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. 2018 May;103(5):437-443.
doi: 10.1136/archdischild-2017-313337. Epub 2017 Nov 25.

Patterns of pain over time among children with juvenile idiopathic arthritis

Amir Rashid  1   2 , Lis Cordingley  1 , Roberto Carrasco  1 , Helen E Foster  3   4 , Eileen M Baildam  5 , Alice Chieng  6 , Joyce E Davidson  7   8 , Lucy R Wedderburn  9   10   11 , Yiannis Ioannou  9   10 , Flora McErlane  4 , Suzanne M M Verstappen  1   2 , Kimme L Hyrich  1   2 , Wendy Thomson  2   12
Affiliations

Patterns of pain over time among children with juvenile idiopathic arthritis

Amir Rashid et al. Arch Dis Child. 2018 May.

Abstract

Objectives: Pain 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.

Methods: This 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.

Results: Data 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.

Conclusions: This 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.

Keywords: adolescent health; epidemiology; musculo-skeletal; pain; rheumatology.

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Conflict of interest statement

Competing interests: KLH has received honoraria from Pfizer and AbbVie for work unrelated to the present article.

Figures

Figure 1
Figure 1
Pain trajectories from baseline to 5-year follow-up. VAS, visual analogue scale.
See this image and copyright information in PMC

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