Best practice & research. Clinical rheumatology
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Evidence from clinical trials, ideally using randomisation and allocation concealment, is essential for informing clinical decisions regarding the benefits and harms of treatments for patients. Where diseases are rare, such as in paediatric rheumatic diseases, patient recruitment into clinical trials can be a major obstacle, leading to an absence of evidence and patients receiving treatments based on anecdotal evidence. ⋯ These are discussed and illustrated with examples from paediatric rheumatology. Regulatory incentives and support from research networks have helped to deliver these trials, but more can be done to continue this important research.
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Best Pract Res Clin Rheumatol · Apr 2014
ReviewAssessment and treatment of pain in children and adolescents.
Pain is one of the most common and distressing symptoms experienced by children and adolescents with juvenile idiopathic arthritis. Pain is known to negatively affect all aspects of health-related quality of life, including physical, emotional, social, and role functioning. The valid and reliable assessment of pain is the first critical step to developing an effective plan for pain management. This chapter will address the following key questions: (1) What is the prevalence and impact of pain in children and adolescents with arthritis? (2) Why is it important for clinicians to assess the multidimensional nature of pain and what are the practical issues that should be considered? (3) What tools are available to help clinicians to assess pain? (4) How can Internet and mobile technologies be used to improve the assessment of pain? (5) What are the recommended strategies for clinically managing pain, including pharmacological, physical, and psychological approaches?
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Best Pract Res Clin Rheumatol · Apr 2014
ReviewOverview of neurodevelopment and pain research, possible treatment targets.
Pain is a common presenting and often persistent symptom for children with rheumatological disease. Pain is not clearly related to disease severity in children with inflammatory juvenile idiopathic arthritis, and presentations of non-inflammatory musculoskeletal pain are common but there is limited evidence to guide management. ⋯ Genotyping, sensory evaluation and neuroimaging may better characterize chronic musculoskeletal pain, identify high-risk groups and/or provide additional outcome measures to monitor disease and treatment progress. An integrated approach to management is required to effectively select and target interventions, reduce pain and disability and improve long-term outcome.