The Gold Standard -
Criteria Used To Determine Cases of EMS
The following is a set of criteria
developed by an expert team of physicians after a review of case
studies of 91 persons who have been diagnosed with Eosinophilia Myalgia
Syndrome by their physicians. After agreeing on the standard, the team of
experts applied it to the cases submitted by treating physicians
and reduced the number of confirmed cases to 50. The criteria is
referred in an article published in the Archives of Internal Medicine in
October of 2001 and referred to as the "Gold Standard."
NEMSN editor Joe Hayes and
President Sharron Lobaugh interviewed Dr. Daniel Clauw about how the criteria
were developed and the implications of using this standard for diagnostic
purposes. A portion of this interview is published in the NEMSN June
edition of the newsletter. The next edition of the newsletter will contain the
rest of the interview.
*Table 1. Proposed
Eosinophilia-Myalgia Syndrome (EMS) Criteria
EMS can be diagnosed if either
pattern 1 or 2 is satisfied. Elements within each of these patterns must
fulfill specified definitions (available from the authors).
Pattern 1
Presence of a documented illness
of abrupt or relatively discrete onset accompanied by evidence in the
absence of the exclusions noted below, of all 3 of the following
manifestations within 6 months of onset: 1) eosinophilia; 2) myalgia; and 3)
at least one of rash, edema, pulmonary involvement or neuropathy.
Pattern 2
Presence of an illness with or
without a documented early episode, accompanied by one of the following
combinations of manifestations, in the absence of the exclusions noted below,
occurring within 24 months of illness onset: 1) facititis, neuropathy, and
myalgia or muscle cramps; or 2) of any 3 or more of fascitis, myopathy,
neuropathy, or eosinophilia (within 6 months of onset).
Exclusions
EMS should not be diagnosed in the
presence of trichinosis, vasculitis, or any other documented infections,
allergic, neoplasitc, connective tissue, or other type of disease that could
adequately explain the clinical manifestations.
*Reference:Table 1
Hertzman, Phillip A.M.D., Clauw, Daniel J. M.D, Duffy Joseph, M.D., Medsger,
Thomas A., M.D., Feinstein, Alvan, R., M.D. "Rigorous New Approach to
Constructing a Gold Standard for Validating New Diagnostic Criteria, as
Exemplified by Eosiniophilia-Myalgia Syndrome, Archives of Internal
Medicine, Vol 161, October 22, 2001, Pg 2303.