December 16, 2019
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Pain more severe for juvenile fibromyalgia vs. other pediatric rheumatic diseases

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Mark Connelly

Juvenile primary fibromyalgia is unique among pediatric rheumatic diseases regarding pain and disability ratings, with pain significantly higher in these patients than those with other childhood rheumatic conditions, according to data published in Pediatric Rheumatology.

“Although we already have evidence that pain can be significantly impairing for children and adolescents who have chronic pain as the primary disorder — as is the case in juvenile fibromyalgia — we know comparatively little in most cases about the extent to which pain is even being reported or associated with difficulties in functioning for youth with other pediatric rheumatic diseases,” Mark Connelly, PhD, of Children’s Mercy Kansas City, told Healio Rheumatology.

“To our knowledge, this is the first study to directly compare reports of pain and measures of limitations in functioning across conditions commonly evaluated and treated in pediatric rheumatology,” he added. “We thought that conducting this study could help identify conditions that may benefit from further pain monitoring and mitigation measures.”

To evaluate the degree to which high pain and functional limitation, as well as the strength of their association, are unique to patients with juvenile primary fibromyalgia compared with other pediatric rheumatic diseases, Connelly and colleagues studied data from the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Legacy Registry. Drawing from 56 centers in North America, the CARRA registry is the largest multi-site clinical database of children and adolescents with a rheumatic disease, according to the researchers.

Juvenile primary fibromyalgia is unique among pediatric rheumatic diseases regarding pain and disability ratings, with pain significantly higher in these patients than those with other childhood rheumatic conditions, according to data.

For their study, Connelly and colleagues conducted a retrospective review of data from 7,753 children and adolescents aged between 5 to 21 years at the time of participation consent, with an initial assessment visit between May 2010 and May 2014. Of those patients, 201 had primary fibromyalgia. The researchers compared the levels and association of pain and function between patients with primary fibromyalgia with those with other rheumatic diseases, including mixed connective tissue disease (MCTD), systemic lupus erythematosus, juvenile dermatomyositis (JDM), juvenile idiopathic arthritis and central nervous system vasculitis.

According to the researchers, pain levels were rated highest among patients with primary fibromyalgia (M=6.4/10; SD=2.4) and lowest for juvenile dermatomyositis (M=1.7/10; SD=2.2). In addition, pain was significantly higher among those with primary fibromyalgia than any other rheumatic disease (effect sizes=0.22-1.05). Functioning and well-being ratings were also significantly worse in the fibromyalgia group compared with patients with other rheumatic diseases (effect sizes=0.62-1.06).

“On average, individuals with juvenile fibromyalgia report high levels of pain and functional disability, levels that exceed those reported in other diseases managed in pediatric rheumatology,” Connelly said. “This further reinforces how difficult this condition can be to live with for children and adolescents that are diagnosed with it.”

However, the magnitude of the association between pain intensity and functional disability was generally was higher in other rheumatic diseases compared with primary fibromyalgia. In addition, pain was most strongly associated with functional limitations in juvenile dermatomyositis, JIA and mixed connective tissue disease.

“Treatments for pediatric rheumatic disease have come a long way in recent years and in many cases are excellent for reducing disease activity, but we know that reduced disease activity does not necessarily correspond with reduced pain,” Connelly said. “One of the main findings of this study suggest that to the extent that pain is not being specifically targeted as an important treatment outcome in pediatric rheumatic disease, quality of life and functioning may be difficult to appreciably improve.” – by Jason Laday

Disclosure: The authors report no relevant financial disclosures.