Daily pain and symptoms in children with polyarticular arthritis.
OBJECTIVE
To analyze patterns of daily pain, stiffness, and fatigue related to juvenile arthritis; to examine the relationships of demographics, disease severity, and psychological adjustment to daily disease symptoms; and to examine daily disease symptoms as predictors of reduced participation in school and social activity.


METHODS
For a 2-month period, 41 children with polyarticular juvenile arthritis completed daily diaries that included measures of symptoms and function. Children also underwent an initial evaluation and 4 followup evaluations that included a joint count, laboratory testing, and completion of questionnaires assessing physical and psychosocial functioning.


RESULTS
Children reported having pain an average of 73% of days, with the majority of children (76%) reporting pain on >60% of all days. On average, children described the intensity of their daily pain as being in the mild to moderate range; however, a significant subgroup (31%) reported pain in the severe range. Higher physician global assessment ratings, increased functional disability, and increased anxiety were significantly associated with increased daily pain and other daily symptoms. Multilevel random-effects analyses indicated that increased daily symptoms of pain, stiffness, and fatigue were significant predictors of reduced participation in school and social activities.


CONCLUSIONS
Physicians should consider treating pain more aggressively in children with arthritis, in order to preserve function in school and social domains, as well as physical function. Moreover, optimal pain management in children with arthritis should include therapeutic regimens addressing anxiety as well as standard pharmacologic interventions.
Division of Rheumatology, Duke University Medical Center, Durham, North Carolina 27710, USA. schan001@mc.duke.edu
Laura E
LE
Schanberg
Kelly K
KK
Anthony
Karen M
KM
Gil
Elana C
EC
Maurin
D000203:Activities of Daily Living / Q000145:classification; D000223:Adaptation, Psychological / Q000145:classification; D000293:Adolescent; D001171:Arthritis, Juvenile / Q000150:complications / Q000503:physiopathology* / Q000523:psychology; D002648:Child; D005221:Fatigue / Q000209:etiology / Q000503:physiopathology / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008499:Medical Records; D010146:Pain / Q000209:etiology / Q000503:physiopathology* / Q000523:psychology; D010147:Pain Measurement; D012720:Severity of Illness Index; D012919:Social Behavior; D011795:Surveys and Questionnaires