Pain in children with rheumatic diseases.

Pain is common in rheumatic diseases in children. Despite recent advances in arthritis treatment, pain continues to be a problem impacting daily functioning and quality of life, and no standard of care for pain management exists. The pathogenesis of pain in children with rheumatic diseases is multifactorial, and treatment of the disease alone may not be enough. Current pain treatment often includes acetaminophen, nonsteroidal anti-inflammatory drugs, and medications that treat arthritis such as methotrexate and etanercept. Nonpharmacologic interventions, such as exercise and cognitive-behavioral therapy as well as the use of analgesics such as opioids in patients whose pain is refractory to standard therapies, should also be considered. The use of systemic corticosteroids to treat pain in children with arthritis should be avoided. Idiopathic pain may coexist in children with rheumatic disease, but treatment of idiopathic pain is different than that of pain due to inflammatory disorders.