Background/Purpose: Previous research has demonstrated that children with Juvenile Idiopathic Arthritis (JIA) experience frequent pain that interferes with performing tasks at home and at school. However, it is unclear whether pain and associated functional limitations persist despite recent advances in the understanding and medical treatment of the disease. The present study used electronic (e-) diaries to determine whether pain, stiffness, and fatigue continue to be common, disabling symptoms in children with JIA despite aggressive contemporary medical management.
Methods: Fifty-nine children with JIA (44 girls, 73% Caucasian, mean age 13.3 years) were recruited during routine pediatric rheumatology clinic visits. Most had mild (42%) or moderate (43%) physician-rated disease activity (minimal 11%, severe 4%). Participants provided current ratings of pain, stiffness, and fatigue intensity; number of painful locations; and functional limitations using a Smartphone e-diary three times each day for one month. Medication information was collected via parent report and checked for accuracy by chart review. Descriptive analyses were conducted to determine typical symptom intensity, frequency, and variability for the sample. Multilevel modeling was then used to analyze associations between symptoms and functional outcomes and between medication use and symptom intensity.
Results: Across 3258 completed e-diary entries, the average pain intensity rating was 26.3/100 (SD = 27.5), average stiffness intensity 24.4/100 (SD =25.2), and average fatigue intensity 42.7/100 (SD = 28.19). Children reported pain (>1/100) on 69% of e-diary entries. No children were entirely pain-free across the reporting period. Children endorsed high pain (> 40/100) on 31% of all e-diaries with 86% reporting high pain at least once in study period. The majority of children in this sample were prescribed DMARDS (chart review 79%, caregiver report 54%). Biologics were the next most commonly prescribed medication (chart review 47%, caregiver report 32%). Few children were taking opioids (chart review 1%, caregiver report 3%). Medication type did not reliably predict differences in symptom intensity. Momentary pain intensity (t(3040) = 19.76, p < .01), number of painful locations (t(3039) = 8.44, p < .01), and stiffness intensity (t(3038) = 2.60, p < .01) uniquely predicted functional limitations, but fatigue intensity did not (t(3037) = -1.71, p= .09).
Conclusion: Self-reported pain, stiffness, and fatigue continue to be common in children with JIA despite contemporary treatment advances including biologics. Prescribed medication class did not have a significant effect on reported symptoms. The findings are surprisingly consistent with previous results from paper daily diary research in the pre-biologic era. There remains a pressing ongoing need to optimize pain and symptom management in JIA.
Disclosure:
M. H. Bromberg,
None;
M. Connelly,
None;
K. K. Anthony,
None;
K. M. Gil,
None;
L. E. Schanberg,
None.
ACR Meeting Abstracts - https://acrabstracts.org/abstract/frequent-self-reported-pain-and-disease-symptoms-in-juvenile-idiopathic-arthritis-persist-despite-advances-in-medication-therapies-an-electronic-diary-study/