The difference in pain and overall well-being assessment between patients with juvenile idiopathic arthritis, their parents, and physicians in Ukraine

Introduction
The purpose of the study is to evaluate the differences in assessment of pain and overall well-being by patients with juvenile idiopathic arthritis (JIA), their parents, and physicians.

Material and methods
A total of 120 children were included in the study: 60 patients with JIA, 30 patients with reactive arthritis (ReA), and 30 healthy children within age range of five to 17 years. They were accompanied by their mothers. Patient and mother were asked to rate the intensity of the child’s pain using a 10-cm Visual Analogue Scale (VAS). The global assessment of child’s overall well-being was made by patient, mother, and physician using the same VAS.

Results
The level of agreement between children, parents, and physician in rating the child’s present pain and global assessment of the child’s overall well-being in JIA patients was good (ICC ≥ 0.75). However, patient-physician agreement in global assessment of overall well-being was much lower compared to patient-parents agreement (ICC = 0.76 vs. ICC = 0.90; p < 0.05). The concordance between pain intensity assessments and overall well-being was defined in more than half of the raters. The present study demonstrated that parents were influenced in the VAS assessment by pain complaints, and physical and psychosocial limitations of their children during daily life activities. The physician’s estimation of overall well-being was based on joint counts and the results of laboratory tests. While parent and physician were likely to base their judgment using different factors, this did not affect good agreement between their decisions and child report. The similarity is associated with an interdependence of certain factors – for example, the deterioration of joint counts is always accompanied by pain complaints, and physical and psychosocial limitations of children with JIA.

Conclusions
Child’s, parent’s, and physician’s assessment of pain and overall well-being should be considered equally valuable indicators of health status and all of the ratings should be implemented in standard paediatric rheumatology care.