Objective. To describe variability of pain intensity experienced by youths with juvenile idiopathic arthritis (JIA) and examine factors related to within-day patterns of pain and the relationship between magnitude of pain variability and quality of life. Methods. Pain intensity was self-reported on a visual analog scale (VAS; range 0 -100) by 112 youths with JIA ages 8 -18 years using electronic diaries 3 times per day for 7 days. Average absolute change in pain (AAC) was computed as a measure of the magnitude of pain variability for each participant. Logistic regression was used to examine the relationship between demographic and disease characteristics and the probability of having high pain variability (AAC >10 VAS units). Linear regression was used to examine the relationship between quality of life (assessed by the Pediatric Quality of Life Inventory) and AAC. The generalized estimating equations approach was used to examine the relationship between the time of day and pain intensity.

Family presence in long-term care (LTC) homes is crucial for meeting the health, psychosocial, and practical needs of residents. Initially during the COVID-19 pandemic, visitation restrictions essentially locked-out families as public health orders prioritized prevention of harm from spread of infection. Although telephone and technology-assisted communication with families was encouraged, many residents were unable to participate. The outcry from families on the injustice of disruption of family units and emerging reports of harms arising from prolonged restrictions highlight the need for provincial and organizational policies to recognize the impact of resident and family separation on well-being. In this commentary we describe family caregiving, review the impact of visitation restrictions on residents, families, and LTC staff, and provide a resident- and family-oriented perspective on policy implications that challenge the outdated notion that extreme restrictions to family presence protect resident health.

The Ottawa Panel recommends the following structured exercises and physical activities for the management of JIA: Pilates, cardio-karate, home and aquatic exercises. Pilates showed improvement in a higher number of outcomes.

We studied children enrolled within 90 days of juvenile idiopathic arthritis diagnosis in the Research in Arthritis in Canadian Children Emphasizing Outcomes (ReACCh-Out) prospective inception cohort to identify longitudinal trajectories of pain severity and features that may predict pain trajectory at diagnosis. A total of 1062 participants were followed a median of 24.3 months (interquartile range = 16.0-37.1 months). Latent trajectory analysis of pain severity, measured in a 100-mm visual analogue scale, identified 5 distinct trajectories: (1) mild-decreasing pain (56.2% of the cohort); (2) moderate-decreasing pain (28.6%); (3) chronically moderate pain (7.4%); (4) minimal pain (4.0%); and (5) mild-increasing pain (3.7%). Mean disability and quality of life scores roughly paralleled the pain severity trajectories. At baseline, children with chronically moderate pain, compared to those with moderate-decreasing pain, were older (mean 10.0 vs 8.5 years, P = 0.01) and had higher active joint counts (mean 10.0 vs 7.2 joints, P = 0.06). Children with mild-increasing pain had lower joint counts than children with mild-decreasing pain (2.3 vs 5.2 joints, P < 0.001). Although most children with juvenile idiopathic arthritis in this cohort had mild or moderate initial levels of pain that decreased quickly, about 1 in 10 children had concerning pain trajectories (chronically moderate pain and mild-increasing pain). Systematic periodic assessment of pain severity in the months after diagnosis may help identify these concerning pain trajectories early and lay out appropriate pain management plans. Focused research into the factors leading to these concerning trajectories may help prevent them.