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

OBJECTIVES: Pain is common in juvenile idiopathic arthritis 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 juvenile idiopathic arthritis. METHODS: JBI methodology for scoping reviews was followed and the review reported against the PRISMA-ScR 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 juvenile idiopathic arthritis aged ≤24 years were included. Data were charted capturing study characteristics, pain measures, disease activity markers, analytic methods, and reported relationships. Findings were synthesised descriptively and presented in tabular, visual, and narrative formats. RESULTS: 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 disease activity scores than with blood biomarkers or imaging, although these disease activity measures may have included subjective or pain-related components. CONCLUSION: Relationships between pain and markers of disease activity in juvenile idiopathic arthritis 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.