Juvenile Primary Fibromyalgia Syndrome Differential Diagnoses

  • Author: Angelo P Giardino, MD, PhD, MPH; Chief Editor: Lawrence K Jung, MD   more...
 
Updated: Nov 28, 2011
 
 

Diagnostic Considerations

In adults, diagnosis of fibromyalgia syndrome (FMS) is based on history, physical examination, laboratory study findings, and exclusion of other potential conditions.

In 1990, the American College of Rheumatology (ACR) defined 2 major diagnostic criteria for classifying FMS in adults. The first is a history of widespread pain for at least 3 months that involves both sides of the body above and below the waist. Specific areas include the cervical skeleton (eg, spine, anterior chest), the shoulders or buttocks (considered for each involved side), and the lower back (considered below the waist).

The second criterion requires pain on 11 of 18 defined tender points (TPs) upon digital palpation with approximately 4 kg per unit area of force. For a positive result, the patient must indicate that palpation is painful (see Physical Examination).

In 1985, Yunus and Masi first compared juvenile primary fibromyalgia syndrome (JPFS) with FMS in adults.[9] The 1990 criteria for adult FMS were found to be less sensitive to the events that occur in childhood FMS. Yunus and Masi proposed FMS criteria that are slightly different for children and adolescents. Their criteria take into consideration a more variable presentation, along with a dependence on adult input to make the diagnosis.

The ACR criteria for adults have not been validated in children; thus current diagnostic criteria for JPFS are based on the Yunus and Masi guidelines.[9]

By these criteria, a JPFS patient should have had 3 or more months of widespread musculoskeletal pain, with 5 or more well-defined TP sites. No other underlying medical conditions that could have caused the symptoms should be present, and routine laboratory test results should be in the normal range. In addition, at least 3 of the following 10 minor criteria (or associated symptoms) should be present (see History):

  • Chronic anxiety or tension
  • Fatigue
  • Poor sleep
  • Chronic headaches
  • Irritable bowel syndrome
  • Subjective soft tissue swelling
  • Numbness
  • Pain modulation by physical activities
  • Pain modulation by weather conditions
  • Pain modulation by anxiety or stress

Although children and adults with FMS experience similar symptoms, children seem to have more sleep disturbances. Compared with adults, children experience pain in fewer body areas (3 versus 5) and have fewer TPs (5 out of 11 versus 11 out of 18). Children have less lower back pain, hand pain, and paraspinal TPs; however, they experience ankle pain and increased pain associated with overactivity.

Go to Fibromyalgia and Rehabilitation and Fibromyalgia for complete information on these topics.

Other conditions to be considered include the following:

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

Differential Diagnoses

Proceed to Workup
 
 
Contributor Information and Disclosures
Author

Angelo P Giardino, MD, PhD, MPH  Associate Professor, Baylor College of Medicine; Chief Medical Officer, Texas Children's Health Plan; Chief Quality Officer, Medicine, Texas Children's Hospital

Angelo P Giardino, MD, PhD, MPH 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: Bayer Honoraria Review panel membership; Pfizer Grant/research funds Independent contractor; MedImmune Honoraria Review panel membership; Teva Pharmacutical travel & honoraria Managed Care Advisory Panel; CIGNA Honoraria Physician Advisory Council

Coauthor(s)

Eileen R Giardino, RN, MSN, PhD, 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, RN, MSN, PhD, 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.

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.

Additional Contributors

Herbert S Diamond, MD Adjunct Professor of Medicine, Division of Rheumatology, University of Pittsburgh 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: Merck Ownership interest Other; Smith Kline Ownership interest Other; Zimmer Ownership interest Other

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.

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

References

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  2. Bennett RM. The fibromyalgia syndrome. In: Textbook of Rheumatology. 5th ed. Philadelphia, PA: WB Saunders Co; 1997:511-9.

  3. Yunus MB. Central sensitivity syndromes: a new paradigm and group nosology for fibromyalgia and overlapping conditions, and the related issue of disease versus illness. Semin Arthritis Rheum. Jun 2008;37(6):339-52. [Medline].

  4. Yunus MB. Fibromyalgia and overlapping disorders: the unifying concept of central sensitivity syndromes. Semin Arthritis Rheum. Jun 2007;36(6):339-56. [Medline].

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  9. Yunus MB, Masi AT. Juvenile primary fibromyalgia syndrome. A clinical study of thirty-three patients and matched normal controls. Arthritis Rheum. Feb 1985;28(2):138-45. [Medline].

  10. Siegel DM, Janeway D, Baum J. Fibromyalgia syndrome in children and adolescents: clinical features at presentation and status at follow-up. Pediatrics. Mar 1998;101(3 Pt 1):377-82. [Medline].

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  15. Neumann L, Smythe HA, Buskila D. Performance of point count and dolorimetry in assessing nonarticular tenderness in children. Arthritis and Rheumatism. 1989;28(2):138-145.

  16. Calabro JJ. Fibromyalgia (fibrositis) in children. Am J Med. Sep 29 1986;81(3A):57-9. [Medline].

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  18. Arnold LM, Russell IJ, Diri EW, et al. A 14-week, randomized, double-blinded, placebo-controlled monotherapy trial of pregabalin in patients with fibromyalgia. J Pain. Sep 2008;9(9):792-805. [Medline].

  19. Rossy LA, Buckelew SP, Dorr N, et al. A meta-analysis of fibromyalgia treatment interventions. Ann Behav Med. Spring 1999;21(2):180-91. [Medline].

  20. Degotardi PJ, Klass ES, Rosenberg BS, et al. Development and evaluation of a cognitive-behavioral intervention for juvenile fibromyalgia. J Pediatr Psychol. Aug 2006;31(7):714-23. [Medline].

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Illustration of 9 paired tender points identified in the 1990 statement of the American College of Rheumatology on fibromyalgia. They are as follows: (a) insertion of nuchal muscles into occiput, (b) upper border of trapezius, (c) muscle attachments to upper medial border of scapula, (d) anterior aspects of the C5–C7 intertransverse spaces, (e) second rib space 3 cm lateral to the sternal border, (f) muscle attachments to lateral epicondyle 2 cm below bony prominence, (g) upper outer quadrant of gluteal muscles, (h) muscle attachments just posterior to greater trochanter, and (i) medial fat pad of knee proximal to joint line.
 
 
 
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