sociocultural factors related to the doctor-patient relationship, such as feelings of trust, similarity, and liking, may mediate previously reported racial discordance effects.In the present study, we tested the effects of doctor-patient shared group membership and patient ratings of doctor similarity, trust and liking on patient reported pain during simulated clinical interactions.A mixed-ethnicity sample of 80 participants (40 male), age 19-54 years old, was divided into two groups ostensibly based on the similarity of their self-reported beliefs (actually random), and then randomly assigned the role of doctor or patient.Participants took part in two simulated clinical interactions in which patients rated pain from 16 thermal heat stimulations delivered by an ingroup or outgroup doctor.Patients reported greater trust, similarity, and liking of ingroup than outgroup doctors, and patients' average ratings of their feelings towards their doctors predicted both continuous pain intensity rating during each heat stimulation and overall pain intensity rating completed after each heat stimulation.These results suggest that interventions aimed at increasing patient feelings of trust, similarity, and liking to their doctors may decrease patient reported pain during medical care regardless of racial and ethnic discordance.Such interventions may help mitigate the negative impact of doctor-patient racial and ethnic discordance in pain treatment.

OBJECTIVE:Arthritis has been an associated finding in juvenile dermatomyositis (JDM), but its prevalence, course, and response to therapy has not been well described. We investigated the frequency, course, and clinical and radiographic features in a large cohort of patients with JDM.METHODS:The charts of 94 patients with idiopathic myositis (1984-99) were reviewed: 80 JDM, 3 juvenile polymyositis (JPM), 5 amyopathic JDM, and 6 overlap myositis syndromes. Compiled data included demographics, clinical features, a detailed description of the arthritis, investigations (radiographs, autoantibodies), course, and response to therapy. All radiographs were independently reviewed by a single radiologist.RESULTS:Sixty-one percent (95% CI 50-72%) of patients with JDM had arthritis. The arthritis was reported a median 4.5 mo (range -73.6 to 76.6 mo) after the JDM onset. When compared to patients with no arthritis, the occurrence of arthritis was not significantly related to sex, race, positive antinuclear antibody or rheumatoid factor, calcinosis, nodules, vasculitis, or Raynaud's phenomenon. The initial involvement was pauciarticular in 67% and polyarticular in 33%. In the pauci group, asymptomatic knee effusions were the predominant finding (n = 19, 58%), and in 18 patients may have been the result of steroid therapy. Two patients evolved from a pauci onset to a polyarticular course. All responded to therapy (corticosteroids; 47 were taking other medications) with remission of the arthritis within a median of 2.0 mo (range 0.1-64.5 mo). However, the arthritis recurred in 39% as the corticosteroids were tapered. Four patients with JDM eventually required corticosteroid wrist injections, with resolution of the arthritis. The arthritis was nonerosive in all cases. No patient with JPM had arthritis. Three of 5 patients with amyopathic JDM and 4 of 6 with overlap myositis syndrome had a nonerosive polyarthritis.CONCLUSION:Nonerosive arthritis involving the knees, wrists, elbows, and fingers is a frequent manifestation of JDM and other idiopathic childhood myositis. The arthritis is seen early in the course of JDM and often responds to treatment. However, the arthritis may recur with tapering of corticosteroids despite remission of the JDM. In a significant proportion of JDM cases, arthritis is the major sequela and may warrant further medical therapy or intraarticular corticosteroid injections.

Myasthenia gravis and polymyositis are each a rare manifestation of immune dysregulation in chronic graft-versus-host disease (cGVHD). We report a 4-year-old boy with idiopathic acquired aplastic anemia who developed myasthenia gravis 22 months and polymyositis 69 months after an allogeneic BMT (5/6 matched, MLC-nonreactive). The occurrence of both syndromes in one patient is unique. Autoimmune dysfunction may be associated with the development of cGVHD as demonstrated by the high incidence of prior aplastic anemia in BMT patients presenting with myasthenia gravis and polymyositis. Recognition of these neurologic manifestations is important in the diagnosis and treatment of cGVHD.