Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.


Daily Electronic Reports of Pain and Activity Difficulties in Children with JIA Versus Children with Other Rheumatic Diseases.

Connelly1,  Mark, Bromberg4,  Maggie H., Anthony3,  Kelly K., Franks2,  Lindsey, Gil4,  Karen M., Schanberg2,  Laura E.

Children's Mercy Hospital and Clinics, Kansas City, MO
Duke University Medical Center, Durham, NC
Duke Unviversity Medical Center, Durham, NC
University of North Carolina at Chapel Hill

Purpose:

To compare children with JIA vs juvenile rheumatic disease (JRD) across daily measures of pain and associated symptoms. The role of pain in predicting activity difficulty also was examined in both disease groups.

Method:

Children participated in a larger study to evaluate pain and functional limitations using electronic reports on handheld computers. Children with polyarticular JIA (26) and children with JRD (15), aged 8–18 yrs, were recruited from a pediatric rheumatology clinic. For 7 days, children completed morning, afternoon, and evening reports of pain characteristics (pain locations on a body map, pain duration on a 4-point scale ranging from "just a few minutes" to ">4 hours", pain intensity and unpleasantness on a visual analog scale [VAS]), fatigue (VAS), and difficulty in school, social, and physical activities (4-point scale ranging from "not at all difficult" to "extremely difficult"). A pediatric rheumatologist provided a diagnosis and disease severity score. Independent sample t-tests were used to evaluate differences in patients' average responses across all assessments between patients in both groups. Hierarchical linear modeling was used to evaluate whether activity difficulty increased at times of greater pain intensity, and whether this relationship differed in direction or magnitude as a function of diagnostic group.

Results:

Children were predominantly Caucasian (81% JIA, 73% JRD) and female (85% JIA, 67% JRD). Children with JIA on average reported significantly greater pain intensity (m=30.6 vs m=9.1, p <.05), pain unpleasantness (m=31.4 vs m=9.8, SD=20.6, p<.05), and pain duration (m=1.7 vs m=.7, SD=1.05, p<.05) than children with JRD. The JIA group experienced pain in more locations (m=.8 vs m=.3, p<.05), greater stiffness intensity (m=30.7 vs m=7.4, p<.05), and higher levels of fatigue (m=43.6 vs m=17.7, p<.05) across all days. Children with JIA on average reported comparably mild levels of activity difficulty relative to children with JRD (m=0.4 vs m=0.6, ns). However, results of hierarchical linear modeling suggested that activity difficulty increased reliably at moments of greater pain intensity for both groups with the magnitude of this relationship greater for children with JIA (t(240)=3.2, p<.01).

Conclusions:

Although children with JIA experience comparably mild difficulty in daily activity participation relative to children with JRD, pain appears to uniquely influence the extent of difficulty these children have participating in daily activities. Pain management should therefore be a focus of JIA treatment to enable children to participate as fully as possible in normative social, academic, and physical activities.

To cite this abstract, please use the following information:
Connelly, Mark, Bromberg, Maggie H., Anthony, Kelly K., Franks, Lindsey, Gil, Karen M., Schanberg, Laura E.; Daily Electronic Reports of Pain and Activity Difficulties in Children with JIA Versus Children with Other Rheumatic Diseases. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :2248
DOI: 10.1002/art.30011

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