Pediatric Rheumatology Online Journal → June 2003 → Health-Related Quality of Life, Disease Activity and Outcome Assessments→ Abstract #33

DAILY PAIN AND SYMPTOMS IN CHILDREN WITH POLYARTICULAR ARTHRITIS

L. E. Schanberg,¹ K. K. Anthony,² K. M. Gil,² E. C. Maurin.²

¹Division of Pediatric Rheumatology, Duke University Medical Center, Durham, NC, United States; ²Department of Psychology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States

Objective: The objectives of the present study were to 1) analyze patterns of daily pain, stiffness, and fatigue related to juvenile arthritis, 2) examine the relationships of demographics, disease severity, and psychological adjustment to daily disease symptoms, and 3) examine daily disease symptoms as predictors of school and social activity reduction.
Method: Forty-one children with polyarticular juvenile arthritis completed daily diaries for a two-month period that included measures of symptoms and function. Children also completed an initial evaluation and four follow-up evaluations that included a joint count, laboratory testing, and completion of questionnaires assessing physical and psychosocial functioning.
Results: Children complained of pain on an average of 73% of days with the majority of children (76%) reporting pain on greater than 60% of all days. Children on average complained of daily pain in the mild to moderate intensity range; however a significant subgroup 31% reported pain in the severe range. Higher physician global assessment ratings, increased functional disability, and increased anxiety significantly related to 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 reductions in school and social activities.
Conclusion: Physicians should consider treating pain more aggressively in children with arthritis 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.