Table 4.

2016 revised American College of Rheumatology diagnostic criteria

Criteria A patient satisfies the modified 2016 fibromyalgia criteria if the following three conditions are met:
1. Widespread pain index (WPI) ≥7 and symptom severity scale (SSS) score ≥5, or WPI of 4∼6 and SSS score ≥9. 2. Generalized pain, defined as pain in at least four of five regions, must be present. Jaw, chest, and abdominal pain are excluded from the generalized pain definition. 3. Symptoms have been generally present for at least 3 months. 4. A diagnosis of fibromyalgia is valid irrespective of other diagnoses. A diagnosis of fibromyalgia does not exclude the presence of other clinically important illnesses.
Ascertainment
1. WPI: note the number of areas in which the patient has had pain over the past week. In how many areas has the patient had pain? Score will be between 0 and 19
Left upper region (Region 1) Jaw, left Shoulder girdle, left Upper arm, left Lower arm, left	Right upper region (Region 2) Jaw, right Shoulder girdle, right Upper arm, right Lower arm, right
Left lower region (Region 3) Hip (buttock, trochanter), left Upper leg, left Lower leg, left	Right lower region (Region 4) Hip (buttock, trochanter), right Upper leg, right Lower leg, right
Axial region (Region 5) Neck Upper back Lower back Chest Abdomen
2. SSS score
Fatigue Waking unrefreshed Cognitive symptoms For each of the three symptoms above, indicate the level of severity over the past week using the following scale:
0=no problem 1=slight or mild problems, generally mild or intermittent 2=moderate, considerable problems, often present and/or at a moderate level 3=severe: pervasive, continuous, life-disturbing problems
The SSS score is the sum of the severity scores of the three symptoms (fatigue, waking unrefreshed, and cognitive symptoms) (0∼9), plus the sum (0∼3) of the number of the following symptoms the patient has been bothered by that occurred during the previous 6 months:
1. Headaches (0∼1) 2. Pain or cramps in lower abdomen (0∼1) 3. Depression (0∼1)
The final symptom severity score is between 0 and 12 The fibromyalgia severity scale is the sum of the WPI and SSS

Adapted from the article of Wolfe et al. (Semin Arthritis Rheum 2016;46:319-29) [10].