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Gudjonsdottir B, Oskarsdottir SA, Kristjansdottir A, Gudmundsdottir JA, Kamban SW, Licina ZA, Gudmundsdottir DB. Impact of Musculoskeletal Pain on Functioning and Disability in Children with Juvenile Idiopathic Arthritis in Iceland. Phys Occup Ther Pediatr 2024; 44:554-571. [PMID: 38178574 DOI: 10.1080/01942638.2023.2299028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 12/20/2023] [Indexed: 01/06/2024]
Abstract
AIMS 1) to map questions of pain from a survey to the International Classification of Functioning, Disability and Health (ICF) 2) to compare the impact of musculoskeletal pain on functioning based on the different components of the ICF in children with juvenile idiopathic arthritis (JIA) and age-matched peers. METHOD A cross-sectional case-control survey. A total of 28 children with JIA and 36 age-matched children participated. The survey included questions on the child's sex and age, about pain experienced, number of painful body areas, pain frequency and three short forms of Patient-Reported Outcome Measurement Information System (PROMIS) pain questionnaires. Sixteen children with JIA (57%) and 10 peers (28%) reported pain during past seven days. Their responses were used in the description of impact of pain. RESULTS After the mapping of the questions to ICF, a comparison between the two groups indicated that a higher number of children with JIA described effects of pain on mental function, mobility, general tasks and demands, than their peers. More children with JIA expressed to others that they had pain, non-verbally and verbally. CONCLUSION The findings provide important information about the impacts of pain on daily life in children with JIA and about their intervention needs.
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Affiliation(s)
- Bjorg Gudjonsdottir
- Department of Physical Therapy, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | | | - Audur Kristjansdottir
- Department of Physical Therapy, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | | | - Solrun W Kamban
- Landspitali - The National University Hospital of Iceland, Children's Medical Center, Reykjavik, Iceland
| | - Zinajda Alomerovic Licina
- Landspitali - The National University Hospital of Iceland, Children's Medical Center, Reykjavik, Iceland
| | - Drifa Bjork Gudmundsdottir
- Landspitali - The National University Hospital of Iceland, Children's Medical Center, Reykjavik, Iceland
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Brandão M, Talih M, Holden S, Fernandes F, Graven-Nielsen T, Lucas R. Pain history and experimental pressure pain responses in adolescents: Results from a population-based birth cohort. Eur J Pain 2024; 28:70-82. [PMID: 37485565 DOI: 10.1002/ejp.2159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 06/23/2023] [Accepted: 07/05/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND Sensitized pain mechanisms are often reported in musculoskeletal pain conditions, but population-based paediatric studies are lacking. We assessed whether adolescents with musculoskeletal pain history had evidence of increased responsiveness to experimental pressure stimuli. METHODS Data were from 1496 adolescents of the Generation XXI birth cohort. Pain history was collected using the Luebeck Pain Questionnaire (self-reported at 13, parent-reported at 7 and 10 years). Two case definitions for musculoskeletal pain were considered: (1) cross-sectional-musculoskeletal pain lasting more than 3 months at age 13 and (2) longitudinal-musculoskeletal pain at age 13 with musculoskeletal pain reports at ages 7 and/or 10. Lower limb cuff pressure algometry was used to assess pain detection and tolerance thresholds, conditioned pain modulation effects (CPM, changes in thresholds in the presence on painful conditioning) and temporal summation of pain effects (TSP, changes in pain intensity to 10 phasic painful cuff stimulations). RESULTS Adolescents with musculoskeletal pain at age 13 plus a history of pain in previous evaluations (longitudinal definition) had lower pain tolerance thresholds compared to the remaining sample (40.2 v. 49.0 kPa, p = 0.02), but showed no differences in pain detection threshold, CPM effect and TSP effect. Pain sensitivity, CPM effects and TSP effects were not significantly different when the current pain only case definition (cross-sectional) was used. CONCLUSIONS Adolescents with current musculoskeletal pain who had a history of pain since childhood had lower tolerance to cuff stimulation. This may suggest long-standing musculoskeletal pain since childhood may contribute to sensitisation, rather than the presence of current pain only. SIGNIFICANCE Repeated musculoskeletal pain up to age 13 years may contribute to higher pain sensitivity (particularly lowered pressure pain tolerance) in the general adolescent population. This does not seem to be the case when reported pain experiences are recent or when the outcomes are temporal pain summation or CPM. In this community-based paediatric sample, the vast majority showed no sign of altered pain processing, but a small fraction may reveal some pain sensitization at 13 years of age.
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Affiliation(s)
- Maria Brandão
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório Para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Porto, Portugal
| | - Makram Talih
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório Para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Porto, Portugal
- Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Sinead Holden
- Center for Neuroplasticity and Pain (CNAP), Aalborg University, Copenhagen, Denmark
| | - Francisco Fernandes
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório Para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Porto, Portugal
- Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | | | - Raquel Lucas
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório Para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Porto, Portugal
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Spekking K, Anink J, de Boer P, Bergstra SA, van den Berg JM, Schonenberg-Meinema D, van Suijlekom-Smit LWA, van Rossum MAJ, Koopman-Keemink Y, Cate RT, Allaart CF, Brinkman DMC, Muller PCEH. Significant pain decrease in children with non-systemic Juvenile Idiopathic Arthritis treated to target: results over 24 months of follow up. Pediatr Rheumatol Online J 2023; 21:90. [PMID: 37633893 PMCID: PMC10464062 DOI: 10.1186/s12969-023-00874-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 08/06/2023] [Indexed: 08/28/2023] Open
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.
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Affiliation(s)
- Katinka Spekking
- Department of Pediatrics, Division of Pediatric Rheumatology, Willem-Alexander Children's Hospital, Leiden, The Netherlands.
| | - Janneke Anink
- De Kinderkliniek, Flevo Hospital, Almere, The Netherlands
| | - Piroska de Boer
- Department of Pediatrics, Division of Pediatric Rheumatology, Willem-Alexander Children's Hospital, Leiden, The Netherlands
| | - Sytske Anne Bergstra
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - J Merlijn van den Berg
- Department of Pediatric Immunology, Rheumatology and Infectious Diseases, Emma Children's Hospital, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Dieneke Schonenberg-Meinema
- Department of Pediatric Immunology, Rheumatology and Infectious Diseases, Emma Children's Hospital, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Lisette W A van Suijlekom-Smit
- Department of Pediatrics/Pediatric Rheumatology, Sophia Children's Hospital Erasmus Medical Center, Rotterdam, The Netherlands
| | - Marion A J van Rossum
- Department of Pediatrics, Emma Children's Hospital, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- Department of Pediatric Rheumatology, Amsterdam Rheumatology and Immunology Center | Reade, Amsterdam, The Netherlands
| | - Yvonne Koopman-Keemink
- Department of Pediatrics, Juliana Children's Hospital, Hagaziekenhuis, the Hague, The Netherlands
| | - Rebecca Ten Cate
- Department of Pediatrics, Division of Pediatric Rheumatology, Willem-Alexander Children's Hospital, Leiden, The Netherlands
| | - Cornelia F Allaart
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Daniëlle M C Brinkman
- Department of Pediatrics, Division of Pediatric Rheumatology, Willem-Alexander Children's Hospital, Leiden, The Netherlands
| | - Petra C E Hissink Muller
- Department of Pediatrics, Division of Pediatric Rheumatology, Willem-Alexander Children's Hospital, Leiden, The Netherlands
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Elfving A, Harila-Saari A, Nilsson L, Berntson L. An explorative study on proteomic analyses related to inflammation and pain in children with juvenile idiopathic arthritis. BMC Pediatr 2023; 23:365. [PMID: 37454049 PMCID: PMC10349407 DOI: 10.1186/s12887-023-04181-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 07/05/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND Our aim was attempting to find proteins involved in the pain process and correlating with pain but not degree of inflammation in children with juvenile idiopathic arthritis (JIA), using a proteomics panel. METHODS A total of 87 plasma samples were collected from 51 children with JIA (51 at diagnosis in a higher disease activity state, 18 at follow-up in a lower disease activity state) and 18 healthy controls. Relative levels of 92 proteins related to a wide range of biological processes in inflammation were obtained using a proximity extension assay panel. Comparisons between children with and without JIA, in different disease categories, by juvenile disease activity score (JADAS27) and degree of pain on a visual analogue scale (VAS), were performed using parametric and non-parametric statistical methods. RESULTS Nineteen proteins involved in arthritic inflammation, such as interleukin 6 (IL-6) and S100 protein A12, were higher in patients with JIA than controls, seven decreased significantly during treatment, and 18 correlated significantly with JADAS27. Three proteins correlated with pain VAS scores in unadjusted analyses: the glial cell line-derived neurotrophic factor (GDNF), transforming growth factor beta, and IL-18R1. Levels of GDNF correlated significantly with pain VAS scores but not with JADAS27. CONCLUSIONS Plasma levels of 18 of 92 tested proteins correlated with degree of disease activity. Levels of three proteins correlated with pain, and levels of one, GDNF, originating from neural cells, correlated with pain without correlating with inflammatory degree, suggesting that it may play a role in pain in JIA. Further studies in larger cohorts are warranted.
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Affiliation(s)
- Andreas Elfving
- Department of Women's and Children's Health, Uppsala University, 75185, Uppsala, Sweden
| | - Arja Harila-Saari
- Department of Women's and Children's Health, Uppsala University, 75185, Uppsala, Sweden
| | - Ludwig Nilsson
- Department of Women's and Children's Health, Uppsala University, 75185, Uppsala, Sweden
| | - Lillemor Berntson
- Department of Women's and Children's Health, Uppsala University, 75185, Uppsala, Sweden.
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Woolnough LU, Lentini L, Sharififar S, Chen C, Vincent HK. The relationships of kinesiophobia and physical function and physical activity level in juvenile idiopathic arthritis. Pediatr Rheumatol Online J 2022; 20:73. [PMID: 36050703 PMCID: PMC9438303 DOI: 10.1186/s12969-022-00734-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 08/17/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Kinesiophobia may hinder physical performance measures and functional quality of life in children with juvenile idiopathic arthritis (JIA). This study aims to quantify differences in physical function in patients with JIA compared to healthy controls, and determine the effects of kinesiophobia on physical function and physical activity. METHODS This was a comparative study of participants with JIA and healthy controls (JIA n = 26, control n = 17). All children with JIA had lower extremity joint involvement. Performance-based measures included gait speed, chair and stair navigation performance. Self-reported measures included Patient Reported Outcome Measurement Information System (PROMIS®) Physical Function Mobility, and Pain Interference and the Pediatric Functional Activity Brief Scale (Pedi-FABS). The Tampa Scale of Kinesiophobia (TSK-11) assessed patient fear of movement due to pain. Linear regression models were used to determine the contribution of TSK-11 scores on performance test and Pedi-FABS scores. RESULTS Gait speeds were 11-15% slower, chair rise repetitions were 28% fewer, and stair ascent and descent times were 26-31% slower in JIA than controls (p < .05). PROMIS® Physical Function Mobility scores were 10% lower and Pain Interference scores were 2.6 times higher in JIA than healthy controls (p = .003). TSK-11 scores were higher in JIA than controls (p < .0001). After controlling for covariates, TSK-11 scores explained 11.7-26.5% of the variance of regression models for stair climb time, chair rise performance and Pedi-FABS scores (p < .05). CONCLUSIONS Children with JIA experience difficulty with tasks related to body transfers. Kinesiophobia is a significant contributor to the functional task performance and may impact clinical outcomes.
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Affiliation(s)
- Leandra U. Woolnough
- grid.15276.370000 0004 1936 8091Department of Pediatrics and Physical Medicine and Rehabilitation, University of Florida, 1600 SW Archer Rd HD-409, PO Box 100296, Gainesville, FL 32610 USA
| | - Logan Lentini
- grid.15276.370000 0004 1936 8091Department of Pediatrics and Physical Medicine and Rehabilitation, University of Florida, 1600 SW Archer Rd HD-409, PO Box 100296, Gainesville, FL 32610 USA
| | - Sharareh Sharififar
- grid.15276.370000 0004 1936 8091Department of Pediatrics and Physical Medicine and Rehabilitation, University of Florida, 1600 SW Archer Rd HD-409, PO Box 100296, Gainesville, FL 32610 USA
| | - Cong Chen
- grid.15276.370000 0004 1936 8091Department of Pediatrics and Physical Medicine and Rehabilitation, University of Florida, 1600 SW Archer Rd HD-409, PO Box 100296, Gainesville, FL 32610 USA
| | - Heather K. Vincent
- grid.15276.370000 0004 1936 8091Department of Pediatrics and Physical Medicine and Rehabilitation, University of Florida, 1600 SW Archer Rd HD-409, PO Box 100296, Gainesville, FL 32610 USA
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Oskarsdottir SA, Kristjansdottir A, Gudmundsdottir JA, Kamban SW, Licina ZA, Gudmundsdottir DB, Gudjonsdottir B. Musculoskeletal pain and its effect on daily activity and behaviour in Icelandic children and youths with juvenile idiopathic arthritis: a cross-sectional case-control study. Pediatr Rheumatol Online J 2022; 20:48. [PMID: 35841034 PMCID: PMC9287931 DOI: 10.1186/s12969-022-00706-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 06/26/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Juvenile idiopathic arthritis is characterised by recurring episodes of acute inflammation, with joint swelling in one or more joints, often accompanied by pain. These episodes can now be controlled better than in the past because of a new category of medications. However, despite more stable disease activity, pain may continue to cause problems in the children with juvenile idiopathic arthritis and can reduce their performance of routine physical activities and participation in social or school activities. AIM To evaluate the prevalence of pain, pain intensity, pain behaviour, and pain interference in Icelandic children with juvenile idiopathic arthritis compared with healthy peers. METHODS A cross-sectional, case-control study including 8-18 years old children; 28 with juvenile idiopathic arthritis and 36 in a control group. The children answered questions on pain experienced during the last 7 days, painful areas of the body and pain frequency. They completed short form versions of the Patient-Reported Outcome Measurement Information System (PROMIS) questionnaires on pain intensity, pain behaviour, and pain interference. RESULTS Significantly more children with juvenile idiopathic arthritis had pain compared with the control group (p = 0.02). Children with JIA also had a greater number of painful body areas (p = 0.03), more pain intensity (p = 0.009), and showed more pain behaviour (p = 0.006), and pain interference (p = 0.002). Children with juvenile idiopathic arthritis who had pain, experienced more pain interference (p = 0.023) than their peers who had pain. However, the groups did not differ in terms of pain intensity (p = 0.102) and pain behaviour (p = 0.058). CONCLUSION The research results indicate that pain experience was different between children with juvenile idiopathic arthritis and the control group. The results suggest that further research of the role of pain management on functional outcomes in children with juvenile idiopathic arthritis is needed.
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Affiliation(s)
- Svanhildur Arna Oskarsdottir
- grid.14013.370000 0004 0640 0021Department of Physical Therapy, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Audur Kristjansdottir
- grid.14013.370000 0004 0640 0021Department of Physical Therapy, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | | | - Solrun W. Kamban
- grid.410540.40000 0000 9894 0842Children’s Medical Center, University Hospital of Iceland, Reykjavik, Iceland
| | - Zinajda Alomerovic Licina
- grid.410540.40000 0000 9894 0842Children’s Medical Center, University Hospital of Iceland, Reykjavik, Iceland
| | - Drifa Bjork Gudmundsdottir
- grid.410540.40000 0000 9894 0842Children’s Medical Center, University Hospital of Iceland, Reykjavik, Iceland
| | - Bjorg Gudjonsdottir
- Department of Physical Therapy, School of Health Sciences, University of Iceland, Reykjavik, Iceland.
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Weng Y, Yi C, Liang H, Lin K, Zheng X, Xiao J, Han H. The Brain Structural-Functional Vulnerability in Drug-Naive Children With Juvenile Idiopathic Arthritis: Insights From the Hippocampus. Front Hum Neurosci 2022; 16:833602. [PMID: 35370580 PMCID: PMC8973270 DOI: 10.3389/fnhum.2022.833602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 02/28/2022] [Indexed: 11/26/2022] Open
Abstract
Objective Leveraging an integrative multimodal MRI paradigm to elaborate on the hippocampus-derived structural and functional changes in children and adolescents with juvenile idiopathic arthritis (JIA) and to explore potential correlations within the “joint-inflammation-brain” axis during the period of central neural system (CNS) development. Methods Twenty-one patients with JIA all completed the multimodal MRI scanning, laboratory tests, and neuropsychological assessments; meanwhile, 23 matched controls were recruited. We then harnessed the spherical harmonics with a point distribution model (SPHARM-PDM) and the ROI-to-voxel functional connectivity (FC) to measure the hippocampal shape and hippocampo-cortical FC patterns. Correlation analysis was performed to explore the potential links in neuroimaging features with disease-related indices. Results Compared to controls, JIA patients only presented an atrophic tendency in the posterior part of the bilateral hippocampus. The hippocampo-cortical FC revealed the between-group divergences mainly located at the pain matrix, striatum, and temporal lobe. Remarkably, the enhanced FC between the right hippocampus and postcentral cortex is positively correlated with the disability index, while the weakened FC of right anterior hippocampus with right insula and that of left posterior hippocampus with left superior temporal gyrus was inversely related to the erythrocyte sedimentation rate and anxiety status, separately. Conclusion As with macroscopic damages, the altered functional-connectome patterns of the hippocampus in JIA patients might be more sensitive to detect the early neuropathological changes. Moreover, the functional disturbances were demonstrated associated with the physical disability, inflammation, and emotional status. These findings may enlighten us on the underlying neuropathological mechanism of CNS comorbidities in JIA.
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Affiliation(s)
- Yifei Weng
- Department of Radiology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Cuili Yi
- Department of Pediatrics, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Hongyan Liang
- Department of Radiology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Kezhao Lin
- Department of Pediatrics, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Xiaohuang Zheng
- Department of Pediatrics, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Jihong Xiao
- Department of Pediatrics, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
- *Correspondence: Jihong Xiao,
| | - Haiwei Han
- Department of Radiology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
- Haiwei Han, ; orcid.org/0000-0003-3608-4931
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Pain pressure thresholds in children and adolescents with idiopathic chest pain. Cardiol Young 2022; 32:252-256. [PMID: 33972004 DOI: 10.1017/s1047951121001840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES The pathophysiology of idiopathic chest pain remains unclear. Studies evaluating pain pressure thresholds in other idiopathic pain syndromes have revealed pain sensitivity in both affected and unaffected areas. The present study aimed to evaluate thoracic and extrathoracic pain pressure thresholds and their correlation with patients' pain characteristics and quality of life. METHODS This cross-sectional, single-blind, controlled study included children and adolescents with idiopathic chest pain. The patients' pain characteristics, including their symptom duration, type of pain, mean pain intensity, mean duration of painful periods, pain frequency, and Pediatric Quality of Life Inventory Child Version scores, were assessed by a paediatric cardiologist via a face-to-face interview. Pain pressure thresholds were measured using an algometer by an algologist who was blinded to the study groups. RESULTS There was a statistically significant difference in pain pressure thresholds in the trapezius; supraspinatus; thoracic 2, 4, and 10 areas; deltoid; and tibia between the patient and healthy control groups. In the patient group, while there was a positive correlation between the mean all-region pain pressure thresholds and age (p = 0.047, r = 0.235), there was no correlation between pain pressure thresholds and symptom duration, pain intensity, and quality of life. CONCLUSION The present study is the first step towards investigating probable pain sensitivity mechanisms in children and adolescents with idiopathic chest pain. We noted lower thoracic and extrathoracic pain pressure thresholds in children and adolescents with idiopathic chest pain than in healthy controls.
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La Hausse De Lalouviere L, Morice O, Fitzgerald M. Altered sensory innervation and pain hypersensitivity in a model of young painful arthritic joints: short- and long-term effects. Inflamm Res 2021; 70:483-493. [PMID: 33715021 PMCID: PMC8012329 DOI: 10.1007/s00011-021-01450-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 02/24/2021] [Accepted: 03/04/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Early life experience can cause long-term alterations in the nociceptive processes underlying chronic pain, but the consequences of early life arthritic joint inflammation upon the sensory innervation of the joint is not known. Here, we measure pain sensitivity and sensory innervation in a young, juvenile and adult rodent model of arthritic joints and test the consequences of joint inflammation in young animals upon adult arthritic pain and joint innervation. METHODS Unilateral ankle joint injections of complete Freund's adjuvant (CFA) (6-20 µl) were performed in young, postnatal day (P)8, adolescent (P21) and adult (P40) rats. A separate cohort of animals were injected at P8, and again at P40. Hindpaw mechanical sensitivity was assessed using von Frey monofilaments (vF) for 10 days. Nerve fibres were counted in sections through the ankle joint immunostained for calcitonin gene-related peptide (CGRP) and neurofilament 200 kDa (NF200). RESULTS Ankle joint CFA injection increased capsular width at all ages. Significant mechanical pain hypersensitivity and increased number of joint CGRP + ve sensory fibres occurred in adolescent and adult, but not young, rats. Despite the lack of acute reaction, joint inflammation at a young age resulted in significantly increased pain hypersensitivity and CGRP+ fibre counts when the rats were re-inflamed as adults. CONCLUSIONS Joint inflammation increases the sensory nociceptive innervation and induces acute pain hypersensitivity in juvenile and adult, but not in young rats. However, early life joint inflammation 'primes' the joint such that adult inflammatory pain behaviour and nociceptive nerve endings in the joint are significantly increased. Early life joint inflammation may be an important factor in the generation and maintenance of chronic arthritic pain.
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Affiliation(s)
- Luke La Hausse De Lalouviere
- Department of Neuroscience, Physiology and Pharmacology, University College London, Medawar Building, Gower Street, London, WC1E 6BT, UK
| | - Oscar Morice
- Department of Neuroscience, Physiology and Pharmacology, University College London, Medawar Building, Gower Street, London, WC1E 6BT, UK
| | - Maria Fitzgerald
- Department of Neuroscience, Physiology and Pharmacology, University College London, Medawar Building, Gower Street, London, WC1E 6BT, UK.
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Arnstad ED, Iversen JM, Uglem M, Glerup M, Romundstad PR, Sand T, Rygg M. Pain sensitivity in young adults with juvenile idiopathic arthritis: a quantitative sensory testing study. Arthritis Res Ther 2020; 22:262. [PMID: 33153493 PMCID: PMC7643261 DOI: 10.1186/s13075-020-02345-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 10/05/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND To study for the first-time, pain perception, pain sensitivity, and self-reported pain in young adults with long disease duration of juvenile idiopathic arthritis (JIA) compared with controls. METHODS Children from Central Norway diagnosed with JIA between 1997 and 2004 were included consecutively in a population-based prospective study. Children with onset 1997-2000 were part of the Nordic JIA cohort. Controls were age- and sex-matched. In 2015-2017, study visits with investigator-blinded quantitative sensory testing (QST) comprising cold and warm detection thresholds (CDT/WDT), cold and heat pain thresholds (CPT/HPT), pressure pain threshold (PPT), and a suprathreshold heat pain test were performed. We constructed separate multilevel models for each variable of detection and pain thresholds with interaction between groups and site adjusted for the effect of age and sex. RESULTS Among 96 young adults with JIA, 71% were female, median age was 22.7 years, disease duration was 16.1 years, and 47% had oligoarticular disease. Among 109 controls, 71% were female, and median age was 23.5 years. Participants with JIA had lower pressure pain thresholds (PPTs) (95% CI) compared to controls, upper limb 888 (846,930) versus 1029 (999,1059) kPa and lower limb 702 (670,734) versus 760 (726,794) kPa. Participants with inactive disease had the lowest PPTs and cold pain thresholds (CPTs), compared to those in remission off medication and those with active disease. Minor differences were found regarding CDT/WDT and CPT/HPT in JIA compared to controls. The median (IQR) temperature needed to evoke pain = 6 on a 0-10 numeric rating scale (NRS) in the suprathreshold heat pain tests were lower in JIA than in controls (46 °C (45-47 °C) versus 47 °C (46-48 °C)). We found no associations between self-reported pain and pain thresholds. CONCLUSIONS Our results indicate for the first time that young adults with long disease duration of JIA may have altered pain perception and sensitivity compared to controls. A clinical implication may be the importance of early treatment to quickly achieve pain-free remission and avoid long-term pain sensitization.
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Affiliation(s)
- Ellen Dalen Arnstad
- Department of Pediatrics, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway.
- Department of Clinical and Molecular Medicine, NTNU-Norwegian University of Science and Technology, Trondheim, Norway.
| | | | - Martin Uglem
- Department of Neuromedicine and Movement Science, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
- Department of Neurology and Clinical Neurophysiology, St. Olavs Hospital, Trondheim, Norway
| | - Mia Glerup
- Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
| | - Pål Richard Romundstad
- Department of Public Health and Nursing, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
| | - Trond Sand
- Department of Neuromedicine and Movement Science, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
- Department of Neurology and Clinical Neurophysiology, St. Olavs Hospital, Trondheim, Norway
| | - Marite Rygg
- Department of Clinical and Molecular Medicine, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
- Department of Pediatrics, St. Olavs Hospital, Trondheim, Norway
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11
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Kwok CHT, Learoyd AE, Canet-Pons J, Trang T, Fitzgerald M. Spinal interleukin-6 contributes to central sensitisation and persistent pain hypersensitivity in a model of juvenile idiopathic arthritis. Brain Behav Immun 2020; 90:145-154. [PMID: 32791212 PMCID: PMC7575902 DOI: 10.1016/j.bbi.2020.08.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 07/27/2020] [Accepted: 08/07/2020] [Indexed: 12/15/2022] Open
Abstract
Pain is the most debilitating symptom in juvenile idiopathic arthritis. As pain correlates poorly to the extent of joint pathology, therapies that control joint inflammation are often inadequate as analgesics. We test the hypothesis that juvenile joint inflammation leads to sensitisation of nociceptive circuits in the central nervous system, which is maintained by cytokine expression in the spinal cord. Here, transient joint inflammation was induced in postnatal day (P)21 and P40 male Sprague-Dawley rats with a single intra-articular ankle injection of complete Freund's adjuvant. Hindpaw mechanical pain sensitivity was assessed using von Frey hair and weight bearing tests. Spinal neuron activity was measured using in vivo extracellular recording and immunohistochemistry. Joint and spinal dorsal horn TNFα, IL1β and IL6 protein expression was quantified using western blotting. We observed greater mechanical hyperalgesia following joint inflammation in P21 compared to P40 rats, despite comparable duration of swelling and joint inflammatory cytokine levels. This is mirrored by spinal neuron hypersensitivity, which also outlasted the duration of active joint inflammation. The cytokine profile in the spinal cord differed at the two ages: prolonged upregulation of spinal IL6 was observed in P21, but not P40 rats. Finally, spinal application of anti-IL-6 antibody (30 ng) reduced the mechanical hyperalgesia and neuronal activation. Our results indicate that persistent upregulation of pro-inflammatory cytokines in the spinal dorsal horn is associated with neuronal sensitisation and mechanical hyperalgesia in juvenile rats, beyond the progress of joint pathology. In addition, we provide proof of concept that spinal IL6 is a key target for treating persistent pain in JIA.
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Affiliation(s)
- Charlie H T Kwok
- Physiology and Pharmacology, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Comparative Biology and Experimental Medicine, University of Calgary, Calgary, Alberta, Canada.
| | - Annastazia E Learoyd
- Department of Neuroscience, Physiology and Pharmacology, University College London, UK
| | - Julia Canet-Pons
- Physiology and Pharmacology, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Comparative Biology and Experimental Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Tuan Trang
- Physiology and Pharmacology, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Comparative Biology and Experimental Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Maria Fitzgerald
- Department of Neuroscience, Physiology and Pharmacology, University College London, UK
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12
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Hanns L, Radziszewska A, Suffield L, Josephs F, Chaplin H, Peckham H, Sen D, Christie D, Carvalho LA, Ioannou Y. Association of Anxiety With Pain and Disability but Not With Increased Measures of Inflammation in Adolescent Patients With Juvenile Idiopathic Arthritis. Arthritis Care Res (Hoboken) 2020; 72:1266-1274. [PMID: 31199593 PMCID: PMC7496487 DOI: 10.1002/acr.24006] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 06/11/2019] [Indexed: 12/13/2022]
Abstract
Objective To explore whether anxiety and depression are associated with clinical measures of disease for adolescent patients with juvenile idiopathic arthritis (JIA) and whether anxiety and depression are associated with increased peripheral proinflammatory cytokine levels in adolescent patients with JIA and in healthy adolescent controls. Methods A total of 136 patients with JIA and 88 healthy controls ages 13–18 years completed questionnaires on anxiety and depressive symptoms. For patients with JIA, pain, disability, physician global assessment (using a visual analog scale [VAS]), and number of joints with active inflammation (active joint count) were recorded. In a subsample, we assessed lipopolysaccharide‐stimulated interleukin 6 (IL‐6) production from peripheral blood mononuclear cells, serum IL‐6, cortisol, and C‐reactive protein levels. Data were analyzed by linear regression analysis. Results Levels of anxiety and depressive symptoms in patients with JIA were not significantly different than those in healthy controls. For patients with JIA, anxiety was significantly associated with disability (β = 0.009, P = 0.002), pain (β = 0.029, P = 0.011), and physician global assessment VAS (β = 0.019, P = 0.012), but not with active joint count (β = 0.014, P = 0.120). Anxiety was not associated with any laboratory measures of inflammation for JIA patients. These relationships were also true for depressive symptoms. For healthy controls, there was a trend toward an association of anxiety (but not depressive symptoms) with stimulated IL‐6 (β = 0.004, P = 0.052). Conclusion Adolescent patients with JIA experience equivalent levels of anxiety and depressive symptoms as healthy adolescents. For adolescent patients with JIA, anxiety and depressive symptoms are associated with pain, disability, and physician global assessment VAS, but not with inflammation.
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13
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Valentino R, Rongo R, Alessio M, Alstergren P, Bucci R, Leone G, D’Antò V, Michelotti A. “Pressure pain threshold over masticatory muscles and temporomandibular joint in patients with juvenile idiopathic arthritis”. J Oral Rehabil 2020; 47:944-950. [DOI: 10.1111/joor.13024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 05/05/2020] [Accepted: 05/16/2020] [Indexed: 12/22/2022]
Affiliation(s)
- Roberta Valentino
- School of Orthodontics Department of Neurosciences, Reproductive Sciences and Oral Sciences University of Naples Federico II Naples Italy
| | - Roberto Rongo
- School of Orthodontics Department of Neurosciences, Reproductive Sciences and Oral Sciences University of Naples Federico II Naples Italy
| | - Maria Alessio
- Department of Translational Medicine University Naples Federico II Naples Italy
| | - Per Alstergren
- Orofacial Pain and Jaw Function Institute of Dental Medicine Karolinska Institutet Huddinge Sweden
- Orofacial Pain Unit Faculty of Odontology Malmö University Malmö Sweden
| | - Rosaria Bucci
- School of Orthodontics Department of Neurosciences, Reproductive Sciences and Oral Sciences University of Naples Federico II Naples Italy
| | - Giovanna Leone
- School of Orthodontics Department of Neurosciences, Reproductive Sciences and Oral Sciences University of Naples Federico II Naples Italy
| | - Vincenzo D’Antò
- School of Orthodontics Department of Neurosciences, Reproductive Sciences and Oral Sciences University of Naples Federico II Naples Italy
| | - Ambrosina Michelotti
- School of Orthodontics Department of Neurosciences, Reproductive Sciences and Oral Sciences University of Naples Federico II Naples Italy
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14
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Learoyd AE, Sen D, Fitzgerald M. The pain trajectory of juvenile idiopathic arthritis (JIA): translating from adolescent patient report to behavioural sensitivity in a juvenile animal model. Pediatr Rheumatol Online J 2019; 17:60. [PMID: 31455369 PMCID: PMC6712651 DOI: 10.1186/s12969-019-0360-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 08/07/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND While pain is a common symptom in JIA patients, it remains unclear why some JIA patients develop ongoing or persistent pain. Complex clinical and social settings confound analysis of individual factors that may contribute to this pain. To address this, we first undertook a retrospective analysis of pain reports in a JIA patient cohort with the aim of identifying potential factors contributing to persistent pain. We then carried out an experimental laboratory study, using joint inflammatory pain behaviour in rodents, to validate the role of these factors in the onset of persistent pain under controlled conditions. METHODS Patients: Retrospective analysis of anonymised pain visual analogue scale (VAS) scores and accompanying clinical scores from 97 JIA patients aged 13-19 (mean: 16.40 ± 1.21) collected over 50 weeks. Rats: Experimental study of pain behaviour following intra-articular microinjection of complete Freund's adjuvant (CFA) in adolescents (n = 25) and young adults (n = 43). Some animals (n = 21) had been previously exposed to joint inflammation in infancy or adolescence. RESULTS Patients: Cluster analysis of patient pain VAS scores revealed three trajectories over 50 weeks: consistently low pain (n = 45), variable pain (n = 30) and persistently high pain (n = 22). Number of actively inflamed joints did not differ in the three groups. High pain at a single visit correlated with greater physician global assessment of disease activity, while a high pain trajectory over 50 weeks was associated with more limited joints but fewer actively inflamed joints. Rats: Rodents administered ankle joint CFA also exhibit low, medium and high joint pain sensitivities, independent of joint inflammation. Prolonged inflammatory pain behaviour was associated with high background pain sensitivity, following joint inflammation at an earlier stage in life. CONCLUSIONS Both JIA patients and rodents differ in their individual pain sensitivity independent of the concurrent joint inflammation. Using experimental animal models allows us to isolate physiological factors underlying these differences, independently of social or clinical factors. The results suggest that a history of prior arthritic activity/joint inflammation may contribute to high pain sensitivity in adolescents with JIA.
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Affiliation(s)
- Annastazia E. Learoyd
- 0000000121901201grid.83440.3bDepartment of Neuroscience, Physiology & Pharmacology, University College London, London, UK
| | - Debajit Sen
- 0000000121901201grid.83440.3bArthritis Research UK Centre for Adolescent Rheumatology, University College London, London, UK
| | - Maria Fitzgerald
- Department of Neuroscience, Physiology & Pharmacology, University College London, London, UK.
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15
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Pas R, Ickmans K, Van Oosterwijck S, Van der Cruyssen K, Foubert A, Leysen L, Nijs J, Meeus M. Hyperexcitability of the Central Nervous System in Children with Chronic Pain: A Systematic Review. PAIN MEDICINE 2019; 19:2504-2514. [PMID: 29304243 DOI: 10.1093/pm/pnx320] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Objective Hyperexcitability of the central nervous system plays an important role in the development and maintenance of chronic pain in adults. This knowledge has led to improved treatment strategies within this population. In children, however, research on the presence of central hyperexcitability is scarce. To further investigate this topic in children with chronic pain, there is a need for a clear literature overview. Design Systematic review. Methods The literature search was performed using the electronic databases PubMed and Web of Science. An article was considered eligible if it included children (age two to 12 years) diagnosed with chronic pain. Articles had to report original research outcomes related to central hyperexcitability, and a comparison with a healthy control group was necessary. Characteristics of the study sample, the assessment, and conclusions regarding central hyperexcitability were extracted from each included article. Results Twelve case-control studies were included with moderate to good methodological quality (510 children with chronic pain and 670 healthy controls). After summarizing the articles' results on indices of central hyperexcitability, we concluded that secondary hyperalgesia might be present in children with recurrent abdominal pain, juvenile fibromyalgia, and juvenile idiopathic arthritis. Preliminary evidence exists for altered cortical nociceptive processing in children with migraine and recurrent abdominal pain. Conclusion Based on the results of this review, central hyperexcitability might be present in in several pediatric chronic pain conditions. Further research on other manifestations of central hyperexcitability (e.g., bottom-up and top-down mechanisms and nociceptive brain changes) is necessary to provide firm evidence about its presence in children with chronic pain.
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Affiliation(s)
- Roselien Pas
- Pain in Motion International Research Group.,Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Kelly Ickmans
- Pain in Motion International Research Group.,Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Belgium
| | - Sophie Van Oosterwijck
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Kelly Van der Cruyssen
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Anthe Foubert
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Laurence Leysen
- Pain in Motion International Research Group.,Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Jo Nijs
- Pain in Motion International Research Group.,Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Belgium
| | - Mira Meeus
- Pain in Motion International Research Group.,Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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16
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Bourdier P, Saidi O, Rochette E, Ratel S, Merlin E, Pereira B, Duché P. Physical activity and sedentary levels in children with juvenile idiopathic arthritis and inflammatory bowel disease. A systematic review and meta-analysis. Pediatr Res 2019; 86:149-156. [PMID: 31029060 DOI: 10.1038/s41390-019-0409-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 03/28/2019] [Accepted: 04/16/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Physical activity (PA) is essential for children throughout their growth and maturation. It improves physiological and psychological health and limits the risk of developing metabolic disorders. However, some chronic physiological and metabolic diseases may lead to decreased PA. The diversity of outcomes in the literature offers no consensus for physical activity and sedentary levels in children with juvenile idiopathic arthritis (JIA) or inflammatory bowel disease (IBD). METHODS A literature review and a meta-analysis were carried out with original studies from a Medline database search. Only high-quality studies (STROBE checklist) written in English comparing PA level or sedentary behavior (SB) between children with the disorders and their healthy peers were considered. The aim was to examine PA and SB in children with JIA or IBD compared to their healthy peers. RESULTS The literature review and meta-analysis identified decreased PA and increased time spent in SB in these populations, which may exacerbate both their lower physical fitness and the symptoms of their health disorders. CONCLUSION Results nevertheless show discrepancies due to the different materials and methods used and the variables measured. Further studies are needed to establish a gold standard method for assessing PA level in these populations.
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Affiliation(s)
- Pierre Bourdier
- Laboratoire des Adaptations Métaboliques en conditions Physiologiques et Physiopathologiques (AME2P), Université Clermont Auvergne, 3533, Clermont-Ferrand, France.,CRNH-Auvergne, 63000, Clermont-Ferrand, France
| | - Oussama Saidi
- Laboratoire des Adaptations Métaboliques en conditions Physiologiques et Physiopathologiques (AME2P), Université Clermont Auvergne, 3533, Clermont-Ferrand, France.,CRNH-Auvergne, 63000, Clermont-Ferrand, France
| | - Emmanuelle Rochette
- CRNH-Auvergne, 63000, Clermont-Ferrand, France.,CHU Clermont-Ferrand, Pédiatrie, Hôpital Estaing, 63000, Clermont-Ferrand, France.,Université Clermont Auvergne, INSERM, CIC 1405, Unité CRECHE, 63000, Clermont-Ferrand, France.,Université de Toulon, Laboratoire IAPS, 83041, Toulon, France
| | - Sébastien Ratel
- Laboratoire des Adaptations Métaboliques en conditions Physiologiques et Physiopathologiques (AME2P), Université Clermont Auvergne, 3533, Clermont-Ferrand, France.,CRNH-Auvergne, 63000, Clermont-Ferrand, France
| | - Etienne Merlin
- CHU Clermont-Ferrand, Pédiatrie, Hôpital Estaing, 63000, Clermont-Ferrand, France.,Université Clermont Auvergne, INSERM, CIC 1405, Unité CRECHE, 63000, Clermont-Ferrand, France.,Université Clermont Auvergne, INRA, UMR 1019 UNH, ECREIN, 63000, Clermont-Ferrand, France
| | - Bruno Pereira
- CHU Clermont-Ferrand, Délégation de la Recherche Clinique et Innovations, 63000, Clermont-Ferrand, France
| | - Pascale Duché
- Université de Toulon, Laboratoire IAPS, 83041, Toulon, France.
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17
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Jacobse J, ten Voorde W, Rissmann R, Burggraaf J, ten Cate R, Schrier L. The effect of repeated methotrexate injections on the quality of life of children with rheumatic diseases. Eur J Pediatr 2019; 178:17-20. [PMID: 30448866 PMCID: PMC6311192 DOI: 10.1007/s00431-018-3286-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 10/29/2018] [Accepted: 11/02/2018] [Indexed: 11/30/2022]
Abstract
In clinical practice, the burden of repeated injections in children with rheumatic disease receiving disease-modifying anti-rheumatic drugs is significant. To investigate the nature and extent of impact on the quality of life after repeated injections, we conducted a literature review. Two relevant papers were identified, both about children with juvenile idiopathic arthritis (JIA) being administered methotrexate. The results suggest that the combination of needle fear, impact of methotrexate treatment, and procedural consequences, e.g., blood sampling, all contribute to the distress and the loss of quality of life of children with JIA. Remarkably, no studies examining fear of injections or injection pain in children with rheumatic diseases receiving biologicals were identified.Conclusion: Strategies to optimize administration of disease modifying anti-rheumatic drugs should be systematically investigated. What is Known: • Repeated parenteral administration of drugs is burdensome for children with rheumatic diseases. What is New: • Needle fear should be investigated systematically to optimize administration of disease-modifying anti-rheumatic drugs.
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Affiliation(s)
- Justin Jacobse
- Department of Pediatric Rheumatology Willem-Alexander Children’s Hospital, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands ,Centre for Human Drug Research, Zernikedreef 8, 2333 CL Leiden, The Netherlands ,Leiden Academic Center for Drug Research, Einsteinweg 55, 2333 CC Leiden, The Netherlands
| | - Wouter ten Voorde
- Centre for Human Drug Research, Zernikedreef 8, 2333 CL Leiden, The Netherlands ,Leiden Academic Center for Drug Research, Einsteinweg 55, 2333 CC Leiden, The Netherlands
| | - Robert Rissmann
- Centre for Human Drug Research, Zernikedreef 8, 2333 CL Leiden, The Netherlands ,Leiden Academic Center for Drug Research, Einsteinweg 55, 2333 CC Leiden, The Netherlands
| | - Jacobus Burggraaf
- Centre for Human Drug Research, Zernikedreef 8, 2333 CL Leiden, The Netherlands ,Leiden Academic Center for Drug Research, Einsteinweg 55, 2333 CC Leiden, The Netherlands
| | - Rebecca ten Cate
- Department of Pediatric Rheumatology Willem-Alexander Children’s Hospital, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Lenneke Schrier
- Department of Pediatric Rheumatology Willem-Alexander Children's Hospital, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
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18
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Unal E, Batu ED, Sonmez HE, Arici ZS, Arin G, Karaca NB, Sag E, Demir S, Hakli DA, Ozcadirci A, Oflaz FB, Alpar R, Bilginer Y, Ozen S. A new biopsychosocial and clinical questionnaire to assess juvenile idiopathic arthritis: JAB-Q. Rheumatol Int 2018; 38:1557-1564. [PMID: 29869009 DOI: 10.1007/s00296-018-4075-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 05/31/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To create a new multidimensional questionnaire for the assessment of juvenile idiopathic arthritis (JIA) patients in standard clinical practice and study the validity and reliability of this questionnaire. METHODS The Juvenile Arthritis Biopsychosocial and Clinical Questionnaire (JAB-Q) was created using the Delphi technique and consensus conference following an initial literature search. The questionnaire has three parts including a clinician form, child form and parent form. This is a patient/parent-centered outcome tool, which helps us to evaluate the biopsychosocial aspects of the patient, including disease activity, posture, functional and psychosocial status, fatigue, and performance in school. From January 2015 to January 2018, 6-18 years old children with JIA were enrolled in the study. The previously validated questionnaires were also applied to each participant to validate the JAB-Q: Juvenile Idiopathic Disease Arthritis Score (JADAS) and Childhood Health Assessment Questionnaire (CHAQ), and the Family Impact Questionnaire (FIS). The same questionnaire was re-administered after one week to assess the test-retest reliability in randomly selected 50 children and their parents. RESULTS A group of experts were invited to the Delphi survey. After the Delphi tours, the final form of the questionnaire containing three parts as clinician form, child form and parent form was created. This tool was applied to 310 JIA patients and their parents. The children and parents easily handled the JAB-Q and filled the forms in around 10-15 min. The validity of the clinician, child and parents' forms were assessed by the JADAS, CHAQ, and FIS, respectively. The validity of these three scales were determined as moderate. In addition, the test-retest reliability of the clinician, child and parents' forms were considerably high. CONCLUSION JAB-Q is a valid and reliable multidimensional biopsychosocial outcome tool that can be used routinely in clinical practice of pediatric rheumatology. The main advantage of this tool is incorporation of patients' and parents' perspectives separately while providing a practical and standard setting for the clinician's evaluation. However, further validation of this tool in an independent cohort is needed to improve its applicability.
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Affiliation(s)
- Edibe Unal
- Department of Physical Therapy and Rehabilitation, Hacettepe University Faculty of Health Sciences, Ankara, Turkey
| | - Ezgi Deniz Batu
- Department of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Hafize Emine Sonmez
- Department of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Zehra Serap Arici
- Department of Pediatric Rheumatology, Şanlıurfa Training and Research Hospital, Şanlıurfa, Turkey
| | - Gamze Arin
- Department of Physical Therapy and Rehabilitation, Hacettepe University Faculty of Health Sciences, Ankara, Turkey
| | - Nur Banu Karaca
- Department of Physical Therapy and Rehabilitation, Hacettepe University Faculty of Health Sciences, Ankara, Turkey
| | - Erdal Sag
- Department of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Selcan Demir
- Department of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Duygu Aydin Hakli
- Department of Biostatistics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Aykut Ozcadirci
- Department of Physical Therapy and Rehabilitation, Hacettepe University Faculty of Health Sciences, Ankara, Turkey
| | - Fatma Birgul Oflaz
- Department of Physical Therapy and Rehabilitation, Hacettepe University Faculty of Health Sciences, Ankara, Turkey
| | - Reha Alpar
- Department of Biostatistics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Yelda Bilginer
- Department of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Seza Ozen
- Department of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey. .,Department of Pediatrics, Division of Rheumatology, Hacettepe University Faculty of Medicine, 06100, Ankara, Turkey.
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19
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Condon C, O’Regan D, MacDermott E, Killeen O. Self-management needs of children with JIA in Ireland: a qualitative survey of families. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2017. [DOI: 10.1080/21679169.2017.1342865] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Cillin Condon
- Physiotherapy Discipline, Trinity College Dublin, Dublin, Ireland
| | - David O’Regan
- Physiotherapy Discipline, Trinity College Dublin, Dublin, Ireland
| | - Emma MacDermott
- Pediatric Rheumatology, Our Lady’s Hospital for Children, Dublin, Ireland
| | - Orla Killeen
- Pediatric Rheumatology, Our Lady’s Hospital for Children, Dublin, Ireland
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Malfliet A, Leysen L, Pas R, Kuppens K, Nijs J, Van Wilgen P, Huysmans E, Goudman L, Ickmans K. Modern pain neuroscience in clinical practice: applied to post-cancer, paediatric and sports-related pain. Braz J Phys Ther 2017; 21:225-232. [PMID: 28579013 PMCID: PMC5537480 DOI: 10.1016/j.bjpt.2017.05.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 01/10/2017] [Accepted: 01/25/2017] [Indexed: 12/18/2022] Open
Abstract
Generalized hypersensitivity in post-cancer, sports-related and pediatric pain. Rationale for pain education, stress management and cognition targeted exercises. Need to change from a biomedical or psychosocial to an integrated approach.
In the last decade, evidence regarding chronic pain has developed exponentially. Numerous studies show that many chronic pain populations show specific neuroplastic changes in the peripheral and central nervous system. These changes are reflected in clinical manifestations, like a generalized hypersensitivity of the somatosensory system. Besides a hypersensitivity of bottom-up nociceptive transmission, there is also evidence for top-down facilitation of pain due to malfunctioning of the endogenous descending nociceptive modulatory systems. These and other aspects of modern pain neuroscience are starting to be applied within daily clinical practice. However, currently the application of this knowledge is mostly limited to the general adult population with musculoskeletal problems, while evidence is getting stronger that also in other chronic pain populations these neuroplastic processes may contribute to the occurrence and persistence of the pain problem. Therefore, this masterclass article aims at giving an overview of the current modern pain neuroscience knowledge and its potential application in post-cancer, paediatric and sports-related pain problems.
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Affiliation(s)
- Anneleen Malfliet
- Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Belgium; Pain in Motion International Research Group,(◊); Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Belgium; Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Belgium.
| | - Laurence Leysen
- Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Belgium; Pain in Motion International Research Group,(◊)
| | - Roselien Pas
- Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Belgium; Pain in Motion International Research Group,(◊); Department of Rehabilitation Sciences and Physiotherapy (REVAKI), Faculty of Medicine and Health Sciences, University of Antwerp, Belgium
| | - Kevin Kuppens
- Pain in Motion International Research Group,(◊); Department of Rehabilitation Sciences and Physiotherapy (REVAKI), Faculty of Medicine and Health Sciences, University of Antwerp, Belgium
| | - Jo Nijs
- Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Belgium; Pain in Motion International Research Group,(◊); Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Belgium
| | - Paul Van Wilgen
- Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Belgium; Pain in Motion International Research Group,(◊); Transcare, Transdisciplinary Pain-management Centre,(◊◊) The Netherlands
| | - Eva Huysmans
- Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Belgium; Pain in Motion International Research Group,(◊)
| | - Lisa Goudman
- Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Belgium; Pain in Motion International Research Group,(◊); Department of Neurosurgery, University Hospital Brussels, Brussels, Belgium
| | - Kelly Ickmans
- Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Belgium; Pain in Motion International Research Group,(◊); Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Belgium
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21
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Bos GJFJ, Lelieveld OTHM, Armbrust W, Sauer PJJ, Geertzen JHB, Dijkstra PU. Physical activity in children with Juvenile Idiopathic Arthritis compared to controls. Pediatr Rheumatol Online J 2016; 14:42. [PMID: 27387754 PMCID: PMC4936199 DOI: 10.1186/s12969-016-0102-8] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Accepted: 06/30/2016] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND To compare physical activity (PA) in children with juvenile idiopathic arthritis (JIA) with controls and to analyse the effect of disease specific factors on PA in children with JIA treated according to current treatment regimes. METHODS PA was measured with a 7-day activity diary and expressed as physical activity level (PAL). Moderate to vigorous physical activity (MVPA) (hours/day) and sedentary time (hours/day) was determined. In children with JIA, medication, the number of swollen and/or painful joints, disease activity, functional ability, pain and well-being was determined. Multivariate regression analysis was performed to analyze differences in PA between JIA and controls, adjusted for influences of age, gender, season, Body Mass Index (BMI) and to analyze predictors of PA in JIA patients. RESULTS Seventy-six children with JIA (26 boys and 50 girls, mean ± SD age 10.0 ± 1.4 years) and 131 controls (49 boys and 82 girls, mean ± SD age 10.4 ± 1.2 years) participated in this study. Children with JIA had a significantly lower PAL (0.10, p = 0.01) corrected for age, BMI, gender and season. They spent less time in MVPA (0.41 h/day, p = 0.06) and had a significantly higher mean time spent in sedentary activities (0.59 h/day, p 0.02) compared to controls. The activity level of children with JIA was related to age, gender, season, feeling of well-being and pain. CONCLUSION Children with JIA have a lower PAL, spent less time in MVPA and spent more time on sedentary activities compared to controls despite current medical treatment and PA encouragement. TRIAL REGISTRATION Data of the children with JIA are from the Rheumates@work study ISRCTN92733069 .
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Affiliation(s)
- G. J. F. Joyce Bos
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, PO Box 30001, 9700 RB Groningen, The Netherlands
| | - Otto T. H. M. Lelieveld
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, PO Box 30001, 9700 RB Groningen, The Netherlands
| | - Wineke Armbrust
- Department of Pediatric Rheumatology, University of Groningen, University Medical Center Groningen, Beatrix Children’s Hospital, PO Box 30001, 9700 RB Groningen, The Netherlands
| | - Pieter J. J. Sauer
- University of Groningen, University Medical Center Groningen, Beatrix Children’s Hospital, PO Box 30001, 9700 RB Groningen, The Netherlands
| | - Jan H. B. Geertzen
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, PO Box 30001, 9700 RB Groningen, The Netherlands
| | - Pieter U. Dijkstra
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, PO Box 30001, 9700 RB Groningen, The Netherlands ,Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, PO Box 30001, 9700 RB Groningen, The Netherlands
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Nørgaard M, Lomholt JJ, Thastum M, Herlin M, Twilt M, Herlin T. Accelerometer-assessed daily physical activity in relation to pain cognition in juvenile idiopathic arthritis. Scand J Rheumatol 2016; 46:22-26. [DOI: 10.3109/03009742.2016.1160146] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- M Nørgaard
- Department of Physiotherapy, Unit of Paediatrics, Aarhus University Hospital, Aarhus, Denmark
| | - JJ Lomholt
- Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
| | - M Thastum
- Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
| | - M Herlin
- Department of Paediatrics, Division of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
| | - M Twilt
- Department of Paediatrics, Division of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
| | - T Herlin
- Department of Paediatrics, Division of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
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The Effects of Orthopedic Manual Physical Therapy in the Management of Juvenile Idiopathic Arthritis: A Case Report. Pediatr Phys Ther 2016; 28:490-7. [PMID: 27661250 DOI: 10.1097/pep.0000000000000319] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Juvenile idiopathic arthritis (JIA) is a cause of disability in childhood. Little research exists concerning physical therapy management, and no evidence exists for orthopedic manual physical therapy (OMPT) for JIA. The purpose of this case report is to describe the use of OMPT in combination with therapeutic exercise in the successful treatment of a child with oligoarticular JIA. KEY POINTS A 6-year-old girl with oligoarticular JIA presented with elbow pain and stiffness interfering with function. Treatment consisted of OMPT in combination with therapeutic exercise and a home exercise program. CONCLUSIONS Improvements were demonstrated in elbow range of motion, pain, Childhood Health Assessment Questionnaire, Pediatric Outcomes Data Collection Instrument, and the Patient Specific Functional Scale. RECOMMENDATIONS FOR CLINICAL PRACTICE Orthopedic manual physical therapy may be considered as a treatment of a child with JIA. RECOMMENDATIONS We provide evidence that OMPT may be considered as a treatment of a child with JIA.
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Falk S, Ipsen DH, Appel CK, Ugarak A, Durup D, Dickenson AH, Heegaard AM. Randall Selitto pressure algometry for assessment of bone-related pain in rats. Eur J Pain 2015; 19:305-12. [PMID: 25057115 DOI: 10.1002/ejp.547] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2014] [Indexed: 12/27/2022]
Abstract
BACKGROUND Deep pain is neglected compared with cutaneous sources. Pressure algometry has been validated in the clinic for assessment of bone-related pain in humans. In animal models of bone-related pain, we have validated the Randall Selitto behavioural test for assessment of acute and pathological bone pain and compared the outcome with more traditional pain-related behaviour measures. METHODS Randall Selitto pressure algometry was performed over the anteromedial part of the tibia in naïve rats, sham-operated rats, and rats inoculated with MRMT-1 carcinoma cells in the left tibia, and the effect of morphine was investigated. Randall Selitto measures of cancer-induced bone pain were supplemented by von Frey testing, weight-bearing and limb use test. Contribution of cutaneous nociception to Randall Selitto measures were examined by local anaesthesia. RESULTS Randall Selitto pressure algometry over the tibia resulted in reproducible withdrawal thresholds, which were dose-dependently increased by morphine. Cutaneous nociception did not contribute to Randall Selitto measures. In cancer-bearing animals, compared with sham, significant differences in pain-related behaviours were demonstrated by the Randall Selitto test on day 17 and 21 post-surgery. A difference was also demonstrated by von Frey testing, weight-bearing and limb use tests. CONCLUSION Our results indicate that pressure applied by the Randall Selitto algometer on a region, where the bone is close to the skin, may offer a way to measure bone-related pain in animal models and could provide a supplement to the traditional behavioural tests and a means to study deep pain.
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Affiliation(s)
- S Falk
- Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Taxter AJ, Wileyto EP, Behrens EM, Weiss PF. Patient-reported Outcomes across Categories of Juvenile Idiopathic Arthritis. J Rheumatol 2015; 42:1914-21. [PMID: 26329337 DOI: 10.3899/jrheum.150092] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Although there is increasing reliance on patient-reported outcomes (PRO) for disease management, there is little known about the differences in PRO across juvenile idiopathic arthritis (JIA) categories. The purpose of our study was to assess PRO across JIA categories, including pain, quality of life, and physical function, and to determine clinical factors associated with differences in these measures across categories. METHODS This was a longitudinal cohort study of patients with JIA at a tertiary care pediatric rheumatology clinic. Subjects, PRO, and clinical variables were identified by querying the electronic medical record. Mixed-effects regression assessed pain, quality of life, and function. RESULTS Subjects with enthesitis-related arthritis (ERA) and undifferentiated JIA had significantly more pain, poorer quality of life, and poorer physical function. The ERA and undifferentiated JIA categories, physician's global disease activity assessment, female sex, and nonsteroidal antiinflammatory drug use were significantly associated with more pain, poorer quality of life, and poorer function. In models limited to ERA, female sex and tender enthesis count were significant predictors of decreased function. CONCLUSION ERA and undifferentiated JIA categories had poorer PRO than other JIA categories. Further work is needed to address ways to improve PRO in children with JIA, with a special focus on children with ERA and undifferentiated JIA.
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Affiliation(s)
- Alysha J Taxter
- From the Department of Pediatric Rheumatology, and Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia; Center for Epidemiology and Biostatistics, The University of Pennsylvania, Philadelphia, Pennsylvania, USA.A.J. Taxter, MD, Fellow, Department of Pediatric Rheumatology, The Children's Hospital of Philadelphia; E.P. Wileyto, PhD, Associate Professor, Center for Epidemiology and Biostatistics, The University of Pennsylvania; E.M. Behrens, MD, Associate Professor, Department of Pediatric Rheumatology, The Children's Hospital of Philadelphia; P.F. Weiss, MD, MSCE, Associate Professor, Department of Pediatric Rheumatology, and Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia
| | - E Paul Wileyto
- From the Department of Pediatric Rheumatology, and Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia; Center for Epidemiology and Biostatistics, The University of Pennsylvania, Philadelphia, Pennsylvania, USA.A.J. Taxter, MD, Fellow, Department of Pediatric Rheumatology, The Children's Hospital of Philadelphia; E.P. Wileyto, PhD, Associate Professor, Center for Epidemiology and Biostatistics, The University of Pennsylvania; E.M. Behrens, MD, Associate Professor, Department of Pediatric Rheumatology, The Children's Hospital of Philadelphia; P.F. Weiss, MD, MSCE, Associate Professor, Department of Pediatric Rheumatology, and Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia
| | - Edward M Behrens
- From the Department of Pediatric Rheumatology, and Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia; Center for Epidemiology and Biostatistics, The University of Pennsylvania, Philadelphia, Pennsylvania, USA.A.J. Taxter, MD, Fellow, Department of Pediatric Rheumatology, The Children's Hospital of Philadelphia; E.P. Wileyto, PhD, Associate Professor, Center for Epidemiology and Biostatistics, The University of Pennsylvania; E.M. Behrens, MD, Associate Professor, Department of Pediatric Rheumatology, The Children's Hospital of Philadelphia; P.F. Weiss, MD, MSCE, Associate Professor, Department of Pediatric Rheumatology, and Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia
| | - Pamela F Weiss
- From the Department of Pediatric Rheumatology, and Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia; Center for Epidemiology and Biostatistics, The University of Pennsylvania, Philadelphia, Pennsylvania, USA.A.J. Taxter, MD, Fellow, Department of Pediatric Rheumatology, The Children's Hospital of Philadelphia; E.P. Wileyto, PhD, Associate Professor, Center for Epidemiology and Biostatistics, The University of Pennsylvania; E.M. Behrens, MD, Associate Professor, Department of Pediatric Rheumatology, The Children's Hospital of Philadelphia; P.F. Weiss, MD, MSCE, Associate Professor, Department of Pediatric Rheumatology, and Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia.
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Schrimpf M, Liegl G, Boeckle M, Leitner A, Geisler P, Pieh C. The effect of sleep deprivation on pain perception in healthy subjects: a meta-analysis. Sleep Med 2015; 16:1313-1320. [PMID: 26498229 DOI: 10.1016/j.sleep.2015.07.022] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 07/17/2015] [Accepted: 07/23/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND There is strong evidence indicating an interaction between sleep and pain. However, the size of this effect, as well as the clinical relevance, is unclear. Therefore, this meta-analysis was conducted to quantify the effect of sleep deprivation on pain perception. METHODS A systematic literature search was conducted using the electronic databases PubMed, Cochrane, Psyndex, Psycinfo, and Scopus. By conducting a random-effect model, the pooled standardized mean differences (SMDs) of sleep deprivation on pain perception was calculated. Studies that investigated any kind of sleep deprivation in conjunction with a pain measurement were included. In cases of several pain measurements within a study, the average effect size of all measures was calculated. RESULTS Five eligible studies (N = 190) for the between-group analysis and ten studies (N = 266) for the within-group analysis were identified. Sleep deprivation showed a medium effect in the between-group analysis (SMD = 0.62; CI95: 0.12, 1.12; z = 2.43; p = 0.015) and a large effect in the within-group analysis (SMD = 1.49; CI95: 0.82, 2.17; z = 4.35; p <0.0001). The test for heterogeneity was not significant in the between-group analysis (Q = 5.29; df = 4; p = 0.2584), but it was significant in the within-group analysis (Q = 53.49; df = 9; p <0.0001). CONCLUSION This meta-analysis confirms a medium effect (SMD = 0.62) of sleep deprivation on pain perception. As this meta-analysis is based on experimental studies in healthy subjects, the clinical relevance should be clarified.
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Affiliation(s)
- Marlene Schrimpf
- Department of Psychotherapy and Biopsychosocial Health, Danube-University Krems, Dr. Karl Dorrek Straße 30, A-3500 Krems, Austria
| | - Gregor Liegl
- Department of Psychotherapy and Biopsychosocial Health, Danube-University Krems, Dr. Karl Dorrek Straße 30, A-3500 Krems, Austria; Medical Clinic, Department of Psychosomatic Medicine, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Markus Boeckle
- Department of Psychotherapy and Biopsychosocial Health, Danube-University Krems, Dr. Karl Dorrek Straße 30, A-3500 Krems, Austria
| | - Anton Leitner
- Department of Psychotherapy and Biopsychosocial Health, Danube-University Krems, Dr. Karl Dorrek Straße 30, A-3500 Krems, Austria
| | - Peter Geisler
- Department of Psychiatry and Psychotherapy, University Hospital Regensburg, Universitätsstraße 84, 93053 Regensburg, Germany
| | - Christoph Pieh
- Department of Psychotherapy and Biopsychosocial Health, Danube-University Krems, Dr. Karl Dorrek Straße 30, A-3500 Krems, Austria; Department of Psychosomatic Medicine, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany; Karl Landsteiner University of Health Sciences, Dr.-Karl-Dorrek-Straße 30, 3500 Krems, Austria.
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Bromberg MH, Schechter NL, Nurko S, Zempsky WT, Schanberg LE. Persistent pain in chronically ill children without detectable disease activity. Pain Manag 2015; 4:211-9. [PMID: 24953073 DOI: 10.2217/pmt.14.6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Children with organic diseases may experience persistent pain in the presence of controlled disease, as evidenced by little or no measurable disease activity or inflammation. Historically, dualistic definitions of pain have informed standard diagnostic approaches to persistent pain; aggressive investigation and treatment targeting underlying disease, even in the absence of evidence indicating disease escalation. Evidence across disease populations, in children with inflammatory bowel disease, sickle cell disease, and juvenile idiopathic arthritis indicates that persistent pain in these conditions may be better conceptualized as functional in nature, potentially resulting from disordered somatosensory processing including central sensitization. Applying a biopsychosocial understanding of persistent pain and multidisciplinary functional pain management strategies may lead to improved health outcomes.
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Affiliation(s)
- Maggie H Bromberg
- Center for Child Health, Behavior, & Development, Seattle Children's Research Institute, M/S CW8-6, PO Box 5371, Seattle, WA 98145, USA
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Abstract
Juvenile idiopathic arthritis (JIA) is the most common chronic rheumatic disease in childhood. Persistent pain is the most common and distressing symptom of JIA, and pain in childhood arthritis is multifactorial. Children and adolescents with persistent pain due to JIA experience significantly more problems with physical, emotional, social, and school functioning than healthy individuals. Assessment of pain at each office visit is the cornerstone of effective pain management and should include an evaluation of pain intensity, interference, and coping. Following the biopsychosocial model of pain management, a multi-modal approach is recommended for pain control in children with arthritis. Pharmacologic strategies for the treatment of pain in JIA include aggressive treatment of the underlying disease as well as the use of acetaminophen and systemic and topical non-steroidal anti-inflammatory drugs for persistent mild pain. Opioids can be considered in the case of moderate to severe persistent pain. Physical therapies and psychological interventions such as cognitive behavioral therapy are also key components of pain management in JIA.
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Dijkstra ME, Anink J, van Pelt PA, Hazes JM, van Suijlekom-Smit LW. Patient-reported Joint Count in Juvenile Idiopathic Arthritis: The Reliability of a Manikin Format. J Rheumatol 2014; 42:527-33. [DOI: 10.3899/jrheum.140073] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective.To evaluate the reliability of a manikin format, patient-reported joint count in juvenile idiopathic arthritis (JIA), and to detect changes in agreement at a second visit.Methods.Patients with JIA aged 12–21 were asked to mark joints with active arthritis on a manikin before their regular clinic visit. The physician then performed a joint count without having seen the patient’s assessment. Agreement between scores of physician-reported and patient-reported joint counts was assessed using ICC. Kappa statistics were used to assess reliability of scoring individual joints.Results.The study included 75 patients with JIA. In general, patients had a low number of active joints (median 1 joint, indicated by the physician). ICC was moderate (0.61) and κ ranged from 0.3–0.7. At the second visit, κ were similar; the ICC was 0.19. When a patient scored 0 joints, the physician confirmed this 93%–100% of the time. When the patient marked ≥ 1 joints, the physician confirmed arthritis 59%–76% of the time. Sensitivity to change was moderate.Conclusion.Agreement between physician and patient on the number of joints with active arthritis was reasonable. Untrained patients tended to overestimate the presence of arthritis when they marked active joints on a manikin-format joint count. When the patient indicated absence of arthritis, the physician usually confirmed this. As the agreement did not improve at followup, future research should focus on the possibility of achieving this through training. For now, the patient-reported joint count cannot replace the physicians’ joint count in clinical practice; it may be used in epidemiological studies with caution.
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Cornelissen L, Donado C, Kim J, Chiel L, Zurakowski D, Logan DE, Meier P, Sethna NF, Blankenburg M, Zernikow B, Sundel RP, Berde CB. Pain hypersensitivity in juvenile idiopathic arthritis: a quantitative sensory testing study. Pediatr Rheumatol Online J 2014; 12:39. [PMID: 25249820 PMCID: PMC4171552 DOI: 10.1186/1546-0096-12-39] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 09/01/2014] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Juvenile Idiopathic Arthritis (JIA) is the most common cause of non-infectious joint inflammation in children. Synovial inflammation results in pain, swelling and stiffness. Animal and adult human studies indicate that localized joint-associated inflammation may produce generalized changes in pain sensitivity. The aim was to characterize pain sensitivity in children with JIA to mechanical and thermal stimulus modalities using quantitative sensory testing (QST) at an affected inflamed joint, and compare to children in clinical remission. Generalized hypersensitivity was evaluated by comparing QST measures at the thenar eminence between JIA and healthy control children. METHODS 60 children aged 7-17 years with JIA participated. QST assessed sensory detection threshold and pain threshold at two sites: (1) affected joint (clinically active or inactive), (2) contralateral thenar eminence. Joint site included finger, wrist, knee and ankle. Clinical status was measured using objective and subjective markers of disease severity. Questionnaires assessed pain intensity and frequency, functional disability, anxiety, pain catastrophization and fatigue. QST data collected from joints were compared within JIA patients: active vs. inactive inflammation; and data from the contralateral thenar eminence were compared between JIA and healthy control cohorts in Europe [EU, (n = 151)] and the US (n = 92). Statistical analyses were performed using Kruskal-Wallis with Dunn's post-hoc comparison, Mann-Whitney or Fisher's exact test, where appropriate. RESULTS Overall, children with JIA reported low pain scores and low degrees of functional disability. Sensory detection thresholds and pain thresholds were similar in "active" compared to "inactive" joints. Despite this, children with JIA had generalized hypersensitivity at the thenar eminence when compared to healthy children for pressure (vs. EU p < 0.001), light touch (vs. EU p < 0.001), cold (vs EU, p < 0.01; vs US, p < 0.001) and heat pain (vs EU, p < 0.05; vs US p < 0.001). CONCLUSIONS JIA is associated with increased sensitivity to painful mechanical and thermal stimuli, even in absence of pain reports, or markers of disease activity. Future research investigating mechanisms underlying pain hypersensitivity in JIA is warranted; this will in turn guide pharmacologic and non-pharmacologic interventions to prevent or reverse these processes.
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Affiliation(s)
- Laura Cornelissen
- Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children’s Hospital; Department of Anesthesia, Harvard Medical School, 333 Longwood Avenue, Boston, MA 02115 USA
| | - Carolina Donado
- Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children’s Hospital; Department of Anesthesia, Harvard Medical School, 333 Longwood Avenue, Boston, MA 02115 USA
| | - Joseph Kim
- Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children’s Hospital; Department of Anesthesia, Harvard Medical School, 333 Longwood Avenue, Boston, MA 02115 USA
| | - Laura Chiel
- Program in Rheumatology, Division of Immunology, Department of Medicine, Boston Children’s Hospital; Department of Pediatrics, Harvard Medical School Boston, Boston, USA
| | - David Zurakowski
- Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children’s Hospital; Department of Anesthesia, Harvard Medical School, 333 Longwood Avenue, Boston, MA 02115 USA
| | - Deirdre E Logan
- Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children’s Hospital; Department of Anesthesia, Harvard Medical School, 333 Longwood Avenue, Boston, MA 02115 USA ,Department of Psychiatry, Harvard Medical School, Boston, USA
| | - Petra Meier
- Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children’s Hospital; Department of Anesthesia, Harvard Medical School, 333 Longwood Avenue, Boston, MA 02115 USA
| | - Navil F Sethna
- Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children’s Hospital; Department of Anesthesia, Harvard Medical School, 333 Longwood Avenue, Boston, MA 02115 USA
| | - Markus Blankenburg
- Department of Pediatric Neurology, Psychosomatic Medicine and Pain Therapy, Center for Child and Adolescent Medicine Olgahospital, Klinikum, Stuttgart, Germany
| | - Boris Zernikow
- German Paediatric Pain Centre, Children’s and Adolescents’ Hospital, Datteln; Chair of Children’s Pain Therapy and Paediatric Palliative Care, Witten/Herdecke University, Datteln, Germany
| | - Robert P Sundel
- Program in Rheumatology, Division of Immunology, Department of Medicine, Boston Children’s Hospital; Department of Pediatrics, Harvard Medical School Boston, Boston, USA
| | - Charles B Berde
- Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children’s Hospital; Department of Anesthesia, Harvard Medical School, 333 Longwood Avenue, Boston, MA 02115 USA
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Abstract
Pain is a common presenting and often persistent symptom for children with rheumatological disease. Pain is not clearly related to disease severity in children with inflammatory juvenile idiopathic arthritis, and presentations of non-inflammatory musculoskeletal pain are common but there is limited evidence to guide management. Pain assessment must extend beyond measures of pain severity to more fully evaluate characteristics of pain, functional impact and psychosocial effects and family interactions. Evaluation of mechanisms of joint pain in adults has identified potential treatment targets, but additional studies are required as the acute and long-term impacts of pain and injury change during postnatal development. Genotyping, sensory evaluation and neuroimaging may better characterize chronic musculoskeletal pain, identify high-risk groups and/or provide additional outcome measures to monitor disease and treatment progress. An integrated approach to management is required to effectively select and target interventions, reduce pain and disability and improve long-term outcome.
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Lalloo C, Stinson JN. Assessment and treatment of pain in children and adolescents. Best Pract Res Clin Rheumatol 2014; 28:315-30. [DOI: 10.1016/j.berh.2014.05.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Weiss PF, Chauvin NA, Klink AJ, Localio R, Feudtner C, Jaramillo D, Colbert RA, Sherry DD, Keren R. Detection of enthesitis in children with enthesitis-related arthritis: dolorimetry compared to ultrasonography. Arthritis Rheumatol 2014; 66:218-27. [PMID: 24449586 DOI: 10.1002/art.38197] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Accepted: 09/10/2013] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To evaluate the distribution of enthesitis and the accuracy of physical examination with a dolorimeter for the detection of enthesitis in children, using ultrasound (US) assessment as the reference standard. METHODS We performed a prospective cross-sectional study of 30 patients with enthesitis-related arthritis (ERA) and 30 control subjects. The following tendon insertion sites were assessed by standardized physical examination with a dolorimeter and US: common extensor on the lateral humeral epicondyle, common flexor on the medial humeral epicondyle, quadriceps at the superior patella, patellar ligament at the inferior patella, Achilles, and plantar fascia at the calcaneus. RESULTS Abnormal findings on US were detected most commonly at the insertion of the quadriceps (30% [18 of 60 sites]), common extensor (12% [7 of 60]), and Achilles (10% [6 of 60]) tendons. The intrarater reliability of US (kappa statistic) was 0.78 (95% confidence interval [95% CI] 0.63-0.93), and the interrater reliability was 0.81 (95% CI 0.67-0.95). Tenderness as detected by standardized dolorimeter examination had poor positive predictive value for US-confirmed enthesitis. In comparison to controls, patients with ERA reported more pain and had lower pain thresholds at every site, including control sites (P < 0.001 for all comparisons). The interrater reliability of dolorimeter examination for detection of enthesitis was low (κ = 0.49 [95% CI 0.33-0.65]). CONCLUSION Compared to US, standardized dolorimeter examination for the detection of enthesitis in children has poor accuracy and reliability. The decreased pain threshold of ERA patients likely contributed to the limited accuracy of the physical examination findings. Further research regarding the utility of US for identifying enthesitis at diagnosis of juvenile idiopathic arthritis, accurately predicting disease progression, and guiding therapeutic decisions is warranted.
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Affiliation(s)
- Pamela F Weiss
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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de Lalouvière LLH, Ioannou Y, Fitzgerald M. Neural mechanisms underlying the pain of juvenile idiopathic arthritis. Nat Rev Rheumatol 2014; 10:205-11. [DOI: 10.1038/nrrheum.2014.4] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Armbrust W, Kaak JG, Bouma J, Lelieveld OTHM, Wulffraat NM, Sauer PJJ, van Sonderen E. Assessment of disease activity by patients with juvenile idiopathic arthritis and the parents compared to the assessment by pediatric rheumatologists. Pediatr Rheumatol Online J 2013; 11:48. [PMID: 24368009 PMCID: PMC3879656 DOI: 10.1186/1546-0096-11-48] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Accepted: 12/16/2013] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Self assessment of arthritis is important for recognition of disease activity and early initiation of therapy. Proper interpretation of physical symptoms is necessary for this. The purpose was to investigate the assessment by patients and parents of disease activity in juvenile idiopathic arthritis (JIA) and to compare their assessments to rheumatologists' assessments. METHODS Patients and parents assessed 69 joints on a paper homunculus and marked each joint with a different color according to presumed presence of disease: active disease (AD), doubt, and non-active disease (NAD). Their assessments were compared to the rheumatologists' assessments. If patients and/or parents marked an inflamed joint, it counted as AD. Pain, functional impairment, and disease duration were analyzed to differentiate more precise between true and false positive and true and false negative assessments. RESULTS We collected assessments of 113 patients and/or parents. AD was assessed 54 times, 33 of which were true positives. NAD was assessed 23 times, 22 of which were true negatives. Doubt was expressed 36 times, 9 of which were assessed by the rheumatologist as AD. Sensitivity and specificity of AD was 0.77 and 0.31. Pain and functional impairment scored highest in AD, intermediate in doubt, and lowest in NAD. CONCLUSION Patients and/or parents seldom missed arthritis but frequently overestimated disease activity. Pain, functional impairment, disease duration, gender, and age did not differentiate between true and false positives for. Patients perceived JIA as active if they experienced pain and functional impairment. To reduce overestimation of the presence of AD we need to improve their understanding of disease activity by teaching them to distinguish between primary symptoms of JIA and symptoms like pain and functional impairment.
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Affiliation(s)
- Wineke Armbrust
- Department of Pediatric Rheumatology, University Medical Center Groningen, Beatrix Children's Hospital, University of Groningen, Groningen, the Netherlands.
| | - Jolanda G Kaak
- University Medical Center Groningen, Beatrix Children’s Hospital, University of Groningen, Groningen, the Netherlands
| | - Jelte Bouma
- Department of Health Sciences, University Medical Center Groningen, Health Psychology Section, University of Groningen, Groningen, the Netherlands
| | - Otto T H M Lelieveld
- Department of Rehabilitation,University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Nico M Wulffraat
- Department of Childrens Rheumatology and Immunology, University Medical Center Utrecht, Wilhelmina Children’s Hospital, University of Utrecht, Utrecht, the Netherlands
| | - Pieter J J Sauer
- University Medical Center Groningen, Beatrix Children’s Hospital, University of Groningen, Groningen, the Netherlands
| | - Eric van Sonderen
- Department of Health Sciences, University Medical Center Groningen, Health Psychology Section, University of Groningen, Groningen, the Netherlands
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Van Oort C, Tupper SM, Rosenberg AM, Farthing JP, Baxter-Jones AD. Safety and feasibility of a home-based six week resistance training program in juvenile idiopathic arthritis. Pediatr Rheumatol Online J 2013; 11:46. [PMID: 24359015 PMCID: PMC3878188 DOI: 10.1186/1546-0096-11-46] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Accepted: 12/14/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Juvenile idiopathic arthritis (JIA), among the most common chronic diseases of childhood, can be associated with attenuated physical activity levels, reduced fitness, decreased functionality and pain. This pilot study aimed to determine the safety, feasibility and effect of a six week resistance training program in children with JIA. METHODS Youth (8-18 years) with JIA participated in a home-based resistance training program. Participants reported pain on an electronic diary once a day for one week prior to training, then once a day on non-exercise days and three times a day (before-exercise, after-exercise, and end-of-day) on exercise days for the subsequent six weeks of training. Secondary outcome measures included inflammation (assessed by ultrasound), muscle size (assessed by ultrasound), muscle strength (assessed by dynamometer) and functional ability (assessed by childhood health assessment questionnaire), measured at baseline and post-training. Participants were also instructed to wear an accelerometer one week prior to training to estimate baseline physical activity levels. Statistical analyses included safety (pain changes and any adverse events), feasibility (adherence to program and modifications made to exercises) and effect of program (differences in secondary measures pre and post training). An alpha level of p < 0.05 was accepted as significant. RESULTS Seven participants completed an average of 12.7 ± 3.4 (range 8-17) exercise sessions out of a possible 18 (70.6%). No adverse events were reported and pain did not increase over the seven weeks. Secondary measures revealed a significant increase in vastus lateralis thickness from pre to post training (p < 0.05). End-of-day pain intensity was correlated to end-of-day stiffness, fatigue and mood (r = .864, r = .581, r = -.637, respectively, p < 0.001). Pain intensity was also correlated with ratings of perceived exertion of the exercise (r = 0.324, p < 0.01). Only two children met the recommended 60 minutes of moderate to vigorous physical activity per day. CONCLUSIONS A six week home-based resistance training program is both safe (absence of pain changes or adverse events over the six weeks) and feasible (comparable adherence rates to other exercise studies involving JIA and individually modifiable) in children with JIA.
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Affiliation(s)
- Cameron Van Oort
- College of Kinesiology, University of Saskatchewan, 87 Campus Drive, Saskatoon, SK, S7N 5B2 Canada
| | - Susan M Tupper
- Saskatoon Health Region, University of Saskatchewan, 87 Campus Drive, Saskatoon, SK, S7N 5B2 Canada
| | - Alan M Rosenberg
- Department of Pediatrics, College of Medicine, University of Saskatchewan, 87 Campus Drive, Saskatoon, SK, S7N 5B2 Canada
| | - Jonathan P Farthing
- College of Kinesiology, University of Saskatchewan, 87 Campus Drive, Saskatoon, SK, S7N 5B2 Canada
| | - Adam D Baxter-Jones
- College of Kinesiology, University of Saskatchewan, 87 Campus Drive, Saskatoon, SK, S7N 5B2 Canada.
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MUNRO JANE, SINGH-GREWAL DAVINDER. Juvenile Idiopathic Arthritis and Pain — More Than Simple Nociception. J Rheumatol 2013; 40:1037-9. [DOI: 10.3899/jrheum.130557] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Lomholt JJ, Thastum M, Herlin T. Pain experience in children with juvenile idiopathic arthritis treated with anti-TNF agents compared to non-biologic standard treatment. Pediatr Rheumatol Online J 2013; 11:21. [PMID: 23641813 PMCID: PMC3653734 DOI: 10.1186/1546-0096-11-21] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Accepted: 04/30/2013] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Anti-TNF agents have proven efficacy in children with severe juvenile idiopathic arthritis (JIA) who are unresponsive to standard therapy. Therefore pain reduction or elimination could be expected. The aim of this study was to compare the pain experience in children with JIA treated with anti-TNF agents (n = 41) or non-biologic standard treatment (n = 50). METHODS All children completed a 2-week pain diary and, for children treated with anti-TNF agents, measures of pain-coping and pain-specific beliefs. Parents rated the child's level of functional disability. Clinical data were collected from the pediatric rheumatologists. RESULTS No significant differences were found between the anti-TNF group and non-biologic standard treatment group for average pain score, number of children with daily pain reported in the pain diary, or level of functional disability. Significantly more children in the anti-TNF group reported no pain at all. Children undergoing standard treatment had significantly higher disease activity. Significant differences were found between the high pain patients treated with anti-TNF agents and the rest of the anti-TNF group in regards to their pain-specific beliefs of disability and harm, and the pain-coping strategy of catastrophizing. CONCLUSION These results indicate that a great proportion of children treated with anti-TNF agents respond well to the treatment in regards to disease activity and pain, but pain was still a problem for a subgroup of children though they were in remission with biological agents. More focus on pain management is needed.
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Affiliation(s)
| | - Mikael Thastum
- Department of Psychology, Aarhus University, Bartholins Allé 9, Aarhus 8000, Denmark
| | - Troels Herlin
- Department of Pediatrics, Aarhus University Hospital, Brendstrupgaardsvej 100, Aarhus N 8200, Denmark
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