What is fibromyalgia, and what links with POTS, hypermobility and ME/CFS are being studied?
Definition of fibromyalgia, published diagnostic criteria and the limits of studies on its coexistence with hypermobility, dysautonomia and ME/CFS.
- 8 sources
- 5 min read
- Clinical review
- Verified 9 November 2026
Key points
- Fibromyalgia is characterized mainly by chronic widespread pain, often associated with fatigue, sleep problems and cognitive difficulties; in July 2025, the French National Authority for Health (HAS) published a good practice guideline for adults [1].
- The 2016 revised ACR criteria combine a Widespread Pain Index (WPI), a Symptom Severity Scale (SSS), generalized pain and a symptom duration; they are applied during a clinical examination, and their self-report questionnaire version is not valid for individual diagnosis [2, 3].
- A systematic review reports concomitant diagnoses of hEDS/HSD and fibromyalgia in high proportions across the included studies, but these are clinical populations and heterogeneous methods: these figures are not general-population prevalence rates [4].
- A 2026 meta-analysis of 17 studies of chronic musculoskeletal pain (13 fibromyalgia, 3 Ehlers-Danlos syndrome, 1 rheumatoid arthritis) estimates a pooled prevalence of dysautonomia of 64%, with very high heterogeneity (I², which measures how much results vary between studies, of 93%); this figure cannot be attributed to fibromyalgia alone [5].
- The coexistence of fibromyalgia with hEDS/HSD, POTS or ME/CFS does not prove a common cause; several diagnoses may be relevant at the same time [1, 4, 6].
Definition and clinical picture
Classification criteria and diagnosis
Fibromyalgia and hEDS/HSD: what do coexistence studies show?
Fibromyalgia, dysautonomia and POTS
French and international guidelines
What is still unknown
References and level of evidence
- Haute Autorité de santé (HAS). Fibromyalgie de l'adulte : conduite diagnostique et stratégie thérapeutique. HAS (French National Authority for Health) good practice guideline (adopted June 19, 2025, published online July 10, 2025) 2025.(guideline or consensus)Limitations: French guideline for adults; does not automatically apply to children or outside France. Read: overview page and the “Recommendations” document (in French).Declared conflicts of interest: Not reviewed in the part of the source that was read
- Wolfe F, Clauw DJ, Fitzcharles MA, Goldenberg DL, Häuser W, Katz RL, Mease PJ, Russell AS, Russell IJ, Walitt B. 2016 Revisions to the 2010/2011 fibromyalgia diagnostic criteria. Seminars in Arthritis and Rheumatism, 46(3):319–329 2016. DOI: 10.1016/j.semarthrit.2016.08.012. PMID: 27916278.(guideline or consensus)Limitations: Criteria revision based on validation studies; the self-report questionnaire version is not valid for individual diagnosis. Read: abstract (detailed criteria read in the HAS reproduction).Declared conflicts of interest: Not reviewed in the part of the source that was read
- French National Authority for Health (HAS), based on Wolfe F et al. 2016. Critères de diagnostic de l'American College of Rheumatology (ACR) révisés 2016. Tool accompanying the HAS fibromyalgia guideline (July 2025) 2025.(guideline or consensus)Limitations: French-language reproduction of the 2016 ACR criteria, for use during a clinical examination; not a self-diagnosis tool. Read: PDF of the tool.Declared conflicts of interest: Institutional document
- Alsiri N, Alhadhoud M, Alkatefi T, Palmer S. The concomitant diagnosis of fibromyalgia and connective tissue disorders: A systematic review. Seminars in Arthritis and Rheumatism, 58:152127 2023. DOI: 10.1016/j.semarthrit.2022.152127. PMID: 36462303.(evidence synthesis)Limitations: Eleven observational studies in adults (nine case-control, two single-group); clinical populations and heterogeneous criteria; rates cannot be transferred to the general population. Read: abstract.Declared conflicts of interest: Not reviewed in the part of the source that was read
- Almutairi NA, Greenwood DC, Sivan M. The prevalence of dysautonomia in chronic musculoskeletal pain: a systematic review and meta-analysis. Rheumatology Advances in Practice, 10(2):rkag034 2026. DOI: 10.1093/rap/rkag034. PMID: 41978692.(evidence synthesis)Limitations: 17 studies (13 fibromyalgia, 3 Ehlers-Danlos syndrome, 1 rheumatoid arthritis); very high heterogeneity (I² = 93%) and variable autonomic assessment methods. Read: full text (PMC13070644).Declared conflicts of interest: The authors declare no conflicts of interest
- Aziz Q, Harris LA, Goodman BP, Simrén M, Shin A. AGA Clinical Practice Update on GI Manifestations and Autonomic or Immune Dysfunction in Hypermobile Ehlers-Danlos Syndrome: Expert Review. Clinical Gastroenterology and Hepatology, 23(8):1291–1302 2025. DOI: 10.1016/j.cgh.2025.02.015. PMID: 40387691.(expert opinion)Limitations: US expert review (best practice advice) without a systematic review or formal grading of the evidence. Read: abstract (16 best practice advice statements).Declared conflicts of interest: Not reviewed in the part of the source that was read
- Macfarlane GJ, Kronisch C, Dean LE, Atzeni F, Häuser W, et al. EULAR revised recommendations for the management of fibromyalgia. Annals of the Rheumatic Diseases, 76(2):318–328 2017. DOI: 10.1136/annrheumdis-2016-209724. PMID: 27377815.(guideline or consensus)Limitations: Literature analyzed up to 2015; predates the 2025 HAS guideline. Read: abstract.Declared conflicts of interest: Not reviewed in the part of the source that was read
- Wu YL, Huang CJ, Fang SC, Ko LH, Tsai PS. Cognitive Impairment in Fibromyalgia: A Meta-Analysis of Case-Control Studies. Psychosomatic Medicine, 80(5):432–438 2018. DOI: 10.1097/PSY.0000000000000575. PMID: 29528888.(evidence synthesis)Limitations: 23 case-control studies published before September 2017; heterogeneous tests. Read: abstract.Declared conflicts of interest: Not reviewed in the part of the source that was read