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    Fibromyalgia is an imprecise, clinically defined syndrome with no histological or other diagnostic abnormalities on investigation, and no known cause. The American College of Rheumatology 1990 diagnostic criteria are widespread pain (both sides of the body, above and below the waist, and spine or anterior chest) together with tenderness at 11 of 18 defined points (Arthritis and Rheumatism 1990;33:160–72). Although it is often thought of as a disease of adults, population studies have shown prevalences of 1% in Swedish adults and 6% in Israeli school children. In American paediatric rheumatology clinics around 7% of new attenders have fibromyalgia.

    Paediatric rheumatologists in Rochester, New York (David M Siegel and colleagues, Pediatrics1998;101:377–82) have analysed their experience of the fibromyalgia syndrome between 1989 and 1995. There were 45 patients aged 9 to 20 years (mean 13) of whom 41 were girls. Although the American College of Rheumatology criteria were used as a basis for diagnosis not all patients fully satisfied them. The main symptoms were fatigue, sleep disturbance, and diffuse pain, each occurring in over 90% of patients. Morning stiffness, morning fatigue, headaches, and changes in symptoms with weather each affected between 80% and 90%. Depression or anxiety was experienced by over a half and irritable bowel syndrome, dysmenorrhoea, worsening on exercise, paraesthesia, and Raynaud’s phenomenon by between a third and a half of patients. Compared to adults, children had more sleep disturbance, fewer tender points (cumulative mean over several visits 9.7), and a better prognosis, most of them improving over two or three years of follow up. Their treatment included low dose tricyclic antidepressants, graded exercise, and non-steroidal anti-inflammatory drugs. Children often benefit from a positive diagnosis of fibromyalgia, especially if it ends a period of intensive investigation and diagnostic uncertainty. The Rochester workers warn about the dangers of them becoming involved with adult orientated fibromyalgia syndrome support groups, which may give too poor an impression of likely outcome.