A RARE DIAGNOSIS IN CHILDREN: JUVENILE FIBROMYALGIA

Öz

Juvenile fibromyalgia (JFM) is a chronic pain condition in children. This extremely rare disease was first described in 1985. Although it is seen at young ages, its incidence is increasing in adolescents. Girls are more affected. Despite the researches, a clear etiology has not been determined. It is thought to be due to hypersensitivity of some synapses and increased activity in the synaptic space. It causes widespread pain, fatigue, sleep diffuculties and school absenteeism in children, and a decrease in school success. This situation affects the quality of life of the patients. It is a very important morbidity problem for both the family and the patient. JFM is similar to the clinic in adult patients with its basic features. But unlike adults, joint laxity or hypermobility is more common in children diagnosed with JFM. There are no specific diagnostic tests to detect the disease. Although it is difficult to diagnose, symptoms should be evaluated together with a detailed physical examination and clinical findings. The criteria developed by Yunus and Massi for JFM in 1985 were revised for children. In addition, the American College of Rheumatology is used in the diagnosis by rearranging the 1990 criteria. Early diagnosis and timely initiation of appropriate treatment are very important for the patient's quality of life. All chronic pain complaints should be evaluated in the differential diagnosis. A detailed physical examination and anamnesis should be taken to ensure that diseases such as thyroid dysfunction, systemic lupus erythematosus, juvenile idiopathic arthritis, and sleep disorders are excluded. Psychosocial support, appropriate physiotherapy, and continuous activity are very beneficial in the treatment of JFM. Additional problems should also be treated in a multidisciplinary manner. The main purpose of the treatment is to relieve pain and maximize the functionality of the patient. In this article, we aimed to review JFM, which is rarely considered in pediatric outpatient clinics.

Anahtar Kelimeler

• Juvenile fibromyalgia
• Pediatrics
• Rheumatology

ÇOCUKLARDA NADİR GÖRÜLEN BİR TANI: JUVENİL FİBROMİYALJİ

Öz

Juvenil fibromiyalji (JFM) çocuklarda görülen kronik bir ağrı durumudur. Oldukça nadir görülen bu hastalık ilk kez 1985 yılında tanımlanmıştır. Küçük yaşlarda görülse de adölesanlarda görülme sıklığı artmaktadır. Kız çocukları daha çok etkilenmektedir. Yapılan araştırmalara rağmen net bir etyoloji belirlenememiştir. Bazı sinapsların aşırı hassaslaşması ve sinaptik aralıktaki aktivite artışına bağlı olduğu düşünülmektedir. Çocuklarda yaygın ağrı, yorgunluk, uyku güçlüğü ve okul devamsızlıkları ve okul başarısında azalmaya neden olmaktadır. Bu durum hastaların yaşam kalitesini etkilemektedir. Hem aile için hem de hasta açısından oldukça önemli bir morbidite sorunudur. JFM temel özellikleri ile yetişkin hastalardaki kliniğe benzemektedir. Yetişkinlerden farklı olarak JFM tanılı çocuklarda eklem gevşekliği veya hipermobilitesi daha yaygın görülmektedir. Hastalığı saptamak için spesifik tanısal testler yoktur. Tanı koymak oldukça zordur. Semptomlar ayrıntılı fizik muayene ve klinik bulgular ile birlikte değerlendirilmelidir. Semptomlar ayrıntılı fizik muayene ve klinik bulgular ile birlikte değerlendirilmelidir. Yunus ve Massi tarafından 1985 yılında JFM için geliştirilen kriterler çocuklarda yeniden revize edilmiştir. Ayrıca Amerikan Romatoloji Koleji 1990 yılındaki kriterleri de yeniden düzenlenerek tanı konulmasında kullanılmaktadır. Erken tanı konulması ve uygun tedaviye zamanında başlanması hastanın yaşam kalitesi açısından oldukça önemlidir. Ayırıcı tanıda tüm kronik ağrı şikayetleri değerlendirilmelidir. Tiroid disfonksiyonu, sistemik lupus eritematozus, juvenil idiyopatik artrit, uyku bozuklukları gibi hastalıkların dışlandığından emin olmak için ayrıntılı bir fizik muayene ve öykü alınması gerekir. JFM tedavisinde psikososyal destek, uygun fizyoterapi ile sürekli aktivite oldukça faydalıdır. Hastalığa ek sorunlar da multi-disipliner bir şekilde tedavi edilmelidir. Tedavide başlıca amaç ağrının giderilip hastanın işlevselliğinin en üst düzeye çıkarılmasıdır. Bu yazıda pediatri polikliniklerinde nadir olarak akla gelen JFM ’yi gözden geçirmeyi amaçladık.

Anahtar Kelimeler

• Juvenil fibromiyalji
• Pediatri
• Romatoloji.

Kaynakça

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