Pain sensitivity in young adults with juvenile idiopathic arthritis: a quantitative sensory testing study

Arnstad, Ellen Dalen; Iversen, Johanne Marie; Uglem, Martin; Glerup, Mia; Romundstad, Pål Richard; Sand, Trond; Rygg, Marite

doi:10.1186/s13075-020-02345-2

Cited by 19 publications

(17 citation statements)

References 46 publications

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“…It is worth mentioning that apart from HPT, in this cross-sectional study, no QST modalities had a significant correlation with the magnitude of the reported pain. This is in accordance with the findings of Arnstad et al [ 17 ] It is well known that the perception of pain is the result of complex biopsychosocial processing. Whether or not such a correlation between QST and reported magnitude of pain exists should be investigated in future longitudinal studies, or larger cross-sectional studies.…”

Section: Discussionsupporting

confidence: 93%

“…A validated QST protocol was originally developed for testing the somatosensory system in adults [ 12 – 15 ], and the QST protocol was validated in healthy children from 5 years and older [ 13 ]. A few studies using QST in children with JIA showed an increased sensitivity to painful mechanical and thermal stimuli at the thenar eminence and knee; even in absence of markers of disease activity, and for a prolonged period of time [ 16 , 17 ]. However, each joint is differently innervated and sensitivity levels differ depending on the tested location (e.g., the face yields different values from the hand) [ 12 , 13 ].…”

Section: Introductionmentioning

confidence: 99%

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Feasibility of quantitative sensory testing in juvenile idiopathic arthritis

et al. 2022

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Objective Juvenile Idiopathic Arthritis (JIA) is a childhood-rheumatic disease with pain as a major early complaint, and in 10–17% pain remains a major symptom. Very few data exist on sensory threshold changes at the knee in JIA, a location in which inflammation often manifests. We determined whether JIA is associated with sensory threshold changes at the knee by using Quantitative Sensory Testing (QST) and established reference values at the knee of children. Methods Sixteen patients with JIA aged 9–18 years with one affected knee and a patient-reported pain by Visual Analog Scale (VAS) > 10 on a 0–100 scale, and 16 healthy controls completed the study and were included for the analysis. QST was assessed in compliance with the German Research Network on Neuropathic Pain (DFNS) standard. Disease severity was determined using Juvenile Disease Activity Score (JADAS. Perceived pain was assessed with a visual analogue scale(0–100). Feasibility of QST was tested in patients aged 6–9. Results Under the age of 9, QST testing showed not to be feasible in 3 out of 5 JIA patients. Patients with JIA aged 9 and older reported an average VAS pain score of 54.3. QST identified a significant reduction in pressure pain threshold (PPT) and increase in cold detection threshold (CDT) compared to healthy controls. PPT is reduced in both the affected and the unaffected knee, CDT is reduced in the unaffected knee, not the affected knee. Conclusion In a Dutch cohort of Patients with JIA, QST is only feasible from 9 years and up. Also, sensory threshold changes at the knee are restricted to pressure pain and cold detection thresholds in Patients with JIA. Perspective This article shows that in a Dutch population, the extensive QST protocol is only feasible in the age group from 9 years and older, and a reduced set of QST tests containing at least pressure pain thresholds and cold detection thresholds could prove to be better suited to the pediatric setting with arthritis.

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Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Feasibility of quantitative sensory testing in juvenile idiopathic arthritis

et al. 2022

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“…and the QST protocol was validated in healthy children from 5 years and older [11]. A few studies using QST in children with JIA showed an increased sensitivity to painful mechanical and thermal stimuli at the thenar eminence and knee; even in absence of markers of disease activity, and for a prolonged period of time [14,15]. However, each joint is differently innervated and sensitivity levels differ depending on the tested location (e.g., the face yields different values from the hand) [10,11].…”

Section: Introductionmentioning

confidence: 99%

Feasibility of Quantitative Sensory Testing in Juvenile Idiopathic Arthritis.

Mensink

Eijkelkamp

Veldhuijzen

et al. 2022

Preprint

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Background Juvenile Idiopathic Arthritis (JIA) is a childhood-rheumatic disease with pain as a major complaint. Very few data exist on sensory thresholds changes at the knee in JIA, a location in which inflammation often manifest. We determined whether JIA is associated with sensory threshold changes at the knee by using Quantitative Sensory Testing (QST) and established reference values at the knee of children.Methods 16 JIA patients aged 9-18 years with one affected knee and a patient-reported pain (VAS)>10 on a 0-100 scale, and 16 healthy controls completed the study and were included for the analysis. QST was assessed in compliance with the DFNS standard. Disease severity was determined using JADAS. Perceived pain was assessed with a visual analogue scale(0-100). Feasibility of QST was tested in patients aged 5-9.Results JIA patients reported an average VAS pain score of 54.3. QST identified a significant reduction in PPT and increase in CDT compared to healthy controls. Under the age of 9, QST testing showed not to be feasible.Conclusion Sensory threshold changes at the knee are restricted to pressure pain and cold detection thresholds in JIA patients. This study shows that in a Dutch population, the extensive QST protocol is only feasible in the age group from 9 years and older, and a reduced set of QST tests containing at least pressure pain thresholds and cold detection thresholds could prove to be better suited to the pediatric setting with arthritis.

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“…Despite juvenile idiopathic arthritis (JIA) being the most common, chronic rheumatic condition of childhood, children frequently have symptoms for months to years before presenting to a pediatric rheumatologist and receiving a diagnosis ( 1 , 2 , 3 ). Untreated juvenile arthritis can lead to chronic pain, muscle atrophy, joint contractures, limb‐length discrepancies, and abnormal growth ( 4 , 5 , 6 , 7 ). It is suggested that there is a critical window of opportunity to diagnose and treat this disease, and early treatment may limit unfavorable outcomes ( 8 , 9 ).…”

Section: Introductionmentioning

confidence: 99%

Association Between Patient‐Reported Outcomes and Treatment Failure in Juvenile Idiopathic Arthritis

Taxter

Donaldson

Rigdon

et al. 2022

ACR Open Rheumatology

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Objective Children with juvenile idiopathic arthritis (JIA) frequently exhibit symptoms months before diagnosis. The aims of this study were to assess whether baseline patient‐reported outcomes (PROs) are associated with changes in JIA pharmacotherapy treatment and whether symptom duration prior to JIA diagnosis is associated with disease activity scores over time. Methods This is a retrospective cohort study of patients with an incident diagnosis of JIA. Patient‐reported symptom duration, pain, energy, disease activity, sleep, anxiety, and depression screenings, as well as provider‐reported disease activity and joint count, were collected during routine clinical care. Cox proportional hazards evaluated PROs, disease activity scores, and symptom duration with initial medication failure within 9 months of diagnosis. Multivariate mixed effects linear regression evaluated the association of symptom duration with disease activity scores. Results There were 58 children (66% female, 35% oligoarticular JIA) in the cohort. Nearly half of patients failed initial therapy within 9 months. Unadjusted analysis showed that higher energy (hazard ratio [HR]: 0.82; 95% confidence interval [CI]: 0.69‐0.99; P = 0.04) and longer symptom duration (HR: 0.96; 95% CI: 0.93‐0.99; P = 0.03) at diagnosis were protective against medication failure. Adjusted analysis showed that symptom duration prior to diagnosis was protective against medication failure (HR: 0.95; 95% CI: 0.92‐0.99; P = 0.02); there was no association between medication failure and pain, psychiatric symptoms, or disease activity scores. There was a positive association with longer symptom duration and higher disease activity at 30 and 60 days, but this was not sustained. Conclusion Higher energy levels and longer symptom duration are protective against initial JIA treatment failures. Initial treatments informed by patient‐reported data could lead to more successful outcomes by changes in treatment paradigms.

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Pain sensitivity in young adults with juvenile idiopathic arthritis: a quantitative sensory testing study

Cited by 19 publications

References 46 publications

Feasibility of quantitative sensory testing in juvenile idiopathic arthritis

Feasibility of quantitative sensory testing in juvenile idiopathic arthritis

Feasibility of Quantitative Sensory Testing in Juvenile Idiopathic Arthritis.

Association Between Patient‐Reported Outcomes and Treatment Failure in Juvenile Idiopathic Arthritis

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