Significant pain decrease in children with non-systemic Juvenile Idiopathic Arthritis treated to target: results over 24 months of follow up

Pediatric Rheumatology, vol. 21, pp. 90

Abstract

BACKGROUND: The aim of this study was to compare pain-scores in three targeted treatment-strategies in JIA-patients and to identify characteristics predicting persistent pain. METHODS: In the BeSt-for-Kids-study 92 DMARD-naïve JIA-patients were randomized in 3 treatment-strategies: 1) initial sequential DMARD-monotherapy 2) initial methotrexate (MTX)/prednisolone-bridging or 3) initial MTX/etanercept. Potential differences in VAS pain scores (0-100 mm) over time between treatment-strategies were compared using linear mixed models with visits clustered within patients. A multivariable model was used to assess the ability of baseline characteristics to predict the chance of high pain-scores during follow-up. RESULTS: Pain-scores over time reduced from mean 55.3 (SD 21.7) to 19.5 (SD 25.3) mm after 24 months. On average, pain-scores decreased significantly with β -1.37 mm (95% CI -1.726; -1.022) per month. No significant difference was found between treatment-strategies (interaction term treatment arm*time (months) β (95% CI) arm 1: 0.13 (-0.36; 0.62) and arm 2: 0.37 (-0.12; 0.86) compared to arm 3). Correction for sex and symptom duration yielded similar results. Several baseline characteristics were predictive for pain over time. Higher VAS pain [β 0.44 (95% CI 0.25; 0.65)] and higher active joint count [0.77 (0.19; 1.34)] were predictive of higher pain over time, whereas, low VAS physician [ -0.34 (-0.55; -0.06)], CHQ Physical [ -0.42 (-0.72; -0.11)] and Psychosocial summary Score [ -0.42 (-0.77; -0.06)] were predictive of lower pain. CONCLUSIONS: Treatment-to-target seems effective in pain-reduction in non-systemic JIA-patients irrespective of initial treatment-strategy. Several baseline-predictors for pain over time were found, which could help to identify patients with a high risk for development of chronic pain. TRIAL REGISTRATION: Dutch Trial Registry number 1574.

Authors 13

1. Katinka Spekking corresponding Aachen Department of Pediatrics Division of Pediatric Rheumatology

   Willem-Alexander Kinderziekenhuis

   Affiliation as printed

   Department of Pediatrics, Division of Pediatric Rheumatology, Willem-Alexander Children's Hospital, Leiden, The Netherlands. k.spekking@lumc.nl

   Department of Pediatrics, Division of Pediatric Rheumatology, Willem-Alexander Children's Hospital, Leiden, The Netherlands

2. Janneke Anink

   Flevoziekenhuis · De Kinderkliniek

   Affiliation as printed

   De Kinderkliniek, Flevo Hospital, Almere, The Netherlands

3. Piroska de Boer Aachen Department of Pediatrics Division of Pediatric Rheumatology

   Willem-Alexander Kinderziekenhuis

   Affiliation as printed

   Department of Pediatrics, Division of Pediatric Rheumatology, Willem-Alexander Children's Hospital, Leiden, The Netherlands

4. Sytske Anne Bergstra Aachen Department of Rheumatology, Leiden University Medical Center

   Leiden University Medical Center

   Affiliation as printed

   Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands

5. J. Merlijn van den Berg

   Emma Kinderziekenhuis · Amsterdam University Medical Centers

   Affiliation as printed

   Department of Pediatric Immunology, Rheumatology and Infectious Diseases, Emma Children's Hospital, Amsterdam University Medical Centers, Amsterdam, The Netherlands

6. Dieneke Schonenberg‐Meinema

   Emma Kinderziekenhuis · Amsterdam University Medical Centers

   Affiliation as printed

   Department of Pediatric Immunology, Rheumatology and Infectious Diseases, Emma Children's Hospital, Amsterdam University Medical Centers, Amsterdam, The Netherlands

7. Lisette W. A. van Suijlekom‐Smit

   Erasmus MC · Erasmus MC - Sophia Children’s Hospital

   Affiliation as printed

   Department of Pediatrics/Pediatric Rheumatology, Sophia Children's Hospital Erasmus Medical Center, Rotterdam, The Netherlands

8. Marion A. J. van Rossum

   Reade · Emma Kinderziekenhuis · Amsterdam University Medical Centers

   Affiliation as printed

   Department of Pediatric Rheumatology, Amsterdam Rheumatology and Immunology Center | Reade, Amsterdam, The Netherlands

   Department of Pediatrics, Emma Children's Hospital, Amsterdam University Medical Centers, Amsterdam, The Netherlands

9. Yvonne Koopman-Keemink

   Haga Hospital · Juliana Kinderziekenhuis

   Affiliation as printed

   Department of Pediatrics, Juliana Children's Hospital, Hagaziekenhuis, the Hague, The Netherlands

10. Rebecca Ten Cate Aachen Department of Pediatrics Division of Pediatric Rheumatology

    Willem-Alexander Kinderziekenhuis

    Affiliation as printed

    Department of Pediatrics, Division of Pediatric Rheumatology, Willem-Alexander Children's Hospital, Leiden, The Netherlands

11. Cornelia F Allaart Aachen Department of Rheumatology, Leiden University Medical Center

    Leiden University Medical Center

    Affiliation as printed

    Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands

12. D. M. C. Brinkman Aachen Department of Pediatrics Division of Pediatric Rheumatology

    Willem-Alexander Kinderziekenhuis

    Affiliation as printed

    Department of Pediatrics, Division of Pediatric Rheumatology, Willem-Alexander Children's Hospital, Leiden, The Netherlands

13. Petra C. E. Hissink Muller Aachen Department of Pediatrics Division of Pediatric Rheumatology

    Willem-Alexander Kinderziekenhuis

    Affiliation as printed

    Department of Pediatrics, Division of Pediatric Rheumatology, Willem-Alexander Children's Hospital, Leiden, The Netherlands