Fibromyalgia syndrome (FMS) is a chronic and often debilitating condition that results in marked difficulties in daily functioning, psychiatric comorbidity and decreased quality of life. Many adult FMS patients report that their symptoms began earlier in life, when the symptoms may have been more amenable to early intervention. However, the developmental course of FMS and its associated symptoms from adolescence through adulthood has never been documented. Prospective longitudinal studies of patients diagnosed with fibromyalgia in adolescence are urgently needed. In this study, we propose to prospectively follow 96 patients diagnosed with juvenile primary fibromyalgia syndrome (JPFS) and 48 healthy controls into their young adult years. These participants are currently enrolled in our completed and ongoing JPFS research, and have completed baseline assessment (Time 1, Mean age 15 years). A Time 2 protocol has been recently implemented to assess current functioning (Mean age 19 years). So far we have demonstrated excellent cohort retention (90%), and preliminary results suggest that as a group, JPFS patients continue to have significant physical and emotional difficulties, but there is considerable variability in outcomes. Participants are now approaching the crucial young adult years, a time of rapid change and new challenges that places greater stress on coping resources for those who are already dealing with chronic pain. We are proposing two additional assessments for the entire cohort in the young adult years (Time 3, Mean Age = 22 years;and Time 4, Mean Age = 24 years). In this controlled, prospective longitudinal study, the primary objective is to first establish whether JPFS patients continue to have greater physical symptoms and impairment, psychiatric symptoms and social difficulties in young adulthood than healthy controls. The secondary objective is to examine developmental trajectories of two key outcomes: physical impairment and depressive symptoms, from adolescence through young adulthood. For each outcome, we hypothesize three distinct trajectories: those who show low initial impairment and continue to show little impairment into young adulthood, those who are initially impaired and get worse over time, and those who are initially impaired but improve over time. We will test whether trajectories of physical impairment and depressive symptoms are independent of one another, and in doing so, we will be able to disentangle aspects of mood from impairment associated with FMS. Moreover, we will test whether change in FMS symptom severity is differentially associated with physical impairment or depressive symptoms. Finally, we will test whether treatment via cognitive-behavioral therapy in adolescence has any persisting effects on long-term outcomes. Information will be gathered from participants and family member/ significant others via on-line surveys. Psychiatric interviews and tender point exams will be conducted in person. The long-term goal is to develop more refined methods to identify patients who are at risk for negative trajectories of physical and emotional outcomes and to design early, targeted interventions.
This project will be the first controlled prospective longitudinal study of adolescents with JPFS. The results will greatly increase our knowledge about the prognosis for patients with JPFS, and the complex relationship between physical and emotional symptoms in fibromyalgia syndrome. Findings will be of direct clinical relevance with respect to knowledge about physical, emotional and social outcomes for JPFS patients, and early identification of those who may be at risk for long term suffering and disability. The study will lay the groundwork for future clinical trials aimed at early and targeted interventions for JPFS.
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|Kashikar-Zuck, Susmita; Parkins, Irina S; Ting, Tracy V et al. (2010) Controlled follow-up study of physical and psychosocial functioning of adolescents with juvenile primary fibromyalgia syndrome. Rheumatology (Oxford) 49:2204-9|