Abstract Details

Title Evidence of Decreased Epidermal Neurite Density in Juvenile Fibromyalgia Patients

Topic Child Neurology and Developmental Neurology

Presentation(s) P3 - Poster Session 3 (5:30 PM-6:30 PM)

Poster/Presentation
Number 7-065

Objective To test whether juvenile fibromyalgia (JFM) is associated with decreased epidermal nerve fiber density, which is a biomarker associated with small-fiber polyneuropathy.

Background

Fibromyalgia is a syndromic label for a multi-symptom illness that includes chronic widespread pain, fatigue, exercise intolerance, and headache. Several labs have reported evidence that ≤40% of adult fibromyalgia patients have decreased epidermal nerve fiber density.

Design/Methods With IRB approval we have thus far screened 20 participants aged 13-20y with juvenile FM diagnosed by pediatric rheumatologists. All 17 meeting the modified American College of Rheumatology criteria for JFM undertook the Functional Disability Inventory, pain rating, and COMPASS-31 autonomic-symptom surveys. All were offered standard PGP9.5-immunolabeled lower-leg skin biopsy. The co-primary outcomes were raw epidermal neurite densities (END) and END prevalence <5^th centile of age/gender/race predicted normal distribution. Matching ethnicity, race, sex, and age requirements were then applied to healthy youngsters previously recruited from the community for blinded skin-biopsy analysis to provide a demographically matched post-hoc control group of all qualifiers; the 25 who met criteria were included.

Results Among the 17 JFM patients, mean age was 16.86±0.19 years, whereas controls averaged 17.9±0.08y (p=0.166). The JFM group had mean END of 239.2±12.1/mm² skin surface area vs. 402.7±16.1/mm² skin surface area in healthy controls (p=0.0034). Among the 12 experimental biopsies so far, 67% (8/12) had END <5^th centile versus 4% (1/25) in healthy controls (Bonferroni-corrected p=0.000101; Fisher's exact test).

Conclusions In concordance with reports of abnormal skin biopsies and other neuropathy-associated findings in adult fibromyalgia patients, both of our outcomes were statistically significant suggesting that low END may be even more prevalent in juvenile fibromyalgia patients. If full SFPN diagnoses are confirmed in some patients, cause-based definitive and disease-modifying treatments (e.g., for infectious, nutritious, genetic, autoimmune neuropathy) become an option. Further study to elucidate the significance of abnormal skin biopsies in JFM is indicated.

Authors/Disclosures
PRESENTER	No disclosure on file
Shan Chen, MD, PhD (Rutgers-Robert Wood Johnson Medical School)	Dr. Chen has nothing to disclose.
	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file
Anne Louise Oaklander, MD, PhD, FAAN (Massachusetts General Hospital)	The institution of Dr. Oaklander has received research support from National Institutes of Health.

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