Session Type: Abstract Submissions (ACR)
Juvenile Fibromyalgia (JFM) is a chronic condition characterized by widespread musculoskeletal pain, fatigue, poor sleep and significant morbidity. Currently, a classification of JFM is based upon one of two published criteria – the 1990 American College of Rheumatology (ACR) criteria for adult fibromyalgia (FM) or the 1985 Yunus and Masi pediatric criteria. Both require a manual tender point examination that is controversial, not routinely or consistently applied by clinicians, and may be influenced by patient anxiety about the procedure. The newer 2010 ACR criteria allows for the use of a validated tool that excludes the use of the tender point exam and includes a clear scoring algorithm for consistency in screening and diagnosis of FM. However, these criteria were developed for adult FM patients and it is not clear whether they can be applied in pediatric populations. The aim of this study was to examine the utility of the new 2010 ACR criteria for pediatric patients with JFM in comparison to the ACR 1990 and Yunus and Masi classification criteria.
Participants were patients (ages 11-17) with primary JFM diagnosed by a rheumatologist or pain physician (N=44, Mage=15.02) and age and gender matched controls (MC) with localized pain conditions, e.g., abdominal pain, headaches, limb pain (N=44, Mage=15.05). Physicians completed a form indicating which set of criteria they used to make a JFM diagnosis (ACR 1990 or Yunus and Masi). The ACR 2010 Widespread Pain Index (WPI), regarding which body locations were painful and Symptom Severity (SS) checklist of associated somatic symptoms were administered by a trained assessor. Total scores for the WPI and SS tools were computed and the ACR 2010 algorithm was used to determine diagnosis of JFM. Also, t-tests were conducted to compare the two groups on number of pain locations and number of symptoms endorsed.
The Yunus and Masi criteria were used the most often (93.2% of the time) by physicians to classify JFM and the ACR 1990 criteria were used far less (6.8%). When the 2010 criteria were applied, 83.7% of patients diagnosed with active JFM by their primary rheumatologist met the ACR 2010 criteria. However, approximately 11.4% of controls with localized pain were also classified as having JFM. JFM participants reported significantly more pain locations and associated symptoms than MC (p<.01).
Preliminary results indicate that the 2010 adult FM ACR Criteria may be a useful tool to screen for JFM in an adolescent population with JFM. The WPI and SS tools that comprise the 2010 criteria are brief and easy to administer and the tender point is not required. Therefore, the ACR 2010 criteria allow for more widespread application and potentially earlier identification of JFM in pediatric practices. However, confirmation of the clinical diagnosis by a specialty trained physician is still recommended. Further validation studies with larger samples to test the sensitivity and specificity of the measure are needed.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/utility-of-the-2010-acr-diagnostic-criteria-for-fibromyalgia-for-pediatric-patients-with-juvenile-fibromyalgia/