Depressive symptoms predict pain and disability in children with JIA
medwireNews: Depressive symptoms are common in adolescents with juvenile idiopathic arthritis (JIA) and could predict future pain and disability, suggests an analysis of the Childhood Arthritis Prospective Study.
Of 102 adolescents with JIA, aged a median of 13.2 years, 14.7% had major depressive disorder at baseline, according to a Mood and Feelings Questionnaire (MFQ) score of 27 or above.
Girls had a significantly higher median MFQ score than boys, at 15.5 versus 10.0 points, and MFQ scores varied significantly according to JIA category, with a median of 19.0 points for individuals with polyarthritis, compared with 10.0 points for those with oligoarthritis and 9.5 points for those with enthesitis-related arthritis.
Yiannis Ioannou (University College London, UK) and co-researchers comment in Rheumatology: “This study has shown for the first time that depressive symptoms are highly prevalent in adolescents with JIA in the UK. This finding justifies actively screening for depressive symptoms in routine clinical practice.”
The presence of depressive symptoms at baseline significantly correlated with all clinical measures of disease, including active joint count (r=0.324), limited joint count (r=0.356), disability (r=0.514), pain (r=0.394), and the patient’s general evaluation of disease (r=0.431). These associations remained significant on regression analyses after adjustment for possible confounders.
And longitudinal analysis showed that high levels of depressive symptoms (31 points on the MFQ) at baseline, compared with low levels (2 points on the MFQ), were significantly associated with worse disability (estimated Child Health Assessment Questionnaire score of 0.71 vs 0.19 points) and pain (estimated 3.14 vs 1.21 cm on visual analog scale) at 12 months, with similar findings seen at 48 months.
However, baseline depressive symptoms were not significantly associated with active or limited joint counts at either 12 or 48 months.
The findings suggest that for many adolescents with JIA, high levels of depression “may mean worse pain and disability as they enter adulthood,” say the researchers.
They therefore conclude: “This work highlights the need for a psychological intervention study with the aim of improving long-term outcomes for adolescents with JIA.”
By Catherine Booth
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