Background/Purpose: Juvenile Idiopathic Arthritis (JIA) is the most common rheumatic disease of childhood. Pain is a distressing and prevalent feature of JIA and can decrease children’s quality of life. Identifying predictors of persisting pain in children with JIA will enable health care providers to better target pain management.
The purpose of this study is to describe consequences and predictors of persisting pain in children with Juvenile Idiopathic Arthritis (JIA).
Methods: The ReACCH-Out cohort consists of approximately 1500 children followed for up to 5 years. In this case-control study, we compared JIA cases of ‘moderate-to-severe persisting pain’ (31 patients) with JIA controls of ‘moderate-to-severe decreasing pain’ (118 patients). Moderate-to-severe pain was defined as > 3.5 cm using a Visual Analogue Scale (VAS). Follow-up was minimum 3 years. Cases were compared to controls using linear mixed models to assess the impact of pain on function, quality of life, and parent and physician global assessments over time. Logistic regression was performed to examine the association between each of the following potential baseline predictors with persisting pain: age at onset, sex, JIA category at baseline, enthesitis at baseline, and active joint count at baseline.
Results: A 1 cm increase in pain intensity was associated with an increase of 0.13 units in Childhood Health Assessment Questionnaire (CHAQ) disability index (CI 95% 0.11-0.14), 0.33 in Juvenile Arthritis Quality of Life Questionnaire (JAQQ) (0.31-0.36), 0.19 in JAQQ psychosocial (0.16-0.22), 0.62 in Parent Global (0.58-0.66), and 0.44 in Physician Global (0.40-0.49) scores; and with a 0.32 units decrease in the Quality of My Life (QoML) score (0.37-0.28). In the final multivariate regression model, enthesitis count at baseline (OR 1.40, CI 95% 1.19-1.76), female sex (4.14, 1.33-16.83) and the overall QoML baseline score (0.82, 0.69-0.98) predicted development of persisting pain.
Conclusion: Among children with JIA with moderate-to-severe pain at baseline, pain intensity was strongly related to function, quality of life and parent and physician global scores while female sex, lower overall quality of life, and higher enthesitis counts at baseline predicted development of persistent pain.
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