The occurrence of transient musculoskeletal pain and fatigue is common in adolescents. When these complaints become persistent and chronic, interfering with the adolescent's daily activities and the appropriate developmental tasks for this stage of life, an explanation of the cause and a plan for how to resume a normal lifestyle are necessary. When a challenge to the teenager's health limits skeletal growth, pubertal progression, mobility, self-reliance, or a sense of mastery of the environment (at present or for the future), the physician is challenged with making a diagnosis and tailoring a treatment plan that attempts to restore the biophysiologic and the psychosocial milieu of the patient and his or her family.

When the adolescent's complaints include swelling, arthralgia, lack of energy, and morning stiffness, the differential diagnosis, although broad, may begin with the question as to whether the patient is suffering from an inflammatory disease or a noninflammatory process. Of the inflammatory diseases that affect adolescents, the most prevalent illness that includes chronic joint pain, swelling, and morning stiffness, frequently accompanied by fatigue or lack of energy, is juvenile rheumatoid arthritis (JRA). Of the noninflammatory conditions that affect this age group with this symptom complex, the fibromyalgia syndrome (FS) must be considered. The presence of JRA does not preclude the coexistence of FS,<sup>43Siegel D.M., Janeway D., Baum J. Fibromyalgia syndrome in children and adolescents: Clinical features at presentation and status at follow-up Pediatrics 1998 ;  101 : 377-382 [cross-ref]

Cliquez ici pour aller à la section Références</sup> and FS can be found in patients with inflammatory diseases other than JRA.<sup>49Wilson R.R., Gluck O.J., Tesser J.R.P., et al. Antipolymer antibody reactivity in a subset of patients with fibromyalgia correlates with severity J Rheumatol 1999 ;  26 : 402-407

Cliquez ici pour aller à la section Références</sup> JRA and FS have well-defined diagnostic criteria set forth by the American College of Rheumatology (ACR). Neither JRA nor FS has laboratory tests or radiographic findings that are necessary or specific for diagnosis, making the history and physical examination of ultimate importance. Laboratory tests and imaging examination are necessary only to exclude other disease entities that may mimic or confound the diagnosis.