Dr. Wolfe replies

To the Editor:

Dr. Toda’s letter¹ contains a number of serious misunderstandings.

It is important to state that what he calls “2011 criteria” are not the American College of Rheumatology (ACR) criteria, are not the 2011 criteria, and are not to be used for clinical diagnosis. They are designed for survey research only.

Here follows my response to Dr. Toda’s points 1 to 6:

1. The proposed survey criteria are clearly stated in the appendix. They do not include the “fibromyalgia symptom score” referred to by Dr. Toda.

2. The criteria are shown in the appendix.

3. We use a self-report form that lists in words the 19 areas mentioned in the appendix. Others have used a manikin.

4. By symptoms we mean pain and the elements of the somatic symptoms scale.

5. What is erroneously called the 2011 criteria are not meant to replace anything. You cannot do survey research with the 1990 ACR criteria because they require a physical examination.

6. The survey criteria are not meant for clinical care. No physician should use them for diagnosis, so there is no problem with inexperienced physicians. The criteria state, “The patient does not have a disorder that would otherwise sufficiently explain the pain.” That is up to the investigator. If Dr. Toda thinks it is okay to study fibromyalgia in patients with bone metastases or with any other disease, he is free to do so.

6-3. Same answer. Whether patients should be excluded from survey research depends on the purpose of the study. Blood examinations are not needed.