Clark P, Burgos-Vargas R, Medina-Palma C, Lavielle P, Marina F F
Clinical Epidemiology Unit, Hospital General de Especialidades Bernardo Sepulveda, Universidad Nacional Autónoma de México Faculty of Medicine, Mexico DF.
J Rheumatol. 1998 Oct;25(10):2009-14.
To determine the prevalence of fibromyalgia (FM) in schoolchildren according to the 2 stage classification process proposed by the 1990 American College of Rheumatology (ACR) Multicenter Criteria Committee on Fibromyalgia.
Stage 1: we administered a pain questionnaire to a sample of 548 schoolchildren (264 boys, 284 girls; mean age 11.9 yrs, range 9-15). Stage 2: two rheumatologists examined all children with diffuse pain. Using thumb palpation, they examined 18 fibromyalgia tender points and 3 pairs of controls points followed by dolorimetry. Additionally, a random sample of 79 children with no pain were selected as controls, following the same procedures (thumb palpation and dolorimetry). The Wilcoxon test was used to compare the distribution of tenderness thresholds between FM and non-FM groups. Kappa statistics for multiple raters was used to assess interobserver agreement.
Seven children, all girls, fulfilled the ACR diagnostic criteria for FM. Thus, the prevalence of FM in this group of schoolchildren reached only 1.2%. The girls with FM had a mean of 14 tender points, whereas controls (n = 79) had 2.4. Pain thresholds were 3.4 kg in children with FM and 5.1 kg in controls (p = 0.004).
The prevalence of FM in our study was 5-fold lower than a previous report. This variance may be due to (1) racial and sociocultural differences between populations; and (2) differences in methodological approach. The difficulties of making accurate estimates of FM across different studies are highlighted.
根据1990年美国风湿病学会（ACR）纤维肌痛多中心标准委员会提出的两阶段分类法，确定学龄儿童纤维肌痛（FM）的患病率。
第一阶段：我们对548名学龄儿童（264名男孩，284名女孩；平均年龄11.9岁，范围9 - 15岁）进行了疼痛问卷调查。第二阶段：两名风湿病学家对所有有弥漫性疼痛的儿童进行检查。他们通过拇指触诊检查了18个纤维肌痛压痛点和3对对照点，随后进行痛觉测量。此外，随机抽取79名无疼痛的儿童作为对照，采用相同程序（拇指触诊和痛觉测量）。使用Wilcoxon检验比较FM组和非FM组之间压痛阈值的分布。使用多评估者的Kappa统计量评估观察者间的一致性。
7名儿童，均为女孩，符合ACR的FM诊断标准。因此，该组学龄儿童中FM的患病率仅为1.2%。患有FM的女孩平均有14个压痛点，而对照组（n = 79）有2.4个。FM儿童的疼痛阈值为3.4千克，对照组为5.1千克（p = 0.004）。
我们研究中FM的患病率比之前的报告低5倍。这种差异可能是由于（1）不同人群之间的种族和社会文化差异；以及（2）方法学方法的差异。强调了在不同研究中准确估计FM的困难。
