eMedicine Specialties > Pediatrics: General Medicine > Rheumatology

Fibromyalgia: Differential Diagnoses & Workup

Author: Angelo P Giardino, MD, PhD, Clinical Associate Professor, Department of Pediatrics, Baylor College of Medicine; Medical Director, Texas Children's Health Plan, Inc
Coauthor(s): Eileen R Giardino, PhD, RN, MSN, FNP-BC, ANP-BC, Associate Professor of Nursing, Department of Acute and Continuing Care, University of Texas Health Sciences Center Houston School of Nursing; Gregory F Keenan, MD, Director of Medical Affairs, Department of Immunology, Centocor, Inc
Contributor Information and Disclosures

Updated: Dec 10, 2008

Differential Diagnoses

Hepatitis C

Other Problems to Be Considered

Anterior chest wall syndrome
Benign rheumatoid nodules
Bursitis
Depression
Dysautonomia
Early spondyloarthropathy
Growing pains
Hypermobility syndrome
Hypochondriasis
Inflammatory bowel disease
Malingering
Multiple sclerosis
Reflex sympathetic dystrophy
Restless leg syndrome
Tendinitis
Thyroid disease
Syndrome of multiple chemical sensitivities

Workup

Laboratory Studies

The patient's history and physical examination guide the laboratory workup for fibromyalgia syndrome (FMS). Because the presentation and diagnosis by exclusion of other physical problems are often confusing, children with fibromyalgia syndrome may be evaluated by numerous physicians who perform various batteries of tests. Most laboratory tests are expected to produce findings within the reference range when fibromyalgia syndrome is diagnosed.

  • Studies to consider in a child presenting with a clinical picture consistent with fibromyalgia syndrome include the following:
    • CBC count: Findings are normal.
    • Erythrocyte sedimentation rate (ESR): The mean ESR is 15 mm/h.
    • Rheumatoid factor (RF): Findings are negative.
    • C-reactive protein and antinuclear antibody (ANA) titer: Findings may be positive. However, because of the high incidence of ANA in the general population, ANA testing should be avoided unless the history and physical examination indicate features and abnormalities not found in FMS.
    • Prolactin serum levels: Findings are negative.
    • Electrolytes: Levels are within the reference range.
    • Liver function tests: Results are normal.
    • Muscle enzymes: Levels are within the reference range.
    • Purified protein derivative (PPD): Findings are negative.
    • Blood and urine cultures: Culture results are negative.
    • Thyroid function tests: Results are normal.
  • Characteristic changes in serotonin, substance P growth hormone, and cortisol suggest autonomic and neuroendocrine system dysregulation.

Imaging Studies

  • Plain radiography including the chest, ribs, and back reveals normal findings.
  • Ultrasonography of the abdomen, pelvis, and paravertebrae reveals normal findings.
  • Bone scanning reveals normal findings.
  • CT scanning and/or MRI study results are normal.
  • Polysomnography, including periodic limb movement in sleep (PLMS) assessment, which is used to evaluate possible sleep disorders, reveals normal findings.

More on Fibromyalgia

Overview: Fibromyalgia
Differential Diagnoses & Workup: Fibromyalgia
Treatment & Medication: Fibromyalgia
Follow-up: Fibromyalgia
Multimedia: Fibromyalgia
References
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References

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Further Reading

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Keywords

fibromyalgia, fibrositis, myofascial syndrome, nonarticular rheumatism, soft tissue rheumatism, fibromyalgia syndrome, FMS, juvenile primary fibromyalgia syndrome, juvenile FMS, pediatric fibromyalgia syndrome, pediatric FMS, juvenile primary FMS, juvenile primary fibromyalgia syndrome, JPFS, anxiety, stress, weather changes, irritable bowel symptoms, poor memory, tension headaches, dizziness, fluid retention, paraesthesias, restless legs, bruising, Raynaud phenomenon, sleep disturbance, central sensitivity syndromes, CSS, juvenile chronic arthritis, periodic limb movement in sleep, PLMS, migraines, restless leg syndrome, joint edema, temporomandibular disorders, myofascial pain syndrome, female urethral syndrome, interstitial cystitis, multiple chemical sensitivity syndrome, posttraumatic stress disorder

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Contributor Information and Disclosures

Author

Angelo P Giardino, MD, PhD, Clinical Associate Professor, Department of Pediatrics, Baylor College of Medicine; Medical Director, Texas Children's Health Plan, Inc
Angelo P Giardino, MD, PhD is a member of the following medical societies: Academic Pediatric Association, American Academy of Pediatrics, American Professional Society on the Abuse of Children, Harris County Medical Society, Helfer Society, and International Society for Prevention of Child Abuse and Neglect
Disclosure: Nothing to disclose.

Coauthor(s)

Eileen R Giardino, PhD, RN, MSN, FNP-BC, ANP-BC, Associate Professor of Nursing, Department of Acute and Continuing Care, University of Texas Health Sciences Center Houston School of Nursing
Eileen R Giardino, PhD, RN, MSN, FNP-BC, ANP-BC is a member of the following medical societies: American Academy of Nurse Practitioners, American College Health Association, American Nurses Association, American Professional Society on the Abuse of Children, and International Society for Prevention of Child Abuse and Neglect
Disclosure: Nothing to disclose.

Gregory F Keenan, MD, Director of Medical Affairs, Department of Immunology, Centocor, Inc
Gregory F Keenan, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Rheumatology
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Herbert S Diamond, MD, Professor of Medicine, Temple University School of Medicine; Chairman Emeritus, Department of Internal Medicine, Western Pennsylvania Hospital
Herbert S Diamond, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American College of Rheumatology, American Medical Association, and Phi Beta Kappa
Disclosure: medifocus Honoraria Review panel membership; health dialogs Honoraria Consulting; West Penn Allegheny Health System None Board membership

CME Editor

Daniel Rauch, MD, FAAP, Director, Pediatric Hospitalist Program, Associate Professor, Department of Pediatrics, New York University School of Medicine
Daniel Rauch, MD, FAAP is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, and Society of Hospital Medicine
Disclosure: Baxter Honoraria Consulting

Chief Editor

Lawrence K Jung, MD, Chief, Division of Pediatric Rheumatology, Children's National Medical Center
Lawrence K Jung, MD is a member of the following medical societies: American Association for the Advancement of Science, American Association of Immunologists, American College of Rheumatology, Clinical Immunology Society, and New York Academy of Sciences
Disclosure: Nothing to disclose.

 
 
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