Pain, functional disability, and their Association in Juvenile Fibromyalgia Compared to other pediatric rheumatic diseases

Pediatr Rheumatol Online J. 2019 Nov 6;17(1):72. doi: 10.1186/s12969-019-0375-9.


Background: Severe pain and impairments in functioning are commonly reported for youth with juvenile fibromyalgia. The prevalence and impact of pain in other diseases commonly managed in pediatric rheumatology comparatively have been rarely systematically studied. The objective of the current study was to determine the extent to which high levels of pain and functional limitations, and the strength of their association, are unique to youth with juvenile primary fibromyalgia syndrome/JPFS) relative to other pediatric rheumatic diseases.

Methods: Using data from 7753 patients enrolled in the multinational Childhood Arthritis and Rheumatology Research Alliance (CARRA) Legacy Registry, we compared the levels and association of pain and functional limitations between youth with JPFS and those with other rheumatic diseases.

Results: Pain levels were rated highest among youth with JPFS (M = 6.4/10, SD = 2.4) and lowest for juvenile dermatomyositis (M = 1.7/10, SD = 2.2), with pain significantly higher in the JPFS group than any other pediatric rheumatic disease (effect sizes = .22 to 1.05). Ratings on measures of functioning and well-being also were significantly worse for patients with JPFS than patients with any other rheumatic disease (effect sizes = .62 to 1.06). The magnitude of association between pain intensity and functional disability, however, generally was higher in other rheumatic diseases than in JPFS. Pain was most strongly associated with functional limitations in juvenile dermatomyositis, juvenile idiopathic arthritis, and mixed connective tissue disease.

Conclusions: JPFS is unique among conditions seen in pediatric rheumatology with regard to ratings of pain and disability. However, pain appears to be comparably or more highly associated with level of functional impairment in other pediatric rheumatic diseases. Pain in childhood rheumatic disease thus would benefit from increased prioritization for research and treatment.

Keywords: Fibromyalgia; Functional disability; Pain; Pediatric rheumatic disease; Registry.

Publication types

  • Comparative Study
  • Observational Study

MeSH terms

  • Activities of Daily Living*
  • Adolescent
  • Child
  • Child, Preschool
  • Female
  • Fibromyalgia / complications*
  • Fibromyalgia / pathology
  • Humans
  • Male
  • Pain / etiology*
  • Pain Measurement
  • Registries
  • Retrospective Studies
  • Rheumatic Diseases / complications*
  • Rheumatic Diseases / pathology
  • Surveys and Questionnaires
  • Young Adult