Discussion
JIA, active joints, pain
DISEASE, PGA
The BeSt for Kids is one of the first treat-to-target studies in newly diagnosed, DMARD naïve, non-systemic JIA patients investigating pain as outcome measure. In the current subanalysis, three frequently used initial treatment strategies were compared for effectiveness in treating pain [Although few studies have addressed pain over time as an outcome, we know from cross sectional data and reports from trials and prospective observational studies that pain scores can remain high after treatment. These high pain levels are reported after treatment according to clinical practice before the availability of biologic treatment [Even though we saw a decrease of active disease and pain in the BeSt for kids study, still some of our patients who did achieve inactive disease continued to have pain. It is this group of patients that deserves additional attention [In addition to this, we could consider adding an extra patient reported outcome, to investigate whether the clinical improvement we find corresponds to what our patients regard as a satisfactory improvement in pain levels [We performed an exploratory analysis to identify baseline factors that predict pain over time. In univariable analyses we identified VAS pain, PGA, VAS patient/parent, number of active joints, PhS and PsS as significant predictors of pain over time. In a multivariable model including all previously tested variables, identified VAS pain, PGA, number of active joints, PhS and PsS remained predictive. This is in accordance with previous literature [Counterintuitively and in contrast to previous studies, in our multivariable model, a lower PGA at baseline was associated with more pain during the two years follow up [Contrary to previous studies we did not find symptom duration as a significant baseline predictor for more pain over time. This could be due to lack of power, as these studies included more patients and the effect that was found was very small [In our previous publication [There are some limitations to our study. The sample size of our study was limited, therefore more subtle differences might have been found in a larger study cohort. Second, pain is multifactorial in nature and affected by many psychosocial patient factors [