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Original article
Patterns of pain over time among children with juvenile idiopathic arthritis
  1. Amir Rashid1,2,
  2. Lis Cordingley1,
  3. Roberto Carrasco1,
  4. Helen E Foster3,4,
  5. Eileen M Baildam5,
  6. Alice Chieng6,
  7. Joyce E Davidson7,8,
  8. Lucy R Wedderburn9,10,11,
  9. Yiannis Ioannou9,10,
  10. Flora McErlane4,
  11. Suzanne M M Verstappen1,2,
  12. Kimme L Hyrich1,2,
  13. Wendy Thomson2,12
  1. 1 Arthritis Research UK Centre for Epidemiology, The University of Manchester, Manchester, UK
  2. 2 NIHR Manchester Musculoskeletal Biomedical Research Unit, Manchester Academic Health Science Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
  3. 3 Musculoskeletal Research Group, Institute Cellular Medicine, Newcastle University, Newcastle, UK
  4. 4 Paediatric Rheumatology, Great North Children’s Hospital, Newcastle, UK
  5. 5 Paediatric Rheumatology, Alder Hey Children’s NHS Foundation Trust, Liverpool, UK
  6. 6 Paediatric Rheumatology, Royal Manchester Children’s Hospital, Manchester, UK
  7. 7 Paediatric Rheumatology, Royal Hospital for Children, Glasgow, UK
  8. 8 Paediatric Rheumatology, Royal Hospital for Sick Children, Edinburgh, UK
  9. 9 University College London (UCL) GOS Institute of Child Health, Great Ormond Street Hospital For Children NHS Trust, London, UK
  10. 10 ARUK Centre for Adolescent Rheumatology, University College London, London, UK
  11. 11 The NIHR Biomedical Research Centre, Great Ormond Street Hospital for Children NHS Trust, London, UK
  12. 12 Arthritis Research UK Center for Genetics and Genomics, The University of Manchester, London, UK
  1. Correspondence to Professor Wendy Thomson, Arthritis Research UK Centre for Genetics and Genomics, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PT, UK; wendy.thomson{at}manchester.ac.uk

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.

  • pain
  • adolescent health
  • epidemiology
  • musculo-skeletal
  • rheumatology

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

https://doi.org/10.1136/archdischild-2017-313337

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    Footnotes

    • Contributors AR, RC, LC, SMMV, KLH and WT were responsible for data cleaning and data analysis. HEF, EB, AC, JED, LRW, YI and FM were responsible for data collection and contribution to the final analysis.

    • Funding The ‘Childhood Arthritis Prospective Study (CAPS)’ is supported by the Arthritis Research UK Special Strategic (grant number 20542); Arthritis Research UK Centre for Epidemiology (grant number 20380 to AR, LC, RC, SMMV, KLH and WT); National Institute for Health Research Manchester Musculoskeletal Biomedical Research Unit to AR, SMMV, KLH and WT; Arthritis Research UK Centre for Genetics and Genomics (grant number 20385 to WT); National Institute for Health Research University College London Hospitals Biomedical Research Centre to YI and LRW and Arthritis Research UK (grant number 20164 to YI and LRW). LW is supported by Arthritis Research UK Grant 20164, and the NIHR Great Ormond Street Hospital Biomedical Research Centre. This work is also supported by the National Institute for Health Research Biomedical Research Centre Funding Scheme and is adopted into the NIHR Clinical Research Network Portfolio (CRN Study ID: 2635).

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

    • Ethics approval The study was approved by the North West Multicentre Research Ethics Committee and all participants gave written informed consent.

    • Provenance and peer review Not commissioned; externally peer reviewed.