Pediatric Rheumatology Online Journal → August 2003 → Pain / Health-Related Quality of Life → Abstract #188

CHRONIC FATIGUE: A PEDIATRIC RHEUMATOLOGY PERSPECTIVE

B. P. Groh,¹ N. P. Otto,¹ B. E. Ostrov.¹

¹Pediatrics, Penn State Milton S. Hershey Medical Center, Hershey, PA

Background: Fatigue is a common complaint in pediatric rheumatology clinics. Multiple etiologies are possible, and the therapeutic approach may vary. We describe this problem in the context of our clinic population.
Methods: We identified 41 patients in our pediatric rheumatology clinic database with the complaint of chronic fatigue ([gt>6 mo.duration).
Results: Patients reviewed included 33 females and 8 males; 2 were hispanic and the others caucasian. Median age at presentation was 15 years (12 - 18) . Eighteen patients experienced debilitating fatigue, while only 15 met the CDC case definition of Chronic Fatigue Syndrome (CFS). Precipitating factors were identified by 25 patients: infections in16 and trauma or surgery in 8. Comorbid diagnoses included: fibromyalgia in 11 patients; irritable bowel syndrome in 7; connective tissue diseases in 10; hypermobility disorders in 5; and Chiari malformations in 2. The most pervasive symptoms reflected orthostasis in 35/41. Tilt table testing was abnormal in 20 of 24 tested. The most frequent therapy for orthostasis was fludrocortisone in 32 patients. Four patients received concurrent therapy with midodrine, and 17 with selective serotonin reuptake inhibitors (SSRIs). Therapies for sleep disturbance and exercise were other common prescriptions. Over time, 14 patients were able to decrease medications; 14 required additional medications. The majority of patients (31/41) reported symptomatic improvement in both fatigue and orthostasis. Symptoms resolved entirely in 4 patients.
Conclusions: Chronic fatigue in the pediatric rheumatology setting may be diagnosed as CFS in 50% of cases. Thus, careful consideration of alternative etiologies is imperative. Patients complaining of chronic fatigue often manifest with orthostasis which can be identified both by symptom review and tilt table testing. Therapy with fludrocortisone, midodrine and SSRIs can be effective in this subgroup. Other therapies may be needed to address the common comorbidities of Irritable Bowel Syndrome and sleep disturbance.