03. Does obesity predict pain in adolescent rheumatology patients with juvenile idiopathic arthritis and chronic pain syndrome?

Abstract

Background: In adults, obesity has been found to be associated with an increase in the symptoms of chronic conditions. In particular, the symptoms of chronic musculoskeletal pain syndrome (Kumar et al., 2015) have been found to correlate with excess weight putting additional strain on the joints (Lee, 2013). However this association has not been found to be causal (Okifuji and Hare, 2015) and has yet to be studied in the adolescent rheumatology juvenile idiopathic arthritis (JIA) and chronic pain syndrome (CPS) populations. Aims: To investigate the hypothesis that there are associations between high pain scores, measured using a 0-10cm pain visual analogue scale (PVAS), and the following indices: body fat measures (fat mass (FM), fat percentage (F%) and body mass index centile (BMI%)), gender, age or disease group (JIA versus CPS) in the adolescent rheumatology population. Methods: Anonymised data (collected between August 2015 and May 2016) was extracted from the University College London Hospital (UCLH) adolescent rheumatology clinical database. SPSS was utilised to create models and assess the relationships between PVAS, age, gender, diagnosis and body fat compositions. 187 datasets met the inclusion criteria. The multiple linear regression models were corrected for age, gender and imbalances in the group sample sizes. Results: There were differences in mean body fat measures and mean PVAS between JIA and CPS populations, as displayed in Table 1 (attached). However, contrary to trends observed in the aforementioned studies, this project found no statistically significant correlations between a higher fat mass, fat percentage and BMI percentile and higher pain scores across the multiple linear regression models, as displayed in Table 2 (attached). Conclusions: In contrast with findings from adult studies, pain in the adolescent CPS population cannot be mainly attributed to obesity. Variations of somatic and psychosocial factors may be contributors to pain in this group, therefore a holistic approach in managing pain in this population in necessary for clinicians. The results of this project demonstrate that the factors which may cause/correlate with pain are incredibly complex. As always, it is important to take a holistic and personalised approach when caring, treating and advising patients on how best to manage their condition. The absence of statistical significance found should not be taken as an indication of a lack of clinical significance; as always patients will be advised on adopting a healthy balanced diet and exercise in order to build and maintain muscular strength. These finding have reinforced the necessity of more research into the variables which may influence pain in the adolescent CPS group.