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Highlights:
Fatigue partially mediated the relationship between pain interference and disability in children with newly diagnosed JIA, and targeting both may reduce disability in early JIA.
Fatigue partially mediates the relationship between pain interference and disability in juvenile idiopathic arthritis, according to data published in the journal Arthritis Care & Research.
“The association between fatigue and pain intensity in juvenile rheumatoid arthritis is well established,” Naomi Chung, Sc.D., of the British Columbia Children’s Hospital and University of British Columbia in Vancouver, and her colleagues write, “However, the association between fatigue and pain interference has not been specifically investigated. Pain interference can negatively impact quality of life and interfere with daily life. However, it is unclear what mechanisms link fatigue, pain interference, and disability.”
Data suggest that fatigue partially mediates the relationship between pain interference and disability in JIA. Image: Adobe Stock
To explore the relationship between these three areas in JIA patients, Chung and his colleagues analyzed data from the Canadian Federation of Paediatric Rheumatology Researchers registry and analyzed 855 patients (44.1% had oligoarthritis) who were enrolled within three months of JIA diagnosis between February 2017 and May 2023.
Fatigue and pain interference were reported through the PROMIS short questionnaire, and physical disability was reported through the Child Health Assessment Questionnaire (CHAQ) disability index. Relationships between fatigue, pain interference, and physical disability were tested using Pearson’s correlation and multiple linear regression, and the potential mediating role of fatigue was assessed using structural equation modeling.
Overall, the majority of JIA patients reported fatigue and pain interference scores similar to the reference population, the researchers wrote. Among all JIA types, patients with rheumatoid factor-positive polyarticular JIA had the highest median fatigue of 57.7, pain interference of 58.5, and disability of 1.
The researchers found that fatigue was strongly correlated with pain interference (r = 0.72, P < .001) and physical disability (r = 0.6, P < .001). Although associated with both, physical disability was more strongly associated with pain interference (β = 0.027, 95% CI, 0.023-0.032) than with fatigue (β = 0.013, 95% CI, 0.01-0.017).
Results from structural equation modeling support Chung et al.’s hypothesis that fatigue is a mediator between pain interference and disability, they write. Pain interference showed a “significant association” with fatigue (beta = 0.72) and a “direct association” with disability (beta = 0.42), while there was a “moderate” direct association between fatigue and disability (beta = 0.29), they added.
“Our study shows that the majority of patients with early JIA have fatigue and pain interference scores within the normal range of the reference population, but a significant minority, especially in children with RF-positive polyarthritis, have severe fatigue and pain interference,” Choong and colleagues wrote. “Fatigue was strongly associated with pain interference in children with JIA, and both were independently associated with disability, even after adjusting for confounding factors.
“As hypothesized, our data support that fatigue partially mediates the relationship between pain interference and disability,” the researchers added. “These findings highlight the importance of addressing both fatigue and pain interference to reduce disability in the early stages of JIA. Future studies should be conducted to develop and evaluate targeted interventions to reduce fatigue and pain interference in JIA.”
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Sources/Disclosures
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Disclosures: Co-author Jean-Philippe Proulx-Gauthier reports receiving grants or contracts for clinical trials from Pfizer. Henrike Schmeling, MD, reports receiving grants or contracts for clinical trials from Pfizer, UCB Biosciences, and AbbVie.
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