Pain-coping scale for children and their parents: a cross-sectional study in children with musculoskeletal pain.

BACKGROUND: In a chronic pain-causing disease such as juvenile idiopathic arthritis, the quality of coping with pain is crucial. Parents have a substantial influence on their children's pain-coping strategies. This study aimed to develop scales for assessing parents' strategies for coping with their children's pain and a shorter improved scale for children usable in clinical practice. METHODS: The number of items in the Finnish version of the pain-coping questionnaire for children was reduced from 39 to 20. A corresponding reduced scale was created for parental use. We recruited consecutive patients from nine hospitals evenly distributed throughout Finland, aged 8-16 years who visited a paediatric rheumatology outpatient clinic and reported musculoskeletal pain during the past week. The patients and parents rated the child's pain on a visual analogue scale from 0 to 100 and completed pain-coping questionnaires and depression inventories. The selection process of pain questionnaire items was performed using factor analyses. RESULTS: The average (standard deviation) age of the 130 patients was 13.0 (2.3) years; 91 (70%) were girls. Four factors were retained in the new, improved Pain-Coping Scales for children and parents. Both scales had 15 items with 2-5 items/factor. The goodness-of-fit statistics and Cronbach's alpha reliability coefficients were satisfactory to good in both scaled. The criterion validity was acceptable as the demographic, disease related, and the depression and stress questionnaires correlated with the subscales. CONCLUSIONS: We created a shorter, feasible pain-coping scale for children and a novel scale for caregivers. In clinical work, the pain coping scales may serve as a visualisation of different types of coping strategies for paediatric patients with pain and their parents and facilitate the identification of families in need of psychological support.

Regulation of CD154-induced interleukin-12 production in synovial fluid macrophages.

Interleukin (IL)-12, being a major cytokine that induces T helper (Th) 1 differentiation and inflammatory response, has been postulated to be an important mediator of synovial inflammation in rheumatoid arthritis (RA). However, the regulation of IL-12 production in RA has not been elucidated. Our knowledge is mainly based on studies of the production of IL-12p40 and not the functional IL-12p70 heterodimer. We have studied the CD154-induced IL-12p40 and IL-12p70 production by synovial fluid (SF) macrophages from patients with RA. CD40 ligation induced the secretion of IL-12p40 but not IL-12p70. The observed increase in IL-10 and tumor necrosis factor (TNF)-alpha production indicated that SF macrophages responded to CD40 ligation. The expression of p40 mRNA was increased significantly and remained upregulated after CD40 ligation, whereas the increase of p35 transcript expression was observed only transiently and at a lower level. We further observed that dendritic cells (DCs) derived in vitro from SF macrophages produced IL-12p70. Most importantly, IL-4 and IL-13 primed SF macrophages to produce IL-12p70, whereas IFN-gamma was not observed to activate IL-12p70 production in these cells, in contrast with normal peripheral blood monocytes. These results provide novel information about the regulation of IL-12p70 production and the function of the cytokine network in RA.