Abstract
BackgroundAnti-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).MethodsAll 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.ResultsNo 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.ConclusionThese 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.
Highlights
Anti-TNF agents have proven efficacy in children with severe juvenile idiopathic arthritis (JIA) who are unresponsive to standard therapy
We discovered that a high-pain group consisting of children with a greater pain experience and lower disease activity compared to the median values of the total group of patients differed significantly from the remaining sample [21,22,23]
We explored differences in the use of paincoping and pain-specific beliefs in a subgroup of children with pain treated with anti-TNF agents compared to pain-free children in the treatment group
Summary
Anti-TNF agents have proven efficacy in children with severe juvenile idiopathic arthritis (JIA) who are unresponsive to standard therapy. 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). Pain in children with juvenile idiopathic arthritis (JIA) is more prevalent than previously recognized and with a high daily prevalence [1,2,3]. With the advent of biological anti-tumor necrosis factor (anti-TNF) agents the treatment options for JIA have improved markedly. Coping is thought to be influenced by a person’s beliefs about a stressor such as pain. But recently beliefs, has been investigated in children with arthritis [17,21,22,23,25,26]
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