P17 What is the experience of pain pre- and post intra-articular steroid injections in children and young people with juvenile idiopathic arthritis?

Abstract

Abstract Background A rheumatology service evaluation was carried out in 2016 whereby we sought to understand whether children and young people (CYP) are receiving appropriate pain relief post-administration of steroid intra-articular injections (IAI’s) and whether extended time waiting for IAI’s increases CYP experience of pain. The British Society for Rheumatology BSPAR section Standard of Care for children and young people with JIA recommends 4 weeks or less waiting time for steroid IAI under general anaesthetic (GA) and 10 days or less for steroid IAI under entonox. Methods Data collection was obtained by patient questionnaire over a 4-month period. Parents/carers and CYP were asked to complete a questionnaire pre-steroid IAI (by a member of staff on the day of the IAI) and the same questionnaire post-steroid IAI (by telephone by the author within 2 weeks of the date of the IAI). Twenty parents/carers or CYP completed the questionnaires. Sixteen of the CYP were female and 4 were male. Median age was 3 years. Eighty percent had a diagnosis of oligoarticular juvenile idiopathic arthritis (JIA). Seventy-five percent had IAI’s under GA and 25% with Entonox. Fifty-four percent had knee(s) injected and 23.5% had ankle(s) injected. Results Sixty percent of CYP waited for 4 weeks or less for steroid IAI under GA. Twenty percent of CYP waited for less than 10 days for steroid IAI under entonox. The range of pain scores for CYP pre IAI was 0-10 and the median was 5. Post IAI the range of pain scores was 0-8 and the median was 3. A positive correlation was found between those waiting longer for IAI’s and higher pain scores. P17 Table 1: CYP experience of pain Pre IAI Post IAI Pain in joints injected or due to be injected 95% 55% CYP taking pain medication 85% 55% Type of pain medication: Diclofenac 10% 10% Ibuprofen 25% 10% Naproxen 5% 5% Naproxen & codeine 5% 0% Naproxen & oramorph 0% 5% Paracetamol 10% 10% Paracetamol & ibuprofen 30% 15% None 15% 40% Refusing 0% 5% General activity affected 90% 60% Pain medication required 80% 50% Pain medication effective 80% (100% of CYP requiring medication) 50% (100% of CYP requiring medication) Conclusion In our small cohort, fifty percent of CYP required no pain medication post-IAI, and fifty percent of CYP who did require pain medication post-IAI perceived the pain medication they were receiving was adequate (Table 1). A positive correlation was found between CYP waiting longer for IAI’s and CYP experiencing higher pain scores therefore, accepting our modest sample size, this service evaluation supports ensuring timely access to IAI and the avoidance of longer waiting times. Conflicts of Interest The authors declare no conflicts of interest.