Ayla Kaçar, Erbil Ünsal, Balahan Makay, Özge Altuğ-Gücenmez

Evaluation of Restless Legs syndrome and growing pains in children with familial Mediterranean fever

Growing pains (GP) and restless leg syndrome (RLS) are one of the frequentlyseen pain syndromes of childhood. These two pain syndromes -GP and RLSmay be confused with exertional leg pain (ELP) of familial Mediterranean fever(FMF). The aim of this study was to evaluate the frequency of fulfilling thecriterion for GP and RLS among children with FMF. Sixty FMF patients and70 healthy controls were enrolled. Clinical and demographic data of patientswere recorded. A questionnaire including the symptoms of GP and RLS wereapplied to all participants and their parents. Twenty-seven patients (45%) hadELP. Ten FMF patients and 10 healthy children fulfilled GP criteria. Therewas not a significant difference between patients and controls regarding GP.Three FMF patients and 7 healthy controls fulfilled RLS criteria. There wasnot a significant difference between two groups regarding RLS. Two out of 27FMF patients with ELP had RLS while one out of 33 FMF patients withoutELP had RLS. Eight out of 27 FMF patients with ELP fulfilled GP criteriawhile two out of 33 FMF patients without ELP fulfilled GP criteria (p=0.01).There was a significant inverse correlation with FMF severity score and GP(p=0.003 and r=-0.376). There was not a significant association with FMFseverity score and RLS. This study suggested that GP and RLS are not morecommon in pediatric FMF patients than their healthy peers.

PDF

___

1. Barron KS, Kastner DL. Periodic fever syndromes and other inherited autoinflammatory diseases. In: Petty RE, Laxer RM, Lindsley CB, Wedderburn L (eds) Textbook of Pediatric Rheumatology, (7th ed). Philadelphia: Elsevier, 2016: 609-626.
2. Ozen S, Bilginer Y. A clinical guide to autoinflammatory diseases: familial Mediterranean fever and next-of-kin. Nat Rev Rheumatol 2014; 10: 135-147.
3. Eshed I, Rosman Y, LivnehA et al. Exertional leg pain in familial Mediterranean fever: a manifestation of an underlying enthesopathy and a marker of more severe disease. Arthritis Rheumatol 2014; 66: 3221-3226.
4. Majeed HA, Al-Qudah AK, Qubain H, Shahin HM. The clinical patterns of myalgia in children with familial Mediterranean fever. Semin Arthritis Rheum 2000; 30: 138-143.
5. Livneh A, Langevitz P, Zemer D, et al. Criteria for the diagnosis of familial Mediterranean fever. Arthritis Rheum 1997; 40: 1879e85.
6. Makay B, Unsal E, Arslan N, Varni JW. Health-related quality of life of school-age children with familial Mediterranean fever. Clin Exp Rheumatol 2009; 27 (2 Suppl 53): S96-S101.
7. Wong MW, Williamson BD, Qiu W, Champion D, Teng A. Growing pains and periodic limb movements of sleep in children. J Paediatr Child Health 2014; 50: 455-460.
8. Walters AS. Toward a better definition of the restless legs syndrome. The International Restless Legs Syndrome Study Group. Mov Disord 1995; 10: 634- 642.
9. Allen RP, Picchietti D, Hening WA, Trenkwalder C, Walters AS, Montplaisir J. Restless legs syndrome: diagnostic criteria, special considerations, and epidemiology. A report from the restless legs syndrome diagnosis and epidemiology workshop at the National Institutes of Health. Sleep Med 2003; 4: 101-119.
10. Yalçinkaya F, Ozen S, Ozçakar ZB, et al. A new set of criteria for the diagnosis of familial Mediterranean fever in childhood. Rheumatology (Oxford) 2009; 48: 395-398.
11. Pras E, Livneh A, Balow JE Jr et al. Clinical differences between North African and Iraqi Jews with familial Mediterranean fever. Am J Med Genet 1998; 75: 216- 219.
12. Peterson H. Growing pains. PediatrClin North Am 1986; 33: 1365-1372.
13. Champion D, Pathirana S, Flynn C, et al. Growing pains: twin family study evidence for genetic susceptibility and a genetic relationship with restless legs syndrome. Eur J Pain 2012; 16: 1224-1231.
14. Tunca M, Akar S, Onen F, et al. Familial Mediterranean fever (FMF) in Turkey: results of a nationwide multicenter study. Medicine 2005; 84: 1-11.
15. Makay B, Kiliçaslan SK, Anik A, et al. Assessment of sleep problems in children with familial Mediterranean fever. Int J Rheum Dis 2017; 20: 2106-2112.
16. Dosman C, Witmans M, Zwaigenbaum L. Iron’s role in paediatric restless legs syndrome - a review. Paediatr Child Health 2012; 17: 193-197.
17. Allen RP, Auerbach S, Bahrain H, Auerbach M, Earley CJ. The prevalence and impact of restless legs syndrome on patients with iron deficiency anemia. Am J Hematol 2013; 88: 261-264.
18. Trenkwalder C, Allen R, Högl B, Paulus W, Winkelmann J. Restless legs syndrome associated with major diseases: A systematic review and new concept. Neurology 2016; 86: 1336-1343.