BackgroundJuvenile Idiopathic Arthritis (JIA) is the most common cause of non-infectious joint inflammation in children. Synovial inflammation results in pain, swelling and stiffness. Animal and adult human studies indicate that localized joint-associated inflammation may produce generalized changes in pain sensitivity. The aim was to characterize pain sensitivity in children with JIA to mechanical and thermal stimulus modalities using quantitative sensory testing (QST) at an affected inflamed joint, and compare to children in clinical remission. Generalized hypersensitivity was evaluated by comparing QST measures at the thenar eminence between JIA and healthy control children.Methods60 children aged 7–17 years with JIA participated. QST assessed sensory detection threshold and pain threshold at two sites: (1) affected joint (clinically active or inactive), (2) contralateral thenar eminence. Joint site included finger, wrist, knee and ankle. Clinical status was measured using objective and subjective markers of disease severity. Questionnaires assessed pain intensity and frequency, functional disability, anxiety, pain catastrophization and fatigue. QST data collected from joints were compared within JIA patients: active vs. inactive inflammation; and data from the contralateral thenar eminence were compared between JIA and healthy control cohorts in Europe [EU, (n = 151)] and the US (n = 92). Statistical analyses were performed using Kruskal-Wallis with Dunn’s post-hoc comparison, Mann-Whitney or Fisher’s exact test, where appropriate.ResultsOverall, children with JIA reported low pain scores and low degrees of functional disability. Sensory detection thresholds and pain thresholds were similar in “active” compared to “inactive” joints. Despite this, children with JIA had generalized hypersensitivity at the thenar eminence when compared to healthy children for pressure (vs. EU p < 0.001), light touch (vs. EU p < 0.001), cold (vs EU, p < 0.01; vs US, p < 0.001) and heat pain (vs EU, p < 0.05; vs US p < 0.001).ConclusionsJIA is associated with increased sensitivity to painful mechanical and thermal stimuli, even in absence of pain reports, or markers of disease activity. Future research investigating mechanisms underlying pain hypersensitivity in JIA is warranted; this will in turn guide pharmacologic and non-pharmacologic interventions to prevent or reverse these processes.Electronic supplementary materialThe online version of this article (doi:10.1186/1546-0096-12-39) contains supplementary material, which is available to authorized users.

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The coronavirus disease 2019 (COVID-19) pandemic has changed the landscape of pediatric graduate medical education. We anticipate that pediatric residents and fellows will acquire new skills to carry with them as practicing pediatricians of the future. Here, we present the collective observations of a resident, fellow, and hospitalist, with the intention of highlighting the challenges and opportunities in trainee education during this unusual and unpredictable time. THE IMPACT OF SOCIAL AND PHYSICAL DISTANCING ON THE LEARNING ENVIRONMENT Direct Interaction With Patients A central tenet in medical education is that spending time at the bedside is best: examine your patients and then examine them again. As Osler observed, "Medicine is learned by the bedside and not in the classroom," 1 and "We miss more by not seeing than we do by not knowing." 2 In a time when the Centers for Disease Control and Prevention is releasing guidelines to conserve personal protective equipment 3 and the public is being asked to distance themselves both socially and physically, thoughtful decisions are being made as to who should examine the patient and how often. In this environment, direct patient interaction is limited, and this central tenet of medical education must be reexamined. Although encounters with inpatients are modified, live outpatient encounters conducted by trainees are near nonexistent. Although some trainees are participating in virtual visits, this opportunity is not yet available to all trainees, and many of the continuity relationships cultivated through well-child checks and routine examinations are on hold. With that, the opportunities to counsel on preventive health, manage chronic disease, and become familiar with less acute yet crucial physical examination findings are lost. Interaction With Colleagues Social and physical distancing guidelines have interfered with the interactions of trainees with the larger interdisciplinary team. Impromptu