Fibromyalgia in children and adolescents: Clinical manifestations and diagnosis
- Yukiko Kimura, MD
Yukiko Kimura, MD
- Professor of Pediatrics
- Rutgers University - New Jersey Medical School
- Division Chief of Pediatric Rheumatology
- Joseph M Sanzari Children's Hospital
- Hackensack University Medical Center
- Gary A Walco, PhD
Gary A Walco, PhD
- Professor of Anesthesiology and Pain Medicine; Adjunct Professor of Pediatrics and Psychiatry
- University of Washington School of Medicine
Fibromyalgia is one of a group of chronic pain disorders that are poorly understood. The etiology and pathogenesis of this disorder are unknown, although data indicate that a significant central sensitization component is at the root of the syndrome [1,2]. It is characterized by chronic and diffuse musculoskeletal pain, fatigue, and nonrestorative sleep, as well as a number of other typical symptoms that may vary from patient to patient. Initially described in adults, this disorder is often seen in children and adolescents and is also referred to as juvenile primary fibromyalgia when it occurs in childhood [3-6]. (See "Pathogenesis of fibromyalgia".)
The clinical manifestations and diagnosis of fibromyalgia in children and adolescents will be reviewed here. The treatment and outcome of juvenile fibromyalgia and the clinical features, diagnosis, and treatment of the disease in adults are presented separately. (See "Fibromyalgia in children and adolescents: Treatment and prognosis" and "Clinical manifestations and diagnosis of fibromyalgia in adults" and "Initial treatment of fibromyalgia in adults".)
The diagnostic criteria for fibromyalgia in children and adolescents are controversial.
Several different classification schema have been proposed in adults. The most frequently used diagnostic criteria were published by the American College of Rheumatology (ACR) in 1990, and preliminary revised criteria were suggested in 2010 [7,8]. The ACR criteria include widespread pain for at least three months duration and the presence of at least 11 tender points at 18 potential sites (table 1). The original criteria were based upon the evaluation of 293 adult patients (mean age of 44.7 years), and the subsequent criteria were based upon evaluation of 196 patients with current fibromyalgia and 67 patients with prior fibromyalgia (mean age of 54.6 years). At no juncture has the application of these criteria to children been validated. A 2014 review makes clear that little progress has been made in this regard .
In 1985, criteria for diagnosing fibromyalgia in children were published based upon a review of 33 children (mean age 14.7 years, range 9 to 17 years) (table 2) . These criteria (referred to as the Yunus criteria) differ from those of the ACR 1990 criteria in requiring fewer tender points (5 versus 11), as well as clinical findings beyond diffuse pain. The other major clinical findings include the absence of another underlying condition or cause and normal laboratory test results.
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- CLINICAL FEATURES
- Tender points
- Sleep disturbance
- Psychosocial impact
- Other symptoms
- Comorbid neuropsychiatric conditions
- DIFFERENTIAL DIAGNOSIS
- Complex regional pain syndrome type 1
- Growing pains
- Systemic exertion intolerance disease (chronic fatigue syndrome)
- Rheumatic diseases
- SUMMARY AND RECOMMENDATIONS