Exploring the relationship between pain and markers of disease activity in juvenile idiopathic arthritis: a scoping review

Pain is common in JIA and may be challenging to treat. Clinical observation has highlighted that pain and markers of disease activity may not align, with important implications for clinical management. This scoping review aimed to map and describe the extent, nature and findings of studies examining relationships between pain and objective or clinical disease activity markers in children and young people with JIA.

Joanna Briggs Institute methodology for scoping reviews was followed and the review reported against the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist reporting guideline. MEDLINE, EMBASE and Scopus were searched from inception to 12 June 2025. Studies examining the relationship between self- or proxy-reported pain and at least one objective or clinical disease activity marker in individuals with JIA aged ≤24 years were included. Data were charted capturing study characteristics, pain measures, disease activity markers, analytic methods and reported relationships. Findings were synthesized descriptively and presented in tabular, visual and narrative formats.

One hundred and twenty-two studies were included. Overall concordance between pain and disease activity markers was uncommon. Pain aligned more consistently with physician-assessed clinical measures and composite DAS than with blood biomarkers or imaging, although the clinical measures and composite DAS may have included subjective or pain-related components.

Relationships between pain and markers of disease activity in JIA are complex and frequently discordant. Divergence between pain and disease activity markers should be anticipated in clinical care and interpreted in parallel rather than as interchangeable indicators.