Fibromyalgia syndrome: Experience in a pediatric rheumatology clinic

Objective To report our experience of fibromyalgia syndrome (FMS) in pediatric rheuma tology clinic settings. Methods Clinical and laboratory data were reviewed in all patients with FMS between March 1992 and March 1996. Patients with FMS and an underlying rheumatic d isease were excluded from the study. At presentation and follow-up visits, all patients had a tender points (TP) count that was conducted by thumb pal pation. Both the children and their parents were questioned concerning the presence of widespread pain or aching. All the patients fulfilled the ACR c riteria for the diagnosis of primary FMS. All children were evaluated by a protocol that included relevant information on FMS. Telephone survey questi onnaires were used for patients who missed some of their follow-lip visits. Results There were 59 children (47 F and 12 M) diagnosed with primary FMS. The mean age at onset was 13.7 years, and the mean age at diagnosis was 15.5 years. The mean duration of follow-up was 18.3 months. Diffuse aching was reporte d in 57 patients (97%), headaches in 45 (76%), and sleep disturbances in 41 (69%). Less common were stiffness in 17 (29%), subjective joint swelling i n 14 (24%), fatigue in 12 (20%), abdominal pain in 10 (17%), and joint hype rmobility and depression in 8 (14%) and 4 (7%) patients, respectively. The mean ESR was 15 mm/h, RF was negative in all patients, and ANA was positive (mean titer 1:160) in 17 patients. The mean initial TP count was 14.6. Nin e patients were not available for follow-up. There were 50 patients availab le for follow-up and survey analysis and of these 30 (60%) had improved whi le 18 (36%) remained unchanged, and 2 (4%) became worse when compared with initial presentation. At the end of study follow-lip, 37 patients (74%) wer e still taking medication (20 of them daily). Out of 25 patients whose TP c ounts were available at the end of follow-up, the mean TP dropped from 14.1 2 to 12.04 (p = 0.09) for the fetal group, and 14.05 to 10.84 (p < 0.01) fo r the patients who had improved. 22 out of 30 patients in the improved grou p and 7 out of 20 in the unchanged or worse group had continued active exer cise programs (p < 0.001). Conclusion The clinical spectrum of FMS in children is similar to that of adults but w ith better outcomes. The TP count correlates with clinical status only in p atients who had improved. Active exercise programs seem to correlate with b etter outcomes. Prospective and larger patient population studies, and a lo nger follow-lip of children with FMS are needed to clarify these findings.