Pain in juvenile chronic arthritis: consequences for the musculo-skeletal system.

Pain in juvenile chronic arthritis is underestimated. Children often don't verbalize their pain adequately. On a pain scale they usually grade pain lower than adults. Pain perception always depends on subjective factors, especially the child's stage of development. The younger the child the more nonverbal pain expressions dominate. Malpositioning of involved joints or abnormal patterns of movement are often the only signs of pain. This is demonstrated in an inquiry directed to the parents of 111 small children with different subgroups of juvenile chronic arthritis. In a reflex reaction children bring their inflamed joints into a pain relieving position. This triggers a vicious circle which may result in joint deformity and permanent handicap. Arthritis interferes with the child's activities. Behavioural changes and finally developmental disturbances can follow.