. J., Winfield, J. B., & Yunus, M. B.
- Affiliations
- University of Kansas (US)
- University of Michigan (US)
- Montreal General Hospital (CA)
- Tufts University (US)
- Rush University Medical Center (US)
- Swedish Medical Center (US)
- University of Alberta (CA)
- The University of Texas at San Antonio Health Science Center (US)
- University of North Carolina at Chapel Hill (US)
- Peoria campus of the University of Illinois System (US)
- ORCID
- Venue
- Arthritis Care & Research
- Publisher
- Wiley
- Published
- 2010-04-29
- Volume
- 62
- Issue
- 5
- Pages
- 600-610
- ISSN
- 0893-7524 (ISSN-L)
- 2151-464X
- 2151-4658
- OpenAlex
- W2049056319
- Cited by
- 3,952
- References
- 25
- Citations by year
- 2026: 159 · 2025: 217 · 2024: 220 · 2023: 233 · 2022: 299 · 2021: 363 · 2020: 287 · 2019: 278 · 2018: 278 · 2017: 262 · 2016: 259 · 2015: 259 · 2014: 237 · 2013: 225 · 2012: 182
- FWCI
- 129.29
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Arthritis Care & Research (publishedVersion)
- PubMed (publishedVersion)
- Deep Blue (University of Michigan) (submittedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Fibromyalgia and Chronic Fatigue Syndrome Research
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Myofascial pain diagnosis and treatment
- Keywords
- fibromyalgia, diagnostic criteria, symptom severity scale, Widespread Pain Index, case definition, fatigue, sleep disorders, cognitive symptoms, somatic symptoms
- MeSH terms
- Fibromyalgia, Health Status Indicators, Humans, Medical Informatics, Pain, Rheumatology, Sensitivity and Specificity, Severity of Illness Index, Societies, Medical, United States, Reproducibility of Results
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
A language model drew the claims from the paper on 2026-10-22, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).
A second model labelled each claim on 2026-10-22 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).
Cited sources are checked with a language model’s help (gpt-6-sol).
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
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