Background/Purpose: Pain trajectories vary in JIA, with some patients developing chronic pain over the course of their illness. Adaptation and recovery under stressful or traumatic conditions, defined as “psychological resilience,” correlates to symptom severity and functioning in other pediatric populations affected by chronic illness. Resilience can be enhanced by therapeutic interventions, making it a potential target for strategies to improve outcomes in disease management. However, psychological resilience has never been studied quantitatively in JIA. This study aimed to apply a validated measure to determine the resilience of children and adolescents with JIA and identify any relationships between pain and resilience in this population.

Methods: 98 children and adolescents with JIA participated in this study, completing the Connor-Davidson Resilience Scale (CD-RISC-25), the PROMIS Pediatric Pain Interference (PPI) Short Form, and the Pain and Symptom Assessment Tool (PSAT). Participants’ caregivers provided information regarding participant demographics and psychiatric health history and also completed the CD-RISC-25. Chart review documented participants’ case history and clinical status including JIA subtype, date of diagnosis, treatment, pain level, well-being, and active joint count during study participation. Spearman correlation coefficients were calculated to determine relationships between resilience scores and other variables, which were non-parametric. To compare resilience among subgroups of participants, Welch’s t-test was used.

Results: Participant resilience scores were normally distributed between 29 and 100 with a mean of 72.93 (sd = 15.96). Comparison of CD-RISC-25 scores to participant age at time of JIA diagnosis (ρ = -0.053, p = 0.60), time elapsed since JIA diagnosis (ρ = 0.10, p = 0.31), and caregiver CD-RISC-25 score (ρ = 0.089, p = 0.38) revealed no statistically significant relationships. Correlations were identified between CD-RISC-25 scores and participants’ reported numeric pain intensity rating (ρ = -0.23, p = 0.023), self-assessed well-being (ρ = -0.33, p < 0.001), and PPI (ρ = -0.48, p < 0.001). CD-RISC-25 scores were similar among participants with and without a reported history of depression or anxiety (t = -1.12, p = 0.27). However, for the 18% of participants with PSAT scores consistent with clinical features of juvenile FM (jFM), CD-RISC-25 scores were significantly lower than those seen in the remainder of the study population (t = -3.23, p = 0.0034).

Conclusion: Psychological resilience varied among study participants and was not found to correlate to age at JIA diagnosis, duration of disease, or caregiver resilience. There was no significant difference observed between levels of resilience among participants with and without a reported history of anxiety or depression. In view of the relationships observed between resilience and pain measures among study participants, the differences in resilience of participants with and without clinical features of jFM are compelling. Future research should focus on longitudinal observations to identify whether low psychological resilience may predict the development of secondary FM in JIA patients.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/surveying-psychological-resilience-and-pain-in-a-cross-section-of-jia-patients/