There are few prevalence studies in the United States about the number of children and teenagers with juvenile fibromyalgia (JFM). However, some estimates, based on the American College of Rheumatology's (ACR) diagnostic criteria, are as high as 6%.
In rheumatology practices, JFM is a fairly common problem. Cincinnati Children Hospital Medical Center in Ohio sees about 40-45 new cases of JFM patients per year, according to Dr. Susmita Kashikar-Zuck, Associate Professor of Pediatrics at the hospital. Not all children will require medication or non-medicinal treatments for the symptoms, and some youth get better over time without any treatment.
Prevalence in Female Patients
The number of girls who are diagnosed with JFM outnumbers boys, just as fibromyalgia is more common in adult women than in men. It is currently not clear why fibromyalgia is more common in females, but there has been some research to indicate that fibromyalgia is genetic with first degree female relatives most likely to have symptoms.
Chronic widespread body pain is the chief symptom of fibromyalgia in both adults and children, which includes sore spots on the muscles. These spots, called "tender points" hurt when pressure is applied to them. The soreness may start in one part of the body and eventually affect others. Further, children with fibromyalgia have stiffness, tightness and burning and aching pains in their muscles. Some research suggests pain can be a far worse symptom for children than known because children may perceive pain as normal and/or don’t speak up about pain.
Other JFM symptoms include sleep disturbances, fatigue, anxiety, chronic headaches, soft tissue swelling, leg pain, restless legs, stomach pains, and cognitive difficulties. Children living with JFM may miss many school days and have difficultly participating in sports and other rigorous activities. And when they are able to attend school, they struggle with memory and concentration issues.
Some research suggests that adolescents with JFM experience problems with peer relationships due to the inability to participate and missing a lot of school. All of these problems put them at risk for social isolation from their peers and cause psychological problems, including anxiety and depression.
Diagnosing adults with FM is based on clinical history, physical examination, lab findings, and exclusion of other diseases. The current ACR criteria for diagnosis has not been validated for diagnosing children so doctors utilize guidelines established in 1985 specific to diagnosing JFM.
When seeking a diagnosis of JFM, a medical exam is done, involving a detailed history, physical exam with a tender points’ assessment, and diagnostic tests to rule out other possible health conditions. The diagnosis of JFM is made when there is widespread pain in five or more tender point sites, three or more other symptoms, including, but not limited to, anxiety, fatigue, sleep disturbances, chronic headaches, and numbness, all other medical conditions have been ruled out, and lab testing shows no other possible explanation for pain and symptoms.
There many unanswered questions about fibromyalgia, especially about what causes it. Possible causes of FM in adolescents are similar to those in adults. Most researchers believe the brains of people with FM sense pain differently, specifically at heightened levels. Moreover, some cases of FM may be triggered by specific events, such as an illness, injury or emotional trauma. Genetic factors may also play a role, as fibromyalgia tends to run in families.
JFM is treated with physical therapies, exercise, cognitive behavioral therapy and medications. Many of the basic lifestyle changes recommended for adults are recommended for JFM, such as improving sleep, eating a healthy diet, and staying active.
Medicinal treatment of JFM is similar to what has been studied and used in adult fibromyalgia. Typical medications prescribed for JFM primarily include skeletal muscle relaxants, low-dose tricyclic anti-depressants, and selective serotonin reuptake inhibitors (SSRIs). There has also been some evidence suggesting non-steroidal anti-inflammatory drugs (NSAIDs), in combination with anti-depressants and non-addictive analgesics are effective for pain and symptom management.
Little is known about the course of JFM if left untreated. A small number of studies show that children and teens benefit from medicinal, psychological and physical interventions, but there has been no follow-up data on the long-term impact of treatments. Further, JFM may have significant effects on quality of life.
JFM may continue into adulthood. Therefore, further investigation is needed to determine the relationship between juvenile and adult fibromyalgia and whether early intervention can alter the progression of this condition.
Reviewed by Afsaneh Khetrapal BSc (Hons)