AB0952 RETROSPECTIVE STUDY OF PROCEDURAL PAIN ANALYSIS DURING JOINT INFILTRATION IN PATIENTS WITH JUVENILE IDIOPATHIC ARTHRITIS
Authors: Emanuele Cocchiara, Claudia Ferrari, Michela Cappella, Carlo Salvarani, Alessandro De Fanti
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Juvenile Idiopathic Arthritis (JIA) is the rheumatic disease more common in childhood. Intra-articular corticosteroid injections (IAC) are a mainstay in the treatment of this disease, unfortunately it is often associated with pain and anxiety, for this reason is extremely important to pay attention both to procedural analgesia and to the reduction of anticipatory anxiety. <h3>Objectives</h3> The primary aim was evaluate the impact of the our analgesic procedure on the perception of infiltration pain; the secondary aims were stratify the results according to the demographic characteristics, number of joints infiltrated for each patient. <h3>Methods</h3> 40 patients (pt) studied between august 2016 and august 2017 (1 year) received a IAC [F/M=25/15, age 8.63 ± 3.41 yrs, weight 32.1 ± 13.9 kg; monoarticular JIA 7 pt (17.5%), oligoarticular 19 (47.5%), polyarticular 14 (35%). 27/40 (67.5%) pt infiltrated in one joint, 13/40 (22.5%) in two or more joints]. One hour earlier of the procedure for each pt was applied 1% prilocaine cream and 30 minuts before administered Midazolam orally at a dose of 0.5 mg/kg (maximum 15 mg), 50% nitrogen protoxide mixture dispensed with a mask, in spontaneous breathing and continuous flow. In 25/40 (62,5%) pt distraction techniques were performed during IAC and in 24/40 (60%) was also applied ice spray before IAC. To monitor pain, before and after IAC, appropriate scales have been used, stratified by age: CHIPPS scale (pt ≤ 5 yrs), Wong-Baker scale for ages 5 to 8, numerical scale analog visual VAS (pt ≥8 yrs). CHIPPS and VAS scales &lt;4: indicative of mild pain. For each pt pain assessment was performed before and after IAC. <h3>Results</h3> VAS before IAC = 0.90 ± 1.67/Median (M) = 0, after IAC = 1.07 ± 1.56/M = 0; CHIPPS before IAC = 0.82 ± 1.88/M = 0, during IAC = 2.75 ± 3.01/M = 2. No significant correlation between VAS scale scores and after IAC and of CHIPPS both before and during IAC and respectively of age, weight, sex, application of ice spray, application of distraction techniques before the execution of the procedure, number of infiltrated joints. Significant correlation between VAS before and after IAC (RHO Spearman 0.397, p = 0.018), CHIPPS before and during IAC (RHO Spearman 0.599, p ≤ 0.0001). Highly significant correlation coefficient between VAS and CHIPPS before IAC (RHO Spearman 0.6, p = 0.0001) and between CHIPPS during IAC and VAS after IAC (RHO Spearman 0.403, p &lt;0.05). Significant difference between CHIPPS before and after IAC (Wilcoxon Ranks Signed Test, R = 8.5, p &lt;0.0001), not between VAS before and after IAC (R = 83, p = 0.62). <h3>Conclusion</h3> In our study the intensity of pain would seem exclusively subjective, in fact it does not depend: on age, number of IAC, on the application of distraction techniques and application of ice spray. Anyway the protocol that we used seems to be effective on pain control (VAS and CHIPPS scale respectively after and during IAC: m ± sd and M. &lt;4 points) and it can be performed on outpatients safely without an anesthetic procedure. Our results encourage to expand the series with a future prospective trial. <h3>References</h3> [1] Oren-Ziv, et al. Sedation methods for intra-articular corticosteroid injections in Juvenile Idiopathic Arthritis: a review. Ped Rheumatol (2015); [2] Nicole M. et al. Systematic Review: Predisposing, Precipitating, Perpetuating, and Present Factors Predicting Anticipatory Distress to Painful Medical Procedures in Children Journal of Pediatric Psychology (2016) <h3>Disclosure of Interests</h3> None declared