Clinical manifestations and diagnosis of fibromyalgia.

Since the publication of the American College of Rheumatology Classification Criteria for Fibromyalgia 18 years ago, there have been an ever-increasing number of research articles and reviews. From the National Library of Medicine alone there are more than 10,000 articles related to fibromyalgia. The major clinical manifestations of fibromyalgia have not changed, but their prevalence, associations, relative importance to the patient, and scientific underpinnings are increasingly better understood. This article provides an update on fibromyalgia symptomatology and looks at issues that need to be considered in the development of updated diagnostic guidelines. There is still no gold standard for making a diagnosis of fibromyalgia, but there is an increasing consensus for the development of new guidelines for diagnosis that modifies the currently proscribed tender point evaluation.