L Höfel1, N Draheim1, A Schramm1, M Georgi1,2, J P Haas3,4. 1. Zentrum für Schmerztherapie junger Menschen, Garmisch-Partenkirchen, Deutschland. 2. Deutsches Zentrum für Kinder- und Jugendrheumatologie, Gehfeldstr. 24, 82467, Garmisch-Partenkirchen, Deutschland. 3. Zentrum für Schmerztherapie junger Menschen, Garmisch-Partenkirchen, Deutschland. haas.johannes-peter@rheuma-kinderklinik.de. 4. Deutsches Zentrum für Kinder- und Jugendrheumatologie, Gehfeldstr. 24, 82467, Garmisch-Partenkirchen, Deutschland. haas.johannes-peter@rheuma-kinderklinik.de.
Abstract
BACKGROUND: Rheumatic diseases, such as juvenile idiopathic arthritis (JIA), are typically associated with acute pain mainly caused by inflammation. Chronic pain is described as pain lasting at least 3 months. In JIA patients chronic pain may occur despite successful treatment. Chronic pain and pain disorders frequently occur during the course of the disease despite successful control of inflammation. OBJECTIVE: Possible interrelations between JIA and pain disorders are presented. METHOD: Besides a review of the available literature, a retrospective cohort study was conducted, including 906 patients with a chronic pain disorder with somatic and psychological factors (CPD) and/or a complex regional pain syndrome type I (CRPS I). The frequency of pre-existing rheumatic illnesses was analyzed. RESULTS: The JIA is a risk factor for the development of a CPD. Especially polyarticular, extended oligoarticular, enthesitis-associated JIA and psoriatic arthropathy were found to be significantly associated with an increased risk for developing CPD. In contrast, an increased risk for development of CRPS I was not observed. CONCLUSION: Our study demonstrates JIA to be a risk factor for the development of chronic pain not only as a result from malpositioning or arthrosis but also as a chronic pain disorder (CPD). Further studies are necessary to clarify the relevance of disease activity and duration and also of psychological factors for the pathogenesis.
BACKGROUND: Rheumatic diseases, such as juvenile idiopathic arthritis (JIA), are typically associated with acute pain mainly caused by inflammation. Chronic pain is described as pain lasting at least 3 months. In JIA patients chronic pain may occur despite successful treatment. Chronic pain and pain disorders frequently occur during the course of the disease despite successful control of inflammation. OBJECTIVE: Possible interrelations between JIA and pain disorders are presented. METHOD: Besides a review of the available literature, a retrospective cohort study was conducted, including 906 patients with a chronic pain disorder with somatic and psychological factors (CPD) and/or a complex regional pain syndrome type I (CRPS I). The frequency of pre-existing rheumatic illnesses was analyzed. RESULTS: The JIA is a risk factor for the development of a CPD. Especially polyarticular, extended oligoarticular, enthesitis-associated JIA and psoriatic arthropathy were found to be significantly associated with an increased risk for developing CPD. In contrast, an increased risk for development of CRPS I was not observed. CONCLUSION: Our study demonstrates JIA to be a risk factor for the development of chronic pain not only as a result from malpositioning or arthrosis but also as a chronic pain disorder (CPD). Further studies are necessary to clarify the relevance of disease activity and duration and also of psychological factors for the pathogenesis.
Authors: R E Petty; T R Southwood; J Baum; E Bhettay; D N Glass; P Manners; J Maldonado-Cocco; M Suarez-Almazor; J Orozco-Alcala; A M Prieur Journal: J Rheumatol Date: 1998-10 Impact factor: 4.666