Background/Purpose: Chronic musculoskeletal pain was described to be a frequent complaint in children and adolescents with assumed relevant impairment of health-related quality of life (HRQoL) as crucial indicator of individual disease burden. Since only a few epidemiological data are available, we investigated the course of single dimensions of patient-assessed HRQoL in children and adolescents with either chronic idiopathic musculoskeletal pain (CIMP) or juvenile idiopathic arthritis (JIA) as two entities of chronic musculoskeletal pain.

Methods: The national pediatric database is an ongoing nationwide prospective observation study on health care of patients with rheumatic-inflammatory or other musculoskeletal diseases referring to pediatric rheumatology departments in Germany. Patients diagnosed with CIMP or JIA enrolled between 2000 and 2008 with a minimal observation period of two years were included in the present analyses. They evaluated annually single generic dimensions of HRQoL on numeric rating scales (NRS, 0-10, 0 best): pain severity, physical capability, limitation in daily life activities, and capability of disease coping. The method of linear multi-level analysis was used to predict two-year courses of these patient-reported outcome measures. Each statistical model was adjusted for sex, age at disease onset, disease duration, calendar year of documentation, and medical care level of recruiting departments (private practice, general children´s hospital, university children´s hospital).

Results: Data of 318 CIMP patients (70% females, age (mean ± sd) 12.0±3.8 years, disease duration 2.4±2.6 years) and 6,103 JIA patients (65% females, age 9.5±4.5 years, disease duration 2.7±3.1 years) were included. At baseline (t₀), CIMP patients assessed all single generic dimensions of HRQoL with poorer scores than JIA patients: pain severity by plus 1.5 NSR points, limitation in daily life activities by plus 0.9, physical capability and disease coping by plus 0.5 NSR points each, and global health state by plus 0.7 NSR points. Compared to t₀, values of single HRQoL dimensions decreased only in JIA up to one (t₁) und two years (t₂) of follow-up, but not in CIMP patients (t₁ versus t₀ p<0.001; t₂ versus t₀ p<0.001). CIMP patients evaluated single generic dimensions of HRQoL persistently worse than JIA patients; this group difference increased for all scales between t₀ and t₂(p<0.05).

Conclusion: Consistently poorer estimates of all investigated measures of HRQoL in children and adolescents with CIMP over the two-year observation period, compared to children with JIA, are first hints for a relevant and long-term burden of disease in these patients. These results may implicate the need for improving medical care conditions for these patients in Germany in order to avoid a possible long-lasting disease career beyond childhood and adolescence.

Support: The national pediatric database is financially supported by the Children´s Arthritis Foundation (Kinder-Rheumastiftung).

ACR Meeting Abstracts - https://acrabstracts.org/abstract/individual-disease-burden-in-children-and-adolescents-with-chronic-musculoskeletal-pain-multilevel-analysis-of-a-nationwide-prospective-longitudinal-observation-study/