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Abstract Number: 2271

Symptom and Treatment Characteristics of Juvenile Primary Fibromyalgia Syndrome: Are Males and Females Created Equal?

Jennifer E. Weiss1, Kenneth N. Schikler2, Alexis Boneparth3, Cara Hoffart4, Mark Connelly5 and The CARRA Registry Investigators6, 1Pediatric Rheumatology, Joseph M Sanzari Children’s Hospital, Hackensack University Medical Center, Hackensack, NJ, 2Department of Pediatrics, Univ of Louisville Schl of Med, Louisville, KY, 3Pediatric Rheumatology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, 4Rheumatology and Integrative Pain Management, Children's Mercy Hospital, Kansas City, MO, 5Children's Mercy Hospital, Kansas City, MO, 6Childhood Arthritis and Rheumatology Research Alliance, Durham, NC

Meeting: 2014 ACR/ARHP Annual Meeting

Keywords: Fibromyalgia and pediatric rheumatology

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Session Information

Session Title: Pediatric Rheumatology - Clinical and Therapeutic Aspects: Systemic Juvenile Idiopathic Arthritis, Spondyloarthropathy and Miscellaneous Pediatric Rheumatic Diseases

Session Type: Abstract Submissions (ACR)

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.


Disclosure:

J. E. Weiss,
None;

K. N. Schikler,
None;

A. Boneparth,
None;

C. Hoffart,
None;

M. Connelly,
None;

T. CARRA Registry Investigators,
None.

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