Background/Purpose

Children and adolescents with persistent widespread musculoskeletal pain frequently present to pediatric rheumatologists for evaluation.  Limited data are available on the characteristics and treatments used for these patients, particularly for males.  Using the Childhood Arthritis and Rheumatology Research Alliance (CARRA) registry, we sought to evaluate the overall demographic, symptom, and treatment characteristics of patients diagnosed with juvenile primary fibromyalgia syndrome (JPFS) and to compare these characteristics as a function of gender.

Methods

Deidentified data on demographics, symptoms, functional measures and treatment characteristics were extracted from the baseline visits of JPFS patients in the CARRA registry between May 2010 and May 2014. 

Results

There were 181 patients (28 males), ages 8-21 years (M = 15.4 +/- 2.3) included. Patients were symptomatic for a mean of 1.7 +/- 2.2 years prior to their first visit to a pediatric rheumatologist, with no significant difference between males and females (M = 2.1 versus 1.6 respectively, t(173)=1.06, p=.29).  The most commonly reported symptoms at baseline included widespread pain (91%), fatigue (84%), disordered sleep (82%), headaches (68%), and extremity numbness/tingling (32%).  Females were more likely to report numbness/tingling (36% versus 13% respectively, χ² = 5.09, p = 0.02).  Table 1 lists treatments tried and recommended.  Males were significantly more likely to have used gabapentin (25% versus 8%, χ² = 7.41, p <0.01).  Of the 64 patients using non-pharmacologic treatment, the most commonly used treatment was physical therapy (59%), with females significantly more likely to have used massage and yoga (Table 1).  Less then 10% of patients tried opioids, serotonin norepinephrine reuptake inhibitors, craniosacral therapy, hypnosis, and biofeedback.

Mean pain scores at baseline were moderate to severe (6.3+/- 2.5/10) and were significantly positively related to CHAQ functional impairment scores (r = .35, p <.01), patient ratings of impairments in health-related quality of life (HRQOL) (r = .42, p<.01), and patient ratings of impairments in overall well-being (r = .64, p<.01).  Males were found to be reliably more disabled based on subjective (patient/parent report) functioning measures (HRQOL and CHAQ), although no differences were observed on physician report measures (physician global assessment and ACR functional class).

 Table 1. Treatments tried and recommended for JPFS patients (N=181)

Treatment	Percent of Patients
	Females (N=154)	Males (N=27)	Total
Medical treatments tried (N=117)
Daily non-steroidal anti-inflammatory drugs	42%	48%	43%
Selective serotonin reuptake inhibitors	29%	14%	26%
Tri-cyclic antidepressants	27%	24%	26%
Gabapentin	12%	33%*	16%
Non-pharmacological treatments tried (N=64)
Physical therapy	59%	62%	59%
Dietary supplements	22%	46%	27%
Therapeutic massage	29%*	8%	25%
Mindfulness/meditation	18%	23%	19%
Chiropractic	18%	8%	16%
Acupuncture/acupressure	16%	8%	14%
Yoga	14%*	0%	11%
Treatments recommended/started at baseline visit (N=181)
Pain education	92%	89%	91%
Graded aerobic activity	78%	67%	76%
Sleep hygiene	72%	57%	70%
General counseling	52%	54%	52%
Physical therapy	56%	57%	56%
Medications	50%	57%	51%
Referral to pain clinic	46%	43%	46%
Cognitive-behavioral therapy	41%	50%	42%
Biofeedback	7%	14%	8%

*Significant gender difference, p<.05.

Conclusion

Based on data from the largest known cohort of JPFS patients, there appear to be few significant gender differences in disease characteristics and treatment.  However, higher levels of disability are reported by male patients despite no comparable differences observed on physician severity measures, suggesting the need to consider gender on evaluation and treatment of JPFS.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/symptom-and-treatment-characteristics-of-juvenile-primary-fibromyalgia-syndrome-are-males-and-females-created-equal/