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Inflammatory arthritis and arthropathy 

Inflammatory arthritis and arthropathy
Chapter:
Inflammatory arthritis and arthropathy
Author(s):

Peter Chira

and Laura E. Schanberg

DOI:
10.1093/med/9780199642656.003.0022
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date: 18 November 2018

Musculoskeletal pain is a common symptom in inflammatory arthritides such as juvenile idiopathic arthritis; however, identifying the underlying pathological process is often challenging for health care providers due to the extensive differential diagnoses. In children with inflammatory arthritides, physical examination abnormalities including swelling and/or pain on movement and joint limitation accompany the pain at initial presentation. Control of disease activity through anti-inflammatories and other disease-modifying agents can limit disease progression and joint damage; however, pain may persist in spite of these measures. Optimal treatment of pain in juvenile idiopathic arthritis and related conditions is based on a biopsychosocial model, which addresses biological, environmental, and cognitive-behavioural factors. Analgesics such as opioids and neuropathic pain medications, in conjunction with other modalities such as pain coping skills training, aerobic exercise, and improved sleep hygiene may be appropriate in certain circumstances. Further research is needed to prospectively identify patients and families early in the course of disease who would benefit from additional support to optimize pain management and limit distress. In addition, future clinical trials should assess the impact of study interventions on pain as a primary endpoint, assessed independently from other response variables.

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