Table 4.

Long-term outcomes of juvenile fibromyalgia syndrome and review of the literature

Reference	Results
Malleson PN et al. Idiopathic musculoskeletal pain syndromes in children. J Rheumatol 1991: 19: 1186-1189	After a variable observation period between 1 and 48 months, 11 of 18 patients with so-called JFMS had persistent symptoms after an average of 11 months.
Buskila D et al. Fibromyalgia syndrome in children - an outcome study. J Rheumatol 1995; 11: 515-8.	A spontaneous remission of symptoms was observed in 13% of patients evaluated after a 30-month follow up.
Siegel DM et al. Fibromyalgia syndrome in children and adolescents: clinical features at presentation and status at follow-up. Pediatrics 1998; 101: 311-81.	In the present study, 46% of the patients improved, 43% remained unchanged, and in 11% symptoms became worse. There was no statistically significant difference between the younger and older patients.
Mikkelsson M. One year outcome of preadolescents with fibromyalgia. J Rheumatol 1999; 16: 614-81.	The JFMS persisted in only 16% of the patients evaluated at a one-year follow up.
Calvo I et al. Pediatric fibromyalgia patients: A follow-up study. Ann Rheum Dis. XIV European League Against Rheumatism Congress Abstracts, Glasgow, Scotland, 1999, p 353.	At 48-month follow-up, 15/11 (68.1%) had no longer fulfilled the FM criteria.
Gedalia A et al. Fibro-myalgia syndrome: experience in a pediatric rheu-matology clinic. Clin Exp Rheumatol 1000; 18: 415-419	Conducted a retrospective study over a period of 4 years. At an average follow-up of 18 months (range 3-65 months), 60% of the children improved, 36% experienced no change and 4% experienced a worsening of pain symptoms.
Kashikar-Zuck S et al. Controlled follow-up study of physical and psycho-social functioning of adolescents with juvenile primary fibromyalgia syndrome. Rheumatology (Oxford) 1010; 49: 1104-1109	Of 48 U.S. American children and adolescents diagnosed with JFMS, after an average of 3.1 years, 61.5% suffered from widespread musculoskeletal pain, and 60.4% fulfilled criteria for so-called JFMS.
Libby CJ et al. Protective and exacerbating factors in children and adolescents with fibromyalgia. Rehabil Psychol 1010; 55: 151-158	Exacerbating factors for widespread musculoskeletal pain included the following: daily hassles, pain-related catastrophizing, lack of self-efficacy and lack of positive family support.
Kashikar-Zuck S et al. Long-Term Outcomes of Adolescents With Juvenile-Onset Fibromyalgia in Early Adulthood. Pediatrics 1014; 133: e591-600.	This prospective study demonstrated that pain and other symptoms persisted into adulthood for 80% of JFMS patients, with associated impairments in physical functioning and mood. At follow-up, one-half of the sample met full criteria for adult FM.