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Fibromyalgia in an 8 y.o. boy
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Fibromyalgia in an 8 y.o. boy - January 17, 2001 6:00:00 AM
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Betty Smoot
Posts: 49
Joined: March 1, 2000
From: Sonoma CA
Status: offline
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Group,
We've been referred an 8 y.o. boy (at the request of the mom) with a dx of Fibromyalgia. He was seen here by the local pediatrician and referred to University (UCSF) rheumatologist. JRA, Lyme ruled out, as I believe were other arthritic and connective tissue disorders. He had been an active boy in sports and school until he developed pain in his LE's, fatigue, and inability to tolerate activity. He's getting better with regard to pain(rx has been homepathy, acupuncture...mom declined the pediatrician recommendation for low dose antidepressants), but he's still clumsy and not at PLF. His recent SED rate was 23. The P.T. doing the intake found him to be unable to heel walk and he had tight heel cords, and he walks a bit on his toes. (She tells me that the boy said his little brothers are starting to do the same) She didn't do a complete neuro eval (due to time...says she'll do at next visit) so doesn't know if any LMN/UMN signs.
We have some peds resources here (books & people), and we'll do the typical searches, talk to MD, make calls to colleagues, etc, but I'm hoping we can use you all as another resource. The primary P.T. will finish her eval this week, but any insight and direction you can give her would be great.
Her questions now include:
1. Are there genetic neurological conditions that first present at this age?
2. From the neurological developmental standpoint what should be look for in an 8 y.o.?
She'll get all her ducks lined up and I'm hoping she'll talk to the MD about a neuro consult, but we'll see what she finds.
Any help would be appreciated.
Thanks very much in advance.
Betty
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Re: Fibromyalgia in an 8 y.o. boy - January 17, 2001 6:42:00 AM
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Andrew M. Ball, MS, PT
Posts: 500
Joined: October 8, 1999
From: Chapel Hill, NC, USA
Status: offline
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Betty,
I'd be doubtful that an 8 year old boy actually has fibroM. It's usually found in women, and has been linked to sleeping disorders. Furthermore, the pain would be more diffuse and systemic than you describe. FibroM is often a trash diagnosis used when the PCP can't find any other cause for the pain (kind of like the old ortho diagnosis of IDK, which either stood for internally deranged knee . . . or I don't know).
But I digress . . .
Even if a connective tissue disorder has been clinically "ruled out," I'd be concerned that something may have been missed. Unless the child had a muscle biopsy (which is typically avoided if at all possible) or a genetic evaluation to search for the marker (specifically at Xp21) you can't be sure.
The mere fact that the child's younger brothers are beginning to present in a similar manner is cause enough for concern. This is begining to sound suggestive of Duchenne Muscular Dystrophy (DMD). DMD usually shows up at about 5 years of age + or - 3 years, though Becker syndrome (a less severe form of DMD), tends to be less severe and has a later onset (e.g. it can also show up at about age 8).
To start with, I'd suggest evaluating from that perspective. Look for a Gower sign when the child gets to standing from the floor (e.g. walking up the legs with his hands), and pseudohypoertrophy of the calf, triceps and gluteal muscles. In many cases, they will feel thick and rubbery to palpation.
Good luck and let us know what develops!
Andrew M. Ball, MS, MBA, PT
[This message has been edited by Andrew M. Ball, MS, PT (edited January 17, 2001).]
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Re: Fibromyalgia in an 8 y.o. boy - January 17, 2001 8:44:00 PM
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Betty Smoot
Posts: 49
Joined: March 1, 2000
From: Sonoma CA
Status: offline
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Drew,
Thanks for the reply.
I'm skeptical of the Fibromyalgia dx too...I usually am, at least a little, because of over-diagnosis.
There are reports in the literature of children meeting the criteria (Journal of Rheumatology 1993 I think, and probably some more recently but I don't have them here), but in one course I took last year the author/lecturer said it was unusual to find it in kids under 10, and that the ratio of girls to boys was closer (6:4). He had an unusual theory re: cause. I digress as well, but it's interesting stuff.
One of the reasons I'm suspect of the dx here is that his SED rate was elevated which is a differential dx test for inflammatory conditions which Fibromyalgia is not.
Also his presentation (gait and tight heel cords) doesn't fit with Fibromyalgia. Lori, the primary P.T. said his calf size is apparently normal, but she mentioned MD/DMD, etc., and is concerned there's something like that going on and perhaps it's some variant with which we, obviously, have no experience.
I'll print up the posts and give them to her. We're happy to have and grateful for your input and guidance.
I'll let you know what she finds and perhaps you'll have other clues for us and we'll follow up on what you've suggested.
Many thanks for your help.
Betty
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