Does a rheumatologist treat fibromyalgia?
Who Can Diagnose Fibromyalgia
A family practice physician, internist, or rheumatologist can diagnose fibromyalgia. In some cases, the patient is referred to a rheumatologist for a diagnosis after being examined by a family practice physician or internist. Rheumatologists are internists or pediatricians with additional training in arthritis and other rheumatic diseases, including fibromyalgia.
See Encinitas arthritis doctor Role in Patient Care
Additional health care practitioners may also first indicate a fibromyalgia diagnosis, such as a chiropractor or physiatrist treating the patient for back pain.
See Arthritis Treatment Specialists
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Clinical Tests
There is no widely accepted medical test to diagnose fibromyalgia. Instead, diagnostic tests are performed to see if another condition could be causing the symptoms.
Blood tests are usually ordered to rule out conditions with similar symptoms. Other tests will depend on the symptoms described, but may include X-rays or an electromyography (EMG), to evaluate muscles’ electrical activity.
See Blood Tests to Help Diagnose Rheumatoid Arthritis (RA)
Examination
Patients typically undergo a thorough physical, with the patient alerting the doctor to areas causing pain. Some doctors may press lightly on the areas of the body called tender points, discreet areas of tenderness in the muscular and tendinous tissue of those with fibromyalgia.
These areas are at uniform and consistent sites in fibromyalgia patients, who are generally unaware of the tender points until a doctor presses on them.
The doctor may also ask whether any relatives have or have had similar symptoms, since fibromyalgia seems to have a genetic component.
See Diagnosing and Treating Rheumatologic Conditions in Children
In This Article:
What You Need to Know About Fibromyalgia
Characteristic Symptoms of Fibromyalgia
How to Get a Fibromyalgia Diagnosis
Multi-Specialty Fibromyalgia Treatment
Medications to Ease Fibromyalgia Symptoms
Criteria for Diagnosis
Guidelines for a fibromyalgia diagnosis have evolved in recent decades. Criteria developed in 1990 emphasized pain symptoms and a physical exam that involved checking on 18 tender points.
In 2010, the American College of Rheumatology revised its criteria for a fibromyalgia diagnosis to take into account symptoms other than pain and increased the number of tender points to 19.1
See Understanding Joint Pain
The 2010 guidelines still considered tender points an important part of the diagnosis, but no longer required that pain be felt in 11 of these points, as determined by a physical exam that involved the doctor pushing down on these locations.2 Some variations on diagnostic criteria have been proposed, but doctors generally follow the 2010 guidelines.
Before being considered for a diagnosis of fibromyalgia, symptoms must have been experienced for at least three months and all other causes for the symptoms ruled out.
If that is the case, the diagnosis is then based on scores in two major areas, widespread pain and symptom severity, experienced by the patient during the past week. To be classified as widespread, the pain must be on the upper part of the body as well as below the waist. It must also be felt on both sides.
See Suffering and Chronic Pain
Widespread Pain Index
Patients are typically asked if they have pain in any of 19 potential tender points. Each tender point where pain is experienced counts as 1 point, with the score on this index ranging from 0 to 19.
Symptom Severity Score
Fatigue, waking unrefreshed, and cognitive symptoms are ranked by severity in this assessment. The extent of additional symptoms typically associated with fibromyalgia is recorded, but these are not ranked by severity. Possible scores are between 0 and 12.
See Getting the Sleep You Need With Fibromyalgia
A major step in the diagnosis is met when the scores match one of these categories:
A Widespread Pain Index score of 7 or more, and a Symptom Severity Scale of 5 or more.
A Widespread Pain Index score of 3 to 6 and a Symptom Severity Scale of 9 or more.
See How to Understand Chronic Pain vs. Acute Pain
Some patients may be provided with an illustrated chart showing tender points and a checklist to note symptoms.