Patterns of pain over time among children with juvenile idiopathic arthritis
Patterns of pain over time among children with juvenile idiopathic arthritis
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DOI：
10.1136/archdischild-2017-313337
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发表时间：
2018-05-01
影响因子：
5.2
通讯作者：
Thomson, Wendy
中科院分区：
文献类型：
--
作者：
Rashid, Amir;Cordingley, Lis;Thomson, Wendy
目的疼痛是青少年特发性关节炎（JIA）的常见症状。疾病活动本身不能解释所有儿童的疼痛症状，提示其他因素可能相关。本研究的目的是描述JIA患儿随着时间的推移所经历的不同疼痛模式，并确定哪些儿童可能经历持续疼痛的预测因素。方法本研究采用1-16岁新发JIA患者的纵向资料。基线和长达5年的随访疼痛数据来自儿童关节炎前瞻性研究（CAPS）。采取了两步走的办法。首先，使用离散混合模型对疼痛轨迹进行建模。其次，使用多项逻辑回归来确定变量与轨迹之间的关联。结果851人的数据被纳入（4年，中位随访）。确定了三组轨迹模型：持续低疼痛（n=453），改善疼痛（n=254）和持续高疼痛（n=144）。疼痛改善或持续强烈疼痛的儿童与持续轻微疼痛的基线平均值不同。与持续的低疼痛相比，发病年龄较大、功能差/残疾和基线时疾病持续时间较长与持续的高疼痛相关。与持续的低疼痛相比，早期疼痛的增加和功能低下/残疾也与持续的高疼痛有关。结论：本研究确定了常规收集的临床因素，这些因素可能表明JIA患者在疾病早期有不良疼痛结局的风险。确定疾病发病时疼痛预后不良风险最高的人群，可使有针对性的疼痛管理策略在疾病早期得到实施，从而降低疼痛预后不良的风险。
Objectives Pain 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.Methods This 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.Results Data 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.Conclusions This 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.