Patterns of pain over time among children with juvenile idiopathic arthritis

Abstract

ObjectivesPain is a very common symptom of juvenile idiopathic arthritis (JIA). Disease activity alone cannot explain symptoms of pain in all children, suggesting other factors may be relevant. The objectives of this study were to describe the different patterns of pain experienced over time in children with JIA and to identify predictors of which children are likely to experience ongoing pain.MethodsThis study used longitudinal-data from patients (aged 1–16 years) with new-onset JIA. Baseline and up to 5-year follow-up pain data from the Childhood Arthritis Prospective Study (CAPS) were used. A two-step approach was adopted. First, pain trajectories were modelled using a discrete mixture model. Second, multinomial logistic regression was used to determine the association between variables and trajectories.ResultsData from 851 individuals were included (4 years, median follow-up). A three-group trajectory model was identified: consistently low pain (n=453), improved pain (n=254) and consistently high pain (n=144). Children with improved pain or consistently high pain differed on average at baseline from consistently low pain. Older age at onset, poor function/disability and longer disease duration at baseline were associated with consistently high pain compared with consistently low pain. Early increases in pain and poor function/disability were also associated with consistently high pain compared with consistently low pain.ConclusionsThis study has identified routinely collected clinical factors, which may indicate those individuals with JIA at risk of poor pain outcomes earlier in disease. Identifying those at highest risk of poor pain outcomes at disease onset may enable targeted pain management strategies to be implemented early in disease thus reducing the risk of poor pain outcomes.

Early Self‐Reported Pain in Juvenile Idiopathic Arthritis as Related to Long‐Term Outcomes: Results From the Nordic Juvenile Idiopathic Arthritis Cohort Study

“…In a multinational quality‐of‐life study from the Pediatric Rheumatology International Trials Organization, pain was found to be a predictor of psychosocial well‐being . In agreement with our study, previous studies have shown that pain at presentation was a strong predictor of persistent pain . In accordance with our results, pain as a predictor of functional disability was also found in a small cross‐sectional study from the US .…”

A Granulocyte-Specific Protein S100A12 as a Potential Prognostic Factor Affecting Aggressiveness of Therapy in Patients with Juvenile Idiopathic Arthritis

“…On the other hand, Giancane et al [ 28 ] stated that the pain should be considered as a direct cause and main indication for treatment in JIA patients. Older age at diagnosis and longer disease duration are the risk factors of lower efficacy in reduction of patients' symptoms [ 29 ]. Measuring the JADAS value on the day of the check-up visit may not be the most informative indicator of patients' well-being between the assessments, which may have influenced the evaluation of the relation between S100A12 and disease activity.…”

Teens Taking Charge: A Randomized Controlled Trial of a Web-Based Self-Management Program With Telephone Support for Adolescents With Juvenile Idiopathic Arthritis

“…The disease course can be unpredictable, and children commonly experience both physical (eg, pain, fatigue, stiffness) and emotional (eg, stress, anxiety, depression) symptoms that may restrict day-to-day function [ 2 - 7 ]. Persistent pain is common and can contribute to adverse psychological effects and functional disability [ 8 , 9 ]. As children mature, they are expected to assume increasing responsibility for disease self-management concomitant with their growing independence and autonomy.…”