P030 Impact of methotrexate on growth in children with Juvenile Idiopathic Arthritis

Rheumatology ◽  
2021 ◽  
Vol 60 (Supplement_5) ◽  
Author(s):  
A Fazaa ◽  
F Rouatbi ◽  
S Miladi ◽  
K Ouenniche ◽  
L Souabni ◽  
...  
Keyword(s):  
Growth Rate ◽  
Juvenile Idiopathic Arthritis ◽  
Growth Velocity ◽  
Disease Duration ◽  
Growth Parameters ◽  
Standard Deviation Score ◽  
Disease Onset ◽  
Lower Growth ◽  
Systemic Jia

Abstract Background Juvenile idiopathic arthritis (JIA) is a heterogeneous group of chronic inflammatory disease which could be responsible for functional impairment and severe growth disturbance. Conventional disease-modifying antirheumatic drugs, such as methotrexate (MTX), may improve growth velocity especially by regulating systemic inflammation. The objective of this study was to evaluate the effect of MTX on growth parameters in pre-pubertal children with JIA and to determine the factors affecting the growth velocity. Methods We assessed height and changes in the height standard deviation score (SDS) at disease onset, at the onset of MTX and at the last follow-up visit in a cross-sectional study of JIA children. All patients were pre-pubertal when MTX began and were followed for at least 6 months afterward. We compared growth parameters (height, growth rate, weight and body mass index (BMI)) in responders and non-responders to MTX. The growth rate was defined as the number of millimeters of height acquired during 1 year. Associations between changes in the height SDS and discrete variables were evaluated using χ2 or Fisher’s exact tests. The significance level was set at 0.05. Results We enrolled 36 pre-pubertal children with JIA (34 boys and 12 girls) who had been treated with MTX orally. Median patient age was 6.2 years [4–13] at the onset of MTX and 8.4 years [6.1–14.9] at the latest follow-up. The median disease duration was 2.7 years [2.5–5.3]. Twenty-one patients (58.3%) had oligoarticular JIA, 2 patients (5.5%) had systemic JIA, 10 (27.7%) had polyarticular JIA and 3 (8.3%) had enthesitis-related arthritis. Nineteen children (52.7%) had received corticosteroids during an average period of 1.7 years [0.6–3] with a mean of 10 mg/day of prednisone or equivalent. The median duration of MTX at the latest follow-up was 3.1 years [0.62–5.5] with a mean MTX dose of 10 mg/m2/week [10–15]. Twenty-eight patients responded to MTX treatment and 8 did not. There were no significant differences between the responders and non-responders for age at treatment initiation, disease duration and mean MTX dose. At MTX onset, no significant differences between the two groups in terms of height (P = 0.52), growth rate (P = 0.08), weight (P = 0.74) and BMI (P = 0.9) were found. One year after MTX therapy, mean height (0.2 vs -1.1; P = 0.03), mean growth rate (0.5 vs –2.9 SDS; P = 0.01), mean weight (0.4 vs -2.3 SDS; P = 0.01) and mean BMI (0.6 vs -1.9; P = 0.04) were significantly higher in the responder group than in non responders, respectively. At the latest follow-up, this increase was significantly maintained for growth rate (P = 0.001) and height (P = 0.002) in the responder group. In the multivariate analysis, patients who required >10 mg/m2/week of MTX, systemic JIA and patients with reliance on steroids had a significantly lower growth velocity after the onset of MTX (P < 001, P = 0.02, P = 0.02 respectively). Conclusion In our study, the increase in growth parameters in pre-pubertal children with JIA was associated with a better control of the disease activity under MTX therapy.

scholarly journals Effect of Biologic Treatments on Growth in Children with Juvenile Idiopathic Arthritis

2013 ◽  
Vol 41 (1) ◽  
pp. 128-135 ◽  
Author(s):  
Florence Uettwiller ◽  
Julie Perlbarg ◽  
Graziella Pinto ◽  
Brigitte Bader-Meunier ◽  
Richard Mouy ◽  
...  
Keyword(s):  
Juvenile Idiopathic Arthritis ◽  
Growth Velocity ◽  
Biologic Therapy ◽  
Disease Onset ◽  
Normal Growth ◽  
Hormone Treatment ◽  
Biologic Agent ◽  
Biologic Treatment ◽  
Lower Growth ◽  
Systemic Jia

Objective.Growth retardation is a frequent complication of severe juvenile idiopathic arthritis (JIA). Biologic treatments may improve growth velocity by controlling systemic inflammation and reducing corticosteroids. Our goals were to compare growth velocity before and after the onset of biologic therapy and to determine whether the JIA subtype, the use of steroids, the requirement of one or several biologic agents, or the disease activity influenced growth velocity.Methods.We retrospectively analyzed the growth of children with JIA who never received growth hormone treatment, who started biologic treatment before puberty, and who were followed for at least 6 months afterward.Results.We included 100 children (33 boys). Median patient age was 7.1 years (range: 1.6–15.7) at the onset of biologic treatment and 11.0 years (range: 2.3–19.5) at the latest followup. Forty-six patients had received corticosteroid and 34 had received more than 1 biologic agent. Patient median height expressed as SD score (SDS) was 0.31 (range: −2.47 to 5.46) at disease onset, −0.24 (−3.63 to 2.90) at biologic therapy onset (p < 0.0001), and −0.15 (−4.95 to 3.52) at the latest followup (p = 0.171 compared to biologic treatment onset). Patients who required several biologics and systemic patients had a significantly lower growth velocity after the onset of biologic treatment. At the latest followup, 18% of our study group had low growth velocities and 19% were below −2SD or shorter than genetically programmed.Conclusion.In a subset of patients, particularly systemic JIA patients and patients who required more than 1 biologic, biologic therapy may be insufficient to restore normal growth velocity.

scholarly journals SAT0495 LONG TERM OUTCOME OF JUVENILE IDIOPATHIC ARTHRITIS IN ADULTHOOD; THE MONOCENTRIC EXPERIENCE OF 520 PATIENTS FOLLOWED FOR 20 YEARS IN A TRANSITION TERTIARY CLINIC OF PEDIATRIC RHEUMATOLOGY.

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1204.2-1204
Author(s):  
I. Pontikaki ◽  
S. Carbogno ◽  
F. Corona ◽  
A. Petaccia ◽  
R. Cimaz
Keyword(s):  
Juvenile Idiopathic Arthritis ◽  
Educational Level ◽  
Disease Duration ◽  
Age At Onset ◽  
Disease Onset ◽  
Clinical Manifestations ◽  
Term Outcome ◽  
Long Term Outcome

Background:Juvenile Idiopathic Arthritis (JIA) is a chronic pediatric inflammatory disease that shows many differences compared to adult-onset arthritis. The different clinical manifestations, the assessment and the management of JIA is the reason that the transition from childhood to adulthood is an important multidimensional process that emphasizes a lot of aspects.Objectives:To describe the long-term outcome of JIA.Methods:Five-hundred and twenty patients affected by JIA and referred to a transition care rheumatology tertiary centre were considered between 1999 and 2019. The outcome assessment included remission, disease duration, medications, number of prosthesis implantation, pregnancies, mortality and social integration (employment status and educational level).Results:A hundred and thirty-eight (26%) males and 382 (73%) females were included; 157 (30%) patients were lost to follow up. The mean age of the patients was 27 (18-57) years, with a mean age at onset of 8 years and an average disease duration of 19 years. Subtypes of JIA at disease onset included 252 (48%) oligoarthritis, 134 (26%) polyarthritis, 64 (12%) systemic arthritis, 22 (4%) psoriatic arthritis, 43 (8%) enthesitis related arthritis and 1 (0.1%) undifferentiated arthritis. Ninty-three (18%) patients suffered of uveitis. Ninty-five implant prosthesis and 16 arthrodesis were recorded. At follow up 198 (38%) patients were on remission of which 107 (20%) off medication. Among the 322 patients still on medication, 84 (16%) were under treatment with oral steroids, 226 (43%) with sDMARDs and 249 (40%) with bDMARDs. Five deaths (1%) occurred in this cohort. Two hundred and thirty-five subjects had a higher educational level, 327 had an employment. We have data of twenty-nine pregnancies. The transition age was considered after the age of 16 years old. The key word for the management of this cohort was the multidisciplinary approach towards each patient, with the collaboration of other specialists (ophthalmologist, orthopedic, dermatologist, gastroenterologist, obstetric and psychologist).Conclusion:In the era of biologic therapy the long-term outcome of JIA underwent an outstanding improvement regarding a lot of variables. Two hundred and thirty-two patients were still followed, not only because of the continuation of the biological therapy, but also for a multidisciplinary care even during remission. JIA often persists over the adulthood, therefore the long term follow-up and care of these patients needs to be conducted by a rheumatologist expertized in JIA in collaboration with other specialists.Disclosure of Interests:None declared

scholarly journals Comparing Five Year Out-Come in Two Cohorts of Patients with Early Rheumatoid Arthritis – A BARFOT Study

2015 ◽  
Vol 9 (1) ◽  
pp. 8-15 ◽  
Author(s):  
Maria L.E Andersson ◽  
Kristina Forslind ◽  
Ingiäld Hafström
Keyword(s):  
Prospective Observational Study ◽  
Disease Activity Score ◽  
Disease Duration ◽  
Disease Onset ◽  
Health Assessment ◽  
Disease Characteristics ◽  
Group 2 ◽  
Assessment Questionnaire ◽  
Group 1

The objective of the study was to compare disease characteristics over the first 5 years of disease in patients with RA, with disease onset in 1990s and 2000s, respectively. Methods : All 2235 patients with early RA (disease duration ≤12 months) were recruited from the BARFOT prospective observational study. These patients were divided into group 1 included 1992 to 1999 (N=1084, 66% women) and group 2 included 2000 to 2006 (N=1151, 69% women). Disease Activity Score (DAS28), VAS pain and Health Assessment Questionnaire (HAQ) were assessed during 5 years. Remission was defined as DAS28 <2.6. Results : At inclusion, both women and men in group 2 had higher mean DAS28 (SD) than group 1, 5.42 (1.22) vs 5.26 (1.19), p=0.004 and 5.28 (1.22) vs 5.00 (1.27), p=0.004, respectively, mainly dependant on pain and not on inflammatory related measures. Over time DAS28 decreased and was in both genders, from 6 months to the 5-year follow-up, significantly lower in group 2. At 5-year, both women and men in group 2 had higher rate of remission than women and men in group 1. However, despite reduction of VAS pain and HAQ there were no differences in pain and HAQ between groups at any time point. Conclusion : Patients included in the 2000s achieved higher frequency of remission at the 5 year follow-up compared with those included in the 1990s, suggested to reflect the more active medical treatment. Interestingly, however, improvement in pain and HAQ did not differ between the two patient cohorts.

scholarly journals P1826ASSESSMENT OF GROWTH PARAMETERS OF CHILDREN IN LONG TERM FOLLOW UP WITH DIFFERENT RELAPSING COURSE OF NEPHROTIC SYNDROME

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Sonia Sharma
Keyword(s):  
Nephrotic Syndrome ◽  
Growth Parameters ◽  
Tertiary Care ◽  
Age At Onset ◽  
Standard Deviation Score ◽  
Pediatric Nephrology ◽  
Group 2 ◽  
Nephrotic Children

Abstract Background and Aims Childhood Nephrotic syndrome has its peak onset in the age group 2-4 years, and that is also a period of significant height growth. Corticosteroids and chronic diseases are known to have long term effects on growth parameters of these children. Hence we assessed and compared the growth of children with Infrequent relapsing (IFRNS) and remission (R) as group 1, Frequent -relapsing (FR), and steroid - dependent (SD) as group 2 and steroid -resistant (SR) as group 3. Method This retrospective single center study collected data from medical records of children presented in a pediatric nephrology clinic in a tertiary care center in New Delhi. Nephrotic children, aged 1-18 years with regular follow up in the period of 2014 to 2019 were included. Basic demographic details including age at onset and age at last follow up in clinic, sex, anthropometry details at last follow up were recorded. We traced initial height at nephrotic syndrome onset to assess growth velocity but were unavailable at the moment so excluded from analysis. Also, children completed less than 1 year follow up, and compliance issues were excluded. Z scores (standard deviation score) for weight, height and BMI were calculated. Initial comparison of three groups as FR/SDNS, IFRNS/R and SRNS was done. But in the second comparison, we combined FR/SD and SR children in one group as Difficult nephrotic syndrome (DNS) group. Anova Kruskal-Wallis test was used to find significance in three groups in table 1. Subsequent analysis was done by the non-parametric statistic method Mann-Whitney Test to assess significance in subgroups of boys and girls. Results: 27 IFR/R nephrotic children, 36 FR/SD, and 15 SRNS were compared as in Table1. D-NS and IFRNS-R for boys and girls ratio (11; 16) & (18; 32) followed for a median period of 18 (max 46; 12), 24.6 (57.6; 12), and 32 (50;12) months respectively. Conclusion Linear growth (height) is the most affected parameters in children in SRNS and FR/SD nephrotic syndrome. Effect is more significant in girls then in boys as they showed improvement in . No difference in weight and BMI is seen on applied statistics in two groups.

scholarly journals Outcome in juvenile idiopathic arthritis: a population-based study from Sweden

2019 ◽  
Vol 21 (1) ◽  
Author(s):  
Elisabet Berthold ◽  
Bengt Månsson ◽  
Robin Kahn
Keyword(s):  
Juvenile Idiopathic Arthritis ◽  
Disease Activity ◽  
Orthopedic Surgery ◽  
Population Based ◽  
Annual Incidence ◽  
Common Disease ◽  
Necrosis Factor Alpha ◽  
Systemic Jia ◽  
Record Review

Abstract Background As the treatment arsenal for children with juvenile idiopathic arthritis (JIA) has expanded during the last decades, follow-up studies are needed on children diagnosed in the era of biological treatment to evaluate if this has improved the outcome. Our aim was to study the epidemiology and outcome of JIA in southern Sweden using a population-based cohort of children with a validated diagnosis of JIA collected over 9 years. Methods Potential cases of JIA between 2002 and 2010 were collected after a database search, using the ICD codes M08-M09. The study area was Skåne, the southernmost county of Sweden (population 1.24 million; 17.6% aged < 16 years). The JIA diagnosis was validated and subcategorized through medical record review based on the criteria defined by the International League of Associations for Rheumatism (ILAR). Parameters on disease activity and pharmacologic treatment were recorded annually until the end of the study period (December 31, 2015). Results In total, 251 cases of JIA were confirmed. The mean annual incidence rate for JIA was estimated to be 12.8/100,000 children < 16 years, with the highest age-specific annual incidence at the age of 2 years (36/100,000). Oligoarthritis was the largest subgroup (44.7%), and systemic JIA was the smallest subgroup (2.8%). Methotrexate was the most common disease-modifying anti-rheumatic drug prescribed (60.6%). Tumor necrosis factor alpha inhibitors were used as treatment for 23.9% of the children. Only 40.0% of the follow-up years, with a median follow-up time of 8 years, were free of arthritis or uveitis. Uveitis occurred in 10.8% of the children (8.0% chronic uveitis), and the need for joint corrective orthopedic surgery was 9.2%. Conclusions The incidence of JIA in this well-defined, population-based cohort is slightly lower than in previously published studies from Scandinavia. The need for orthopedic surgery and the presence of uveitis are diminished compared to studies with patients diagnosed more than 20 years ago. Children with JIA however still experience disease activity more than 50% of the time. In conclusion, we still have long-term challenges in the care for children with JIA, in spite of state-of-the-art treatment.

Predictors of Hip Disease in the Systemic Arthritis Subtype of Juvenile Idiopathic Arthritis

2011 ◽  
Vol 38 (5) ◽  
pp. 954-958 ◽  
Author(s):  
MICHELLE BATTHISH ◽  
BRIAN M. FELDMAN ◽  
PAUL S. BABYN ◽  
PASCAL N. TYRRELL ◽  
RAYFEL SCHNEIDER
Keyword(s):  
Juvenile Idiopathic Arthritis ◽  
Median Time ◽  
Joint Destruction ◽  
Disease Onset ◽  
Systemic Jia ◽  
Kaplan Meier ◽  
Hip Disease ◽  
The Mean ◽  
Censored Observations ◽  
Aggressive Interventions

Objective.Hip involvement occurs in 20%–40% of all cases of juvenile idiopathic arthritis (JIA). Patients with systemic JIA (sJIA) are affected most frequently. The aim of our study was to investigate the predictors of clinical hip disease and radiographic hip damage in sJIA.Methods.The medical records (1997–2007) of all children (n = 98) with sJIA were reviewed. Potential clinical and laboratory predictors were examined at presentation and at 3 and 6 months. To account for censored observations, we used survival analysis.Results.During the study period, 59 children met our inclusion criteria. The mean age at diagnosis was 7.8 years. Thirty patients (51%) developed clinical hip disease, with 12 (20%) developing radiographic evidence of hip damage. The median time to develop clinical hip disease was 24 months. Using Kaplan-Meier estimates, 25% of patients develop radiographically evident hip damage within 43 months. At presentation, patients in whom clinical hip disease later developed had polyarthritis (hazard ratio 2.51, p = 0.01), elevated IgG (HR 1.12, p = 0.01) and IgM (HR 2.71, p = 0.02), and higher CHAQ scores (HR 1.65, p = 0.02). At 3 months after disease onset, patients in whom radiographic hip damage later developed had fever (HR 4.78, p = 0.02), polyarthritis (HR 4.63, p = 0.02), and higher CHAQ scores (HR 3.20, p = 0.005). At 6 months, polyarthritis was the strongest predictor of both clinical hip disease and radiographic hip damage.Conclusion.Half of patients with sJIA develop clinical hip disease a median time of 24 months from diagnosis. Early identification of predictors of hip disease and damage in patients with sJIA may suggest earlier, more aggressive interventions to prevent joint destruction.

scholarly journals Long-term follow-up on effectiveness and safety of etanercept in juvenile idiopathic arthritis: the Dutch national register

2008 ◽  
Vol 68 (5) ◽  
pp. 635-641 ◽  
Author(s):  
F H M Prince ◽  
M Twilt ◽  
R ten Cate ◽  
M A J van Rossum ◽  
W Armbrust ◽  
...  
Keyword(s):  
Juvenile Idiopathic Arthritis ◽  
Adverse Events ◽  
Rheumatoid Factor ◽  
Serious Adverse Events ◽  
American College Of Rheumatology ◽  
Systemic Jia ◽  
Long Term Follow Up ◽  
Remission Criteria

Objective:We undertook an observational study to obtain a complete overview of the long-term effectiveness and safety of etanercept in patients with different juvenile idiopathic arthritis (JIA) subtypes.Methods:At baseline we collected patient and disease characteristics of all Dutch patients with JIA who started treatment with etanercept. Disease activity was evaluated (at start of the study, after 3 months and then yearly) according to the JIA core set of the American College of Rheumatology paediatric definition for 30, 50 and 70% improvement (ACR Pedi 30, 50 and 70). Use of etanercept and concomitant drugs was monitored. Adverse events were recorded.Results:We included 146 patients with JIA with a median follow-up of 2.5 years per patient (range 0.3–7.3). JIA subtypes represented: 27% systemic, 8% polyarticular rheumatoid factor positive, 38% polyarticular rheumatoid factor negative, 19% oligoarticular extended, 3% enthesitis-related and 5% psoriatica. Most patients (77%) met the criteria of the ACR Pedi 30 in the first 3 months of treatment. For the majority of patients this improvement was sustained; 53 (36%) of all patients met the remission criteria. No other second-line agents were needed in 43 patients. Although patients with systemic JIA responded initially less to etanercept therapy than patients from other subtypes, those who did respond showed equal effectiveness in the long term. Serious adverse events rate was low (0.029 per patient year).Conclusions:Etanercept is effective and safe in JIA, even for a large proportion of the patients with systemic JIA. The greatest improvement occurred in the first 3 months of treatment, and was sustained for a long time in most patients (up to 75 months).

scholarly journals Growth patterns of patients with Noonan syndrome: correlation with age and genotype

2016 ◽  
Vol 174 (5) ◽  
pp. 641-650 ◽  
Author(s):  
Catie Cessans ◽  
Virginie Ehlinger ◽  
Catherine Arnaud ◽  
Armelle Yart ◽  
Yline Capri ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Noonan Syndrome ◽  
Growth Parameters ◽  
Standard Deviation Score ◽  
Growth Patterns ◽  
Healthy Population ◽  
Length Standard ◽  
Study Population ◽  
Multiple Lentigines

Background Growth patterns of patients with Noonan syndrome (NS) were established before the involved genes were identified. Objective The goal of this study was to compare growth parameters according to genotype in patients with NS. Subjects and methods The study population included 420 patients (176 females and 244 males) harboring mutations in the PTPN11, SOS1, RAF1, or KRAS genes. NS-associated PTPN11 mutations (NS-PTPN11) and NS with multiple lentigines-associated PTPN11 mutations (NSML-PTPN11) were distinguished. Birth measures and height and body mass index (BMI) measures at 2, 5, 10 years, and adulthood were compared with the general population and between genotypes. Results Patients with NS were shorter at birth (mean birth length standard deviation score (SDS): –1.0 ± 1.4; P < 0.001) and throughout childhood than the healthy population, with height SDS being –2.1 ± 1.3 at 2 years, and –2.1 ± 1.2 at 5 and 10 years and adulthood (P < 0.001). At birth, patients with NS-PTPN11 were significantly shorter and thinner than patients with NSML-PTPN11, SOS1, or KRAS. Growth retardation was significantly less severe and less frequent at 2 years in patients with NSML-PTPN11 and SOS1 than in patients with NS-PTPN11 (P < 0.001 and P = 0.002 respectively). Patients with NS had lower BMI at 10 years (P < 0.001). No difference between genotypes was demonstrated. Conclusion Determining the growth patterns of patients with NS according to genotype should better inform clinicians about the natural course of growth in NS so that they can optimize the follow-up and management of these patients.

scholarly journals Efficacy and Safety of Thalidomide as Adjunct Therapy in Refractory Systemic Juvenile Idiopathic Arthritis Patients

2017 ◽  
Vol 42 (1) ◽  
pp. 49-52
Author(s):  
Mohammed Mahbubul Islam ◽  
Mohammad Imnul Islam ◽  
Manik Kumar Talukdar ◽  
Mujammel Haque ◽  
Shahana A Rahman
Keyword(s):  
Juvenile Idiopathic Arthritis ◽  
Systemic Juvenile Idiopathic Arthritis ◽  
Permanent Disability ◽  
Systemic Jia ◽  
Conventional Dmards ◽  
Active Arthritis ◽  
Transient Elevation ◽  
Thalidomide Treatment ◽  
Systemic Onset

About 50% of systemic onset juvenile idiopathic arthritis (sJIA) patients run a recalcitrant disease course and resistant to the conventional disease modifying anti inflammatoy drugs (DMARDs), ultimately resulting in permanent disability from joint destructions. Thalidomide has been reported as an effective and safe drug in the management of systemic JIA due to its immunomodulatory properties. This was an interventional study, aimed to evaluate the efficacy of thalidomide in refractory JIA patients. Twenty five systemic JIA patients who were refractory to conventional DMARDs were included in this study. These patients were prescribed thalidomide at a dose of 2-3mg/kg/day for 12 months. Efficacy of thalidomide was assessed by using Wallace criteria at 6th month and 12th month of thalidomide treatment. Active arthritis was improved in 55% and 73% of the patients at 6th and 12th month of thalidomide treatment respectively. Fever and rash subsided in 72.8% and 81.2% of patients respectively at 12th month of follow up. Hepatosplenomegaly and lymphadenopathy regressed in 100% of patients at 12th month follow up. ESR was also improved in 50% and 68.2% cases at 6th and 12th months respectively. Few minor side effects were observed like transient elevation of liver enzyme and somnolence in this study. It may be concluded that thalidomide is safe and effective in refractory JIA patients.

scholarly journals Patterns of pain over time among children with juvenile idiopathic arthritis

2017 ◽  
Vol 103 (5) ◽  
pp. 437-443 ◽  
Author(s):  
Amir Rashid ◽  
Lis Cordingley ◽  
Roberto Carrasco ◽  
Helen E Foster ◽  
Eileen M Baildam ◽  
...  
Keyword(s):  
Juvenile Idiopathic Arthritis ◽  
Multinomial Logistic Regression ◽  
Age At Onset ◽  
Management Strategies ◽  
Disease Onset ◽  
Common Symptom ◽  
Pain Outcomes ◽  
First Pain ◽  
Over Time

ObjectivesPain is a very common symptom of juvenile idiopathic arthritis (JIA). Disease activity alone cannot explain symptoms of pain in all children, suggesting other factors may be relevant. The objectives of this study were to describe the different patterns of pain experienced over time in children with JIA and to identify predictors of which children are likely to experience ongoing pain.MethodsThis study used longitudinal-data from patients (aged 1–16 years) with new-onset JIA. Baseline and up to 5-year follow-up pain data from the Childhood Arthritis Prospective Study (CAPS) were used. A two-step approach was adopted. First, pain trajectories were modelled using a discrete mixture model. Second, multinomial logistic regression was used to determine the association between variables and trajectories.ResultsData from 851 individuals were included (4 years, median follow-up). A three-group trajectory model was identified: consistently low pain (n=453), improved pain (n=254) and consistently high pain (n=144). Children with improved pain or consistently high pain differed on average at baseline from consistently low pain. Older age at onset, poor function/disability and longer disease duration at baseline were associated with consistently high pain compared with consistently low pain. Early increases in pain and poor function/disability were also associated with consistently high pain compared with consistently low pain.ConclusionsThis study has identified routinely collected clinical factors, which may indicate those individuals with JIA at risk of poor pain outcomes earlier in disease. Identifying those at highest risk of poor pain outcomes at disease onset may enable targeted pain management strategies to be implemented early in disease thus reducing the risk of poor pain outcomes.

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