Background/Purpose: Injectable medications are frequently used to treat Juvenile Idiopathic Arthritis (JIA).  Fear of pain and needle fear have been identified as barriers to injectable medication adherence.  High levels of injection fear have correlated with worse disease outcomes in other chronic diseases such as type 1 diabetes.  The purpose of this study was to evaluate the prevalence of injection fear in a population of JIA patients using injectable medicines. 

Methods: Inclusion criteria included a diagnosis of Juvenile Idiopathic Arthritis based on ILAR criteria and treatment with an injectable JIA medication.  Patients and parents completed questionnaires on injection fear, medication adherence, anxiety, depression, and arthritis disease activity.  Data about JIA disease characteristics and details about the patient’s injectable medicine were also collected.  Injection fear was measured using the injection section of the Diabetes Fear of Injecting and Self-Testing Questionnaire (D-FISQ).  Patients age 10-22 completed the self-report D-FISQ, and parents completed the D-FISQ as proxy reporters for patients ages 5-17.  The D-FISQ is a 15-item survey about emotions and physical symptoms at time of an injection.  Each item has 4 possible answer choices with a corresponding numerical score (almost never 0, sometimes 1, often 2, almost all the time 3).  The D-FISQ score is the sum of all items with scores ranging 0 to 45.  Previous work has defined a D-FISQ score ≥6 to indicate injection fear with higher scores indicating greater levels of injection fear. The prevalence of injection fear was determined by calculating the number of patients with D-FISQ score ≥6 divided by the total number of patients surveyed. A similar calculation was made for D-FISQ scores obtained by parent report.   

Results: Seventy-three JIA patients ages 5-22 and 58 parents from a pediatric rheumatology clinic were enrolled.  The patients were 71% female and 63% white. The age range of the enrolled patients was 6-22 with mean age 14.77 (SD 3.98).  JIA patient D-FISQ scores ranged from 0 to 41 with median of 11 (IQR 17). Parents proxy report on D-FISQ showed similar scores to patient report with range 0-43 and median 10 (IQR 21.75). The patient report D-FISQ classified 47 patients as having injection fear with a prevalence of injection fear in this cohort as 64.38% by patient report.  Parent proxy D-FISQ identified 37 patients with injection fear with injection fear prevalence of 63.79% by parent report.

Conclusion: This study found that approximately 64% of patients with JIA using injectable medications have injection fear.  The prevalence of injection fear in JIA patients as determined by the D-FISQ is higher than previously reported rates of injection fear in pediatric patients with type 1 diabetes (23% in one study, 37% in another).  The high rate of injection fear in JIA patients highlights the importance of future research to better understand the association between injection fear and outcome measurements.  

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/injection-fear-in-juvenile-idiopathic-arthritis-patients-using-injectable-medications/