A RARE DIAGNOSIS IN CHILDREN: JUVENILE FIBROMYALGIA

Year 2022, , 354 - 358, 18.07.2022

Hüseyin Kaplan , Emine Özdemir Kaçer

https://doi.org/10.18229/kocatepetip.842767

Abstract

Juvenile fibromyalgia (JFM) is a chronic pain condition in children. This extremely rare disease was first described in 1985. Although it is seen at young ages, its incidence is increasing in adolescents. Girls are more affected. Despite the researches, a clear etiology has not been determined. It is thought to be due to hypersensitivity of some synapses and increased activity in the synaptic space. It causes widespread pain, fatigue, sleep diffuculties and school absenteeism in children, and a decrease in school success. This situation affects the quality of life of the patients. It is a very important morbidity problem for both the family and the patient. JFM is similar to the clinic in adult patients with its basic features. But unlike adults, joint laxity or hypermobility is more common in children diagnosed with JFM. There are no specific diagnostic tests to detect the disease. Although it is difficult to diagnose, symptoms should be evaluated together with a detailed physical examination and clinical findings. The criteria developed by Yunus and Massi for JFM in 1985 were revised for children. In addition, the American College of Rheumatology is used in the diagnosis by rearranging the 1990 criteria. Early diagnosis and timely initiation of appropriate treatment are very important for the patient's quality of life. All chronic pain complaints should be evaluated in the differential diagnosis. A detailed physical examination and anamnesis should be taken to ensure that diseases such as thyroid dysfunction, systemic lupus erythematosus, juvenile idiopathic arthritis, and sleep disorders are excluded. Psychosocial support, appropriate physiotherapy, and continuous activity are very beneficial in the treatment of JFM. Additional problems should also be treated in a multidisciplinary manner. The main purpose of the treatment is to relieve pain and maximize the functionality of the patient. In this article, we aimed to review JFM, which is rarely considered in pediatric outpatient clinics.

Keywords

Juvenile fibromyalgia, Pediatrics, Rheumatology

ÇOCUKLARDA NADİR GÖRÜLEN BİR TANI: JUVENİL FİBROMİYALJİ

Abstract

Juvenil fibromiyalji (JFM) çocuklarda görülen kronik bir ağrı durumudur. Oldukça nadir görülen bu hastalık ilk kez 1985 yılında tanımlanmıştır. Küçük yaşlarda görülse de adölesanlarda görülme sıklığı artmaktadır. Kız çocukları daha çok etkilenmektedir. Yapılan araştırmalara rağmen net bir etyoloji belirlenememiştir. Bazı sinapsların aşırı hassaslaşması ve sinaptik aralıktaki aktivite artışına bağlı olduğu düşünülmektedir. Çocuklarda yaygın ağrı, yorgunluk, uyku güçlüğü ve okul devamsızlıkları ve okul başarısında azalmaya neden olmaktadır. Bu durum hastaların yaşam kalitesini etkilemektedir. Hem aile için hem de hasta açısından oldukça önemli bir morbidite sorunudur. JFM temel özellikleri ile yetişkin hastalardaki kliniğe benzemektedir. Yetişkinlerden farklı olarak JFM tanılı çocuklarda eklem gevşekliği veya hipermobilitesi daha yaygın görülmektedir. Hastalığı saptamak için spesifik tanısal testler yoktur. Tanı koymak oldukça zordur. Semptomlar ayrıntılı fizik muayene ve klinik bulgular ile birlikte değerlendirilmelidir. Semptomlar ayrıntılı fizik muayene ve klinik bulgular ile birlikte değerlendirilmelidir. Yunus ve Massi tarafından 1985 yılında JFM için geliştirilen kriterler çocuklarda yeniden revize edilmiştir. Ayrıca Amerikan Romatoloji Koleji 1990 yılındaki kriterleri de yeniden düzenlenerek tanı konulmasında kullanılmaktadır. Erken tanı konulması ve uygun tedaviye zamanında başlanması hastanın yaşam kalitesi açısından oldukça önemlidir. Ayırıcı tanıda tüm kronik ağrı şikayetleri değerlendirilmelidir. Tiroid disfonksiyonu, sistemik lupus eritematozus, juvenil idiyopatik artrit, uyku bozuklukları gibi hastalıkların dışlandığından emin olmak için ayrıntılı bir fizik muayene ve öykü alınması gerekir. JFM tedavisinde psikososyal destek, uygun fizyoterapi ile sürekli aktivite oldukça faydalıdır. Hastalığa ek sorunlar da multi-disipliner bir şekilde tedavi edilmelidir. Tedavide başlıca amaç ağrının giderilip hastanın işlevselliğinin en üst düzeye çıkarılmasıdır. Bu yazıda pediatri polikliniklerinde nadir olarak akla gelen JFM ’yi gözden geçirmeyi amaçladık.

Keywords

Juvenil fibromiyalji, Pediatri, Romatoloji.

References

• 1. Kashikar-Zuck S, Ting TV. Juvenile fibromyalgia: current status of research and future developments. Nature Reviews Rheumatology. 2014;10(2):89-96.
• 2. Stanford EA, Chambers CT, Biesanz JC, et al. The frequency, trajectories and predictors of adolescent recurrent pain: a population-based approach. Pain. 2008;138(1):11-21.
• 3. Siegel DM, Janeway D, Baum J. Fibromyalgia syndrome in children and adolescents: clinical features at presentation and status at follow-up. Pediatrics. 1998;101(3):377-82.
• 4. Eraso R, Bradford N, Fontenot C, et al. Pediatric rheumatology Fibromyalgia syndrome in young children: onset at age 10 years and younger. Clinical and Experimental Rheumatology. 2007;25:639-44.
• 5. Yunus MB, Masi AT. Juvenile primary fibromyalgia syndrome. A clinical study of thirty‐three patients and matched normal controls. Arthritis & Rheumatism: Official Journal of the American College of Rheumatology. 1985;28(2):138-45.
• 6. Zernikow B, Wager J, Hechler T, et al. Characteristics of highly impaired children with severe chronic pain: a 5-year retrospective study on 2249 pediatric pain patients. BMC Pediatrics. 2012;12(1):1-12.
• 7. Häuser W, Fitzcharles M-A. Facts and myths pertaining to fibromyalgia. Dialogues in Clinical Neuroscience. 2018;20(1):53-62.
• 8. Russell IJ, Larson AA. Neurophysiopathogenesis of fibromyalgia syndrome: a unified hypothesis. Rheumatic Disease Clinics 2009;35(2):421-35.
• 9. Clauw DJ.Fibromyalgia and related conditions. Mayo Clinic Proceedings. 2015;90(5): 680-92.
• 10. Reid GJ, Lang BA, McGrath PJ. Primary juvenile fibromyalgia. Psychological adjustment, family functioning, coping, and functional disability. Arthritis & Rheumatism: Official Journal of the American College of Rheumatology. 1997;40(4):752-60.
• 11. Korszun A, Young EA, Engleberg NC, et al. Use of actigraphy for monitoring sleep and activity levels in patients with fibromyalgia and depression. Journal of Psychosomatic Research. 2002;52(6):439-43.
• 12. Bjersing JL, Lundborg C, Bokarewa MI, et al. Profile of cerebrospinal microRNAs in fibromyalgia. PLoS One. 2013;8(10):e78762.
• 13. Doppler K, Rittner HL, Deckart M, et al. Reduced dermal nerve fiber diameter in skin biopsies of patients with fibromyalgia. Pain. 2015;156(11):2319-25.
• 14. Smart PA, Waylonis GW, Hackshaw KV. Immunologic Profile Of Patients With Fibromyalgia1. American Journal of Physical Medicine & Rehabilitation. 1997;76(3):231-4.
• 15. De Sanctis Vincenzo AV, Ashraf TS, Nada S, et al. The juvenile fibromyalgia syndrome (JFMS): a poorly defined disorder. Acta Bio Medica Atenei Parmensis. 2019;90(1):134- 48.
• 16. Gedalia A, Press J, Klein M, Buskila D. Joint hypermobility and fibromyalgia in schoolchildren. Annals of the Rheumatic Diseases.1993;52(7):494-6.
• 17. Rowe PC, Barron DF, Calkins H, et al. Orthostatic intolerance and chronic fatigue syndrome associated with Ehlers-Danlos syndrome. The Journal of Pediatrics. 1999;135(4):494-9.
• 18. Kashikar-Zuck S, Parkins IS, Graham TB, et al. Anxiety, mood, and behavioral disorders among pediatric patients with juvenile fibromyalgia syndrome. The Clinical Journal of Pain. 2008;24(7):620-6.
• 19. Mikkelsson M, Sourander A, Piha J, et al. Psychiatric symptoms in preadolescents with musculoskeletal pain and fibromyalgia. Pediatrics. 1997;100(2):220-7.
• 20. Kashikar-Zuck S, Flowers SR, Verkamp E, et al. Actigraphy-based physical activity monitoring in adolescents with juvenile primary fibromyalgia syndrome. The Journal of Pain. 2010;11(9):885-93.
• 21. Kashikar-Zuck S, Johnston M, Ting TV, et al. Relationship between school absenteeism and depressive symptoms among adolescents with juvenile fibromyalgia. Journal of Pediatric Psychology. 2010;35(9):996-1004.
• 22. Conte PM, Walco GA, Kimura Y. Temperament and stress response in children with juvenile primary fibromyalgia syndrome. Arthritis & Rheumatism. 2003;48(10):2923-30.
• 23. Wolfe F, Clauw DJ, Fitzcharles MA, et al. The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. Arthritis Care & Research 2010;62(5):600-10.
• 24. Ting TV, Barnett K, Lynch-Jordan A, et al. 2010 American College of Rheumatology adult fibromyalgia criteria for use in an adolescent female population with juvenile fibromyalgia. The Journal of Pediatrics. 2016;169:181-7. e1.
• 25. Zemel L, Blier PR. Juvenile fibromyalgia: a primary pain, or pain processing, disorder. Seminars in Pediatric Neurology. 2016; 23: 231-41.
• 26. Kashikar-Zuck S, King C, Ting TV, Arnold LM. Juvenile fibromyalgia: different from the adult chronic pain syndrome? Current Rheumatology Reports. 2016;18(4):19.
• 27. Draheim N, Ebinger F, Schnöbel-Müller E, et al. Aktualisierte Leitlinie Schmerz. 2017;31:296-307.
• 28. Zernikow B, Gerhold K, Bürk G, et al. Definition, Diagnostik und Therapie von chronischen Schmerzen in mehreren Körperregionen und des sogenannten Fibromyalgiesyndroms bei Kindern und Jugendlichen. Der Schmerz. 2012;26(3):318-30.
• 29. McLeod JD. Juvenile fibromyalgia syndrome and improved recognition by pediatric primary care providers. Journal of Pediatric Health Care. 2014;28(2):9-18.
• 30. Ericsson A, Palstam A, Larsson A, et al. Resistance exercise improves physical fatigue in women with fibromyalgia: a randomized controlled trial. Arthritis Research &
• Therapy. 2016;18(1):1-12.
• 31. Ambrose KR, Golightly YM. Physical exercise as non-pharmacological treatment of chronic pain: why and when. Best Practice & Research Clinical Rheumatology. 2015;29(1):120-30.
• 32. Gmuca S, Sherry DD. Fibromyalgia: treating pain in the juvenile patient. Pediatric Drugs. 2017;19(4):325-38.
• 33. Black WR, Kashikar-Zuck S. Exercise interventions for juvenile fibromyalgia: current state and recent advancements. Pain management. 2017;7(3):143-8.