Early Self-Reported Pain in Juvenile Idiopathic Arthritis as Related to Long-Term Outcomes: Results From the Nordic Juvenile Idiopathic Arthritis Cohort Study
Early Self-Reported Pain in Juvenile Idiopathic Arthritis as Related to Long-Term Outcomes: Results From the Nordic Juvenile Idiopathic Arthritis Cohort Study
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DOI：
10.1002/acr.23715
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发表时间：
2019-07-01
影响因子：
4.7
通讯作者：
Pelkonen, Pirkko
中科院分区：
文献类型：
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作者：
Arnstad, Ellen Dalen;Rypdal, Veronika;Pelkonen, Pirkko
目的研究幼年特发性关节炎（JIA）病程早期自述疼痛对其远期预后的预测作用。方法从挪威、瑞典、芬兰和丹麦的特定地理区域前瞻性地纳入1997 - 2000年连续发病的JIA病例。自我报告的疾病相关疼痛以10厘米视觉模拟量表（VAS疼痛）测量。纳入标准是疾病发病后6个月的疼痛评分基线访问，随后是8年的研究访问。根据Wallace et al（2004）的初步标准定义缓解。18岁儿童采用《儿童健康评估问卷》和《儿童健康问卷家长表》对功能障碍进行测量。使用青少年关节炎损伤指数对损伤进行评分。结果最终的研究队列包括243名参与者，其中120名参与者（49%）患有少关节发病。基线时，76%的患者报告VAS疼痛评分为bb100，而8年时报告的为57%。报告基线疼痛的患者中有一半在8年后也报告了疼痛，但强度较低。与无疼痛相比，基线时疼痛强度越高，8年后疼痛越多，功能残疾越多，损伤越多，不服药缓解越少。基线疼痛预示着在疾病过程中更多地使用改善疾病的抗风湿药物/生物制剂。基线时报告疼痛的少关节性JIA患者更有可能发展为延伸性少关节性JIA或其他预后不良的JIA类别。结论：早期自我报告的疾病相关疼痛在JIA儿童和青少年中很常见，似乎预示着持续疼痛和不利的长期疾病结局。
Objective To study self-reported pain early in the disease course of juvenile idiopathic arthritis (JIA) as a predictor of long-term disease outcomes. Methods Consecutive cases of JIA with disease onset from 1997 to 2000 from defined geographical areas of Norway, Sweden, Finland, and Denmark were prospectively enrolled in this population-based cohort study. Self-reported, disease-related pain was measured on a 10-cm visual analog scale (VAS pain). Inclusion criteria were a baseline visit with a pain score 6 months after disease onset, followed by an 8-year study visit. Remission was defined according to Wallace et al (2004) preliminary criteria. Functional disability was measured by the Childhood Health Assessment Questionnaire and the Child Health Questionnaire Parent Form if the child was age = 18 years. Damage was scored using the Juvenile Arthritis Damage Index. Results The final study cohort consisted of 243 participants, and 120 participants (49%) had oligoarticular onset. At baseline, 76% reported a VAS pain score >0 compared to 57% reporting at 8 years. Half of those who reported baseline pain also reported pain at 8 years but at a lower intensity. Compared to no pain, higher pain intensity at baseline predicted more pain at 8 years, more functional disability, more damage, and less remission without medication. Baseline pain predicted more use of disease-modifying antirheumatic drugs/biologics during the disease course. Participants with oligoarticular JIA reporting pain at baseline were more likely to develop extended oligoarticular JIA or other JIA categories with an unfavorable prognosis. Conclusion Early self-reported, disease-related pain among children and adolescents with JIA is common and seems to predict persistent pain and unfavorable long-term disease outcomes.