Background Juvenile Idiopathic Arthritis (JIA) is the most common rheumatic disease of childhood. Pain is a frequent complaint and an important reason for reduced quality of life for these children and adolescents. Knowledge of pain and its relevance for quality of life and disease outcome is limited.
Objectives To study self-reported pain early in the disease course as predictor of persistent pain and disease outcome in a long-term perspective.
Methods Consecutive cases of JIA with disease onset in 1997 to 2000 from defined geographical areas of Sweden, Denmark, Finland and Norway were prospectively included in a population-based cohort study (1). Self-reported pain was measured on a 10 cm visual analogue scale (VASpain). Remission at 8-year follow-up was defined according to the preliminary criteria described by Wallace (2). Finnish participants did not fill in the pain score and were excluded. The final study population consisted of 302 children, 204 of these had filled in the pain score both 6 months after disease onset and at 8-year follow-up. For multivariable analyses we used binomial regression in STATA.
Results Among the 204 children, 69% were girls, median onset age was 5.9 years and 50% had oligoarticular disease 6 months after onset. Six months after disease onset 74% reported VASpain >0. At 8-year follow-up 57% reported VASpain >0, and 61% was either not in remission or in remission on medication. We found an association between early pain reports and outcome 8 years later. For participants reporting no pain at 6 months, the risk of reporting pain at 8-year follow-up was 28% and the risk of not being in remission or in remission on medication was 27%. On the contrary, for participants reporting VASpain >0 at 6 months, the risk of reporting pain at 8 year was 68% and the risk of not being in remission or in remission on medication was 73%. The results were similar after adjustments for age and sex.
Conclusions Early pain report appears to be predictive of both more severe disease outcome and more persistent pain in a long-term perspective.
Nordal E, et al. Arthritis Rheum 2011;63:2809-18
Wallace CA, et al. J Rheumatol 2004;31:2290-4
Disclosure of Interest None declared