Fibromyalgia syndrome in children and adolescents: clinical features at presentation and status at follow-up.

OBJECTIVES: To 1) describe the characteristic features of fibromyalgia syndrome (FS) in a pediatric population, 2) note similarities and differences with FS in adults, and 3) determine outcome after treatment. SETTING AND DESIGN: The Pediatric Rheumatology Clinic at the University of Rochester Medical Center is staffed by two pediatric rheumatologists and serves as a regional subspecialty referral service with approximately 450 annual patient visits, of which approximately 120 are initial evaluations. A retrospective medical record review from 1989 to 1995 was used to identify and describe the study population, and a structured telephone interview served to determine current status and response to treatment. RESULTS: A total of 45 subjects were identified (41 female; 42 white; mean age, 13.3 years), of whom 33 were available for telephone interview at a mean of 2.6 years from initial diagnosis (0.1 to 7.6 years). Of a possible 15 symptoms associated with FS, subjects reported a mean of 8, with >90% experiencing diffuse pain and sleep disturbance. Less frequent were headaches (71%), general fatigue (62%), and morning stiffness (53%). The mean cumulative number of tender points summed over all visits was 9.7 (of 18). Telephone interviews showed improvement in most patients, with a mean positive change of 4.8 on a self-rating scale of 1 to 10 comparing current status to worst-ever condition. CONCLUSIONS: FS in patients referred to a pediatric rheumatology clinic is characterized by diffuse pain and sleep disturbance, the latter being more common than that in adults. The mean number of tender points summed over all visits is fewer than the criterion of 11 established for adults at a single visit. The majority of patients improved over 2 to 3 years of follow-up.

Effect of adrenaline on plasma concentrations of bupivacaine following intra-articular injection of bupivacaine for knee arthroscopy.

We administered 0.5% bupivacaine 30 ml either with or without adrenaline 5 micrograms ml-1 randomly to 16 healthy outpatients, to determine the efficacy of local and intra-articular local anaesthesia for knee arthroscopy and whether or not adrenaline should be added to intra-articular bupivacaine. Bupivacaine concentrations were measured in plasma obtained 15, 30, 45 and 60 min after intra-articular injection. Patients receiving bupivacaine with adrenaline had significantly smaller plasma concentrations of bupivacaine at all times than did patients receiving plain bupivacaine. The maximal concentrations of bupivacaine in the plain group (median 515 ng ml-1, range 46-875 ng ml-1) were greater than those in the adrenaline group (median 33 ng ml-1, range 7-125 ng ml-1) (P = 0.001). All patients found the anaesthetic satisfactory. We conclude that intra-articular/local anaesthesia is satisfactory for outpatient arthroscopic surgery, and that adrenaline should probably be added to bupivacaine before intra-articular injection.