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Adolescent Fibromyalgia may persist into adulthood, study shows
Thursday 22 August 2013
New Orleans—The vast majority of patients diagnosed in adolescence with juvenile-onset fibromyalgia (JFM) continue to endure the disease or its associated symptoms into young adulthood, according to a long-term follow-up study.
“We found that almost 50% of our sample met the American College of Rheumatology’s (ACR) criteria for fibromyalgia, [whereas] others had subclinical symptoms that didn’t fulfill all classification criteria, but they were not in complete remission,” said senior author Susmita Kashikar-Zuck, PhD, associate professor, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, in a telephone interview with Pain Medicine News. The study was presented at the 32nd annual meeting of the American Pain Society (poster 121).
The study sample consisted of 85 patients with JFM who have been followed for seven years thus far. Patient selection was based on Yunus and Masi’s criteria (Arthritis Rheum 1985;28:138-145). At follow-up, 39 of the 85 patients (45.8%) met the ACR’s criteria for adult FM, and 32 patients (37.6%) had continuing subclinical FM symptoms. The remaining 14 patients (16%) reported freedom from pain. Patients who met the criteria for adult FM had significantly higher rates of depression, anxiety and physical impairment.
The study began in 2001, with the first follow-up in 2005. The current seven-year follow-up represents the third phase in this ongoing effort. The study cohort was 95.6% female and 85.9% white. The mean age at follow-up was 21.73 years.
At follow-up, participants responded online to the Widespread Pain Index (WPI) and the symptom severity scale, both components of the ACR’s criteria questionnaire. For the WPI, participants indicated in which of 19 body areas they had pain. The responses were later confirmed at an in-person visit by a trained examiner who performed a standard tender point examination of 18 predefined body sites. If widespread pain and associated symptoms were present for more than three months and the participant experienced pain upon palpation of at least 11 of the 18 sites, the patient met the ACR criteria for FM.
A Likert scale was used to assess the severity of the three cardinal symptoms associated with FM—fatigue, waking up feeling unrefreshed and difficulty concentrating. The researchers also collected data on 40 somatic symptoms associated with FM, including dizziness, numbness, irritable bowel and nausea.
Patients with FM at follow-up had significantly higher levels of anxiety, depression and physical impairment than those with subclinical FM and those who were pain-free.
The study was conducted against a background of scant information about the extent to which the symptoms of JFM persist from childhood through adolescence and into adulthood, and the rate of adolescent patients who go on to meet the ACR criteria for adult FM.
Based on their findings, the researchers cautioned that children and adolescents who complain of widespread musculoskeletal pain that persists for more than three months and who seek medical care for their symptoms should warrant concern, as this may indicate the onset of chronic pain disorder.
Commenting on this study, Daniel J. Clauw, MD, professor of anesthesiology, medicine (rheumatology) and psychiatry at the University of Michigan and director of the Chronic Pain and Fatigue Research Center in Ann Arbor, said he thought the study was “extremely important.”
“Pediatricians have long considered fibromyalgia and a number of other ‘functional’ pain syndromes to be benign because many of these adolescents have resolution of pain. But most do not, and this study shows that instead of considering this to be a benign problem that adolescents outgrow, this should be considered the first manifestation of a lifelong disease that would likely have a markedly better prognosis if treated more aggressively at the outset.”
The above originally appeared here.
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