Consequences and Predictors of Persisting Pain in Children with Juvenile Idiopathic Arthritis: A Case Control Study Nested in the ReACCh-Out Cohort

Tara McGrath¹, Jaime Guzman ², Lori Tucker ³, Natalie Shiff ⁴, Maryna Yaskina ⁵, Susan Tupper ⁶ and Dax Rumsey ⁷, ¹University of British Columbia, Vancouver, Canada, ²University of British Columbia and BC Children's Hospital, Vancouver, Canada, ³BC Children's Hospital, Vancouver, British Columbia, Canada, ⁴Florida, Gainesville, ⁵Women and Children's Research Institute, Edmonton, Canada, ⁶Saskatoon, Canada, ⁷University of Alberta, Edmonton, Canada

Meeting: 2020 Pediatric Rheumatology Symposium

Keywords: child, Chronic pain, Enthesitis, juvenile idiopathic arthritis (JIA), pain

Session Information

The 2020 Pediatric Rheumatology Symposium, originally scheduled for April 29 – May 2, was postponed due to COVID-19; therefore, abstracts were not presented as scheduled.

Date: Friday, May 1, 2020

Session Title: Poster Session 2

Session Type: ACR Abstract Session

Session Time: 5:00PM-6:00PM

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.

Figure 1: Change in Median Pain Scores over time in Cases and Controls. Legend: The length of the box represents the interquartile range (IQR). The circles within the box represent the group mean and the horizontal line within the box represents the group median. The whiskers are drawn to the most extreme points in the group that lie within the fences. The upper fence is defined as the third quartile (represented by the upper edge of the box) plus 1.5 times the interquartile range (IQR). The lower fence is defined as the first quartile (represented by the lower edge of the box) minus 1.5 times the interquartile range.

Disclosure: T. McGrath, None; J. Guzman, None; L. Tucker, None; N. Shiff, Abbvie, 1, 2, Novartis, 1, 2, Gliead, 1, 2, Mylan, 1, 2; M. Yaskina, None; S. Tupper, None; D. Rumsey, None.

To cite this abstract in AMA style:

McGrath T, Guzman J, Tucker L, Shiff N, Yaskina M, Tupper S, Rumsey D. Consequences and Predictors of Persisting Pain in Children with Juvenile Idiopathic Arthritis: A Case Control Study Nested in the ReACCh-Out Cohort [abstract]. Arthritis Rheumatol. 2020; 72 (suppl 4). https://acrabstracts.org/abstract/consequences-and-predictors-of-persisting-pain-in-children-with-juvenile-idiopathic-arthritis-a-case-control-study-nested-in-the-reacch-out-cohort/. Accessed August 3, 2021.

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