Background:In patients with JIA, growth impairment and variance in body composition are well-known long-term complications that may be associated with prolonged drug therapy (e.g. glucocorticoids) as well as impaired physical and psychosocial well-being. An increased accumulation of body fat represents a significant risk factor for metabolic abnormalities and a modifiable variable for a number of comorbidities. Recently, evidence has emerged in favour of the potential negative influence of overweight on the course of the disease and treatment response [1].Objectives:The study aimed a) to estimate the prevalence of underweight, overweight and obesity in children and adolescents with JIA compared to the general population, and b) to investigate correlates of patients’ weight status.Methods:A cross-sectional analysis of physicians’ recorded body weights and heights of patients with JIA enrolled in the NPRD in the year 2019 was performed. Underweight (BMI <10th), overweight (BMI >90th) and obesity (BMI >97th) were defined according to age- and sex-specific percentiles used in the German reference system. For comparison with data from the general population [2], sex- and age-matched pairs of 3-17-year-old patients and controls were generated. A multinomial logistic regression analysis was performed to examine the association between weight status and patients’ clinical and self-reported outcomes.Results:In total, data from 6.515 children and adolescents with JIA (age 11.2 ± 4.1 years, disease duration 4.9 ± 3.8 years, 67% girls, 40% persistent oligoarthritis) were included. Of these, 3.334 (age 5.9 ± 2.1 years, 52.5% girls) could be considered for matched-pair analysis. Compared with the general population, patients underweight, overweight and obesity rates were 10.6% (vs. 8.1%), 8.8% (vs. 8.5%) and 6.1% (vs. 5.7%), respectively. No significant sex differences were found in either group. Largest difference in prevalence was registered for underweight, specifically in the age group 3-6 years (12.9% patients vs. 5.9% controls). Similar to the general population, higher rates of overweight were observed in adolescent patients than in affected children (19.1% age group 11-13 vs. 8.4% age group 3-6). While the highest underweight prevalence was registered in patients with RF+ polyarthritis (16%), patients with Enthesitis-related arthritis (22%), psoriatic arthritis (21%) and systemic JIA (20%) showed the highest overweight rates (including obesity). Younger age (OR = 0.51, 95% CI = 0.31-0.83), more frequent physical activity (OR = 0.92, 95% CI = 0.85-0.99) and high parental vocational education (OR = 0.39, 95% CI = 0.18-0.80) were independently associated with a lower likelihood of being overweight/obese.Conclusion:The overall prevalence of underweight, overweight and obesity in children and adolescents with JIA is comparable to that found in the general population. Behavioural health promotion, including regular physical activity, as part of the treatment strategy in JIA should preventively already begin at preschool age and necessarily be made accessible to patients of all educational levels.References:[1]Giani T et al. The influence of overweight and obesity on treatment response in juvenile idiopathic arthritis. Front Pharmacol 2019;10:637.[2]Schienkiewitz A et al. BMI among children and adolescents: prevalences and distribution considering underweight and extreme obesity. Bundesgesundheitsbl 2019;62:1225–1234.Acknowledgements:The National Paediatric Rheumatological Database has been funded by AbbVie, Chugai, Novartis and GSK.Disclosure of Interests:Florian Milatz: None declared, Jens Klotsche: None declared, Martina Niewerth: None declared, Jana Hörstermann: None declared, Daniel Windschall: None declared, Frank Weller-Heinemann Speakers bureau: Pfizer, AbbVie, SOBI, Roche and Novartis., Frank Dressler: None declared, Rainer Berendes: None declared, Johannes-Peter Haas: None declared, Gerd Horneff: None declared, Kirsten Minden Speakers bureau: Pfizer, AbbVie, Consultant of: Novartis
Background:Mental disorders often begin in the vulnerable phase of adolescence and young adulthood. Young people with chronic diseases are particularly at risk. Early recognition of mental health problems is necessary in order to be able to support those affected in a timely and adequate manner. By implementing a web-based generic screening tool for mental health in routine care, patients with juvenile idiopathic arthritis (JIA) and mental health conditions can be identified and provided with targeted treatment.Objectives:To investigate the prevalence of mental health conditions in young people with JIA in routine rheumatology care.Methods:Mental health screening is implemented as an add-on module to the National Paediatric Rheumatology Database (NPRD). The current data was gathered over a period of 24 months. Patients complete the screening tool which includes the Patient Health Questionnaire1 (PHQ-9, score 0-27) and the Generalized Anxiety Disorder scale2 (GAD-7, score 0-21) via a web-based questionnaire. The cut-off for critical values in PHQ-9 and GAD-7 were defined as values ≥ 10. Simultaneously, other data, such as sociodemographic data, disease activity (cJADAS10, score 0-30), functional status (CHAQ, score 0-3) were collected as well.Results:The analysis included 245 patients (75% female) with a mean age of 15.7 years and a mean disease duration of 8.8 years. 38.8% of the patients had oligoarthritis (18.0% OA, persistent/20.8% OA, extended) and 23.3% RF negative polyarthritis. At the time of documentation 49 patients (30.6%) had an inactive disease (cJADAS10 ≤ 1) and 120 (49.4%) no functional limitations (CHAQ = 0). In total, 53 patients (21.6%) had screening values in either GAD-7 or PHD-9 ≥10. Patients with critical mental health screening values showed higher disease activity and more frequent functional limitations than inconspicuous patients (cJADAS10 (mean ± SD): 9.3 ± 6 vs. 4.9 ± 4.9; CHAQ: 0.66 ± 0.6 vs. 0.21 ± 0.42). When compared to males, females were significantly more likely to report either depression or anxiety symptoms (11.7% vs. 24.9%, p = 0.031).17.6% of all patients with valid items for these data reported to receive psychological support, meaning psychotherapeutic support (14.5%) and/or drug therapy (8.6%). Among those with a critical mental health screening score, 38.7% received psychological support (psychotherapeutic support (35.5%) and/or drug therapy (16.1%)).Conclusion:Every fifth young person with JIA reported mental health problems, however, not even every second of them stated to receive psychological support. The results show that screening for mental health problems during routine adolescent rheumatology care is necessary to provide appropriate and targeted support services to young people with a high burden of illness.References:[1]Löwe B, Unützer J, Callahan CM, Perkins AJ, Kroenke K. Monitoring depression treatment outcomes with the patient health questionnaire-9. Med Care. 2004 Dec;42(12):1194-201.[2]Spitzer RL, Kroenke K, Williams JB, Löwe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006 May 22; 166(10):1092-7.[3]The screening data were collected as part of COACH (Conditions in Adolescents: Implementation and Evaluation of Patient-centred Collaborative Healthcare), a project supported by the Federal Ministry of Education and Research (FKZ: 01GL1740F).Disclosure of Interests:Sascha Eulert: None declared, Martina Niewerth: None declared, Jana Hörstermann: None declared, Claudia Sengler: None declared, Daniel Windschall: None declared, Tilmann Kallinich: None declared, Jürgen Grulich-Henn: None declared, Frank Weller-Heinemann Consultant of: Pfizer, Abbvie, Sobi, Roche, Novartis, Ivan Foeldvari Consultant of: Gilead, Novartis, Pfizer, Hexal, BMS, Sanofi, MEDAC, Sandra Hansmann: None declared, Harald Baumeister: None declared, Reinhard Holl: None declared, Doris Staab: None declared, Kirsten Minden: None declared
Background:Physical activity (PA), including sport participation is essential for children throughout their growth and maturation. It improves physiological and psychosocial health and limits the risk of developing metabolic disorders. The beneficial effect of PA specifically in patients with JIA has also been linked to its potential regulatory effect on the balance between pro- and anti-inflammatory responses [1].Objectives:The study aimed i) to quantify the frequency of PA and participation in (organised) sports compared to the general population, ii) to determine self-reported reasons for not practicing sports, and iii) to identify clinical parameters associated with non-participation in sports.Methods:Data from children and adolescents with JIA recorded in the National Paediatric Rheumatological Database (NPRD) in the year 2019 were considered for the analyses. In accordance with the methodology used in the general population survey (KIGGS) [2], achievement of the WHO recommendations on PA for at least 60 minutes per day as well as sport-related data were determined on the basis of self-reported outcomes in individuals aged 3 to 17 years. In order to compare PA-related data with the general population, a sex- and age-matched sample was drawn. A logistic regression model was used to explore the association between non-participation in sports and patients’ clinical outcomes.Results:Data of 5.333 matched-pairs (mean age 11.0 ± 4.3 years, female 67%, patients’ disease duration 4.8 ± 3.8 years, persistent oligoarthritis 43%) were available for evaluation. Almost 38% of patients aged 3 to 17 years met the recommended PA amount (76% aged 3 to 6; 48% aged 7 to 10; 30% aged 11 to 13; 15% aged 14 to 17). In matched controls, 21% fulfilled the WHO recommendations on PA (41% aged 3 to 6; 23% aged 7 to 10; 17% aged 11 to 13; 10% aged 14 to 17). Largest differences across JIA categories were found in persistent oligoarthritis (43%) and enthesitis-related arthritis (22%). 64% of patients and 74% of controls reported participating in sports, of which 72% of patients and 58% of controls stating to participate in a formally organised way. In both groups, boys indicated organised sports participation more often than girls. Among those who declared not participating in sports, “no interest” (patients 27% vs. controls 29%), “no suitable offer nearby” (patients 25% vs. controls 31%), “health restrictions” (patients 22% vs. controls 4%) and “no time” (patients 15% vs. controls 23%) were the most frequently mentioned reasons (multiple responses possible). CJADAS-10 (OR = 1.02, 95% CI = 1.00-1.04), CHAQ (OR = 1.79, 95% CI = 1.50-2.14), DMARD use (OR = 1.32, 95% CI = 1.15-1.53) and disease duration (OR = 0.97, 95% CI = 0.95-0.99) were significantly associated with non-participation in sports.Conclusion:Based on self-reported data, children and adolescents with JIA meet the WHO recommendation on PA more often than general population controls. Patients are less frequently engaged in sports, but more often involved in formally organised forms. In order to bring joyful, interesting PA opportunities in line with WHO recommendations, further components (e.g. intensity), facilitators and barriers to PA and sports need to be addressed in the future while controlling for JADAS and CHAQ.References:[1]Rochette E et al. JIA and physical activity: possible inflammatory and immune modulation and tracks for interventions in young populations. Autoimmun Rev 2015;14:726–734.[2]Finger JD et al. Körperliche Aktivität von Kindern und Jugendlichen in Deutschland - Querschnittergebnisse aus KiGGS Welle 2 und Trends. Journal of Health Monitoring 2018;3:24-31.Acknowledgements:The National Paediatric Rheumatological Database has been funded by AbbVie, Chugai, Novartis and GSK.Disclosure of Interests:Florian Milatz: None declared, Martina Niewerth: None declared, Jens Klotsche: None declared, Jana Hörstermann: None declared, Sandra Hansmann: None declared, Tilmann Kallinich: None declared, Christoph Rietschel: None declared, Ralf Trauzeddel: None declared, Joachim Peitz: None declared, Matthias Hartmann: None declared, Hermann Girschick: None declared, Kirsten Minden Speakers bureau: Pfizer, AbbVie, Consultant of: Novartis.
BackgroundInsights in pathogenesis and the availability of new biologic drugs have created requirements and an increasing interest for encouragement of physical activity (PA) as long-term treatment option in patients with juvenile idiopathic arthritis (JIA). A low level of PA in healthy individuals is related to a higher incidence of overweight and hypertension in later life. This low level of PA might even be more dangerous for children with JIA, as they also have elevated inflammatory parameters, perhaps increasing the risk of future cardiovascular diseases.ObjectivesSince children and adolescents with physical disabilities may have an increased risk for developing a sedentary lifestyle, the objective was to investigate if encouragement of PA in most German medical care settings has led to PA levels in JIA similar to that of healthy counterparts.MethodsData from children and adolescents with JIA recorded in the German National Paediatric Rheumatologic Database (NPRD) in the year 2017 were considered for the analyses. In accordance with the methodology used in the general population survey [1], the achievement of the WHO recommendations on PA for health was determined on the basis of self-reported outcomes in individuals aged 3 to 17 years. Patients met the WHO criteria if they stated to be physically active for at least 60 minutes per day.ResultsIn 2017, the data from 5.918 patients (mean age 11.2 ± 4.1 years, female 67%, disease duration 4.6 ± 3.7 years, persistent oligoarthritis 42%) were available for evaluation. Almost 35% of patients aged 3 to 17 years met the recommended physical activity level (72% aged 3 to 6; 47% aged 7 to 10; 27% aged 11 to 13; 16% aged 14 to 17). In the general population, 26% fulfilled the WHO recommendations on PA (46% aged 3 to 6; 27% aged 7 to 10; 38% aged 11 to 13; 12% aged 14 to 17). In multivariable analyses, increasing age (OR 1.27; 95%CI: 1.24-1.29), psoriatic arthritis (OR 1.49; 95%CI: 1.06-2.11), overweight (OR 1.33; 95%CI: 1.04-1.71), functional disability (OR 0.83; 95%CI: 0.69-0.98), and worse patient-reported overall well-being (OR 1.10; 95%CI: 1.03-1.17) were associated with non-achieving the recommended PA amount.ConclusionEncouraging PA in most German medical care settings and the growing attention of the importance of regular PA for pleasure and health benefits may have led to a similar or even higher amount of PA compared to healthy counterparts. However, since a large proportion does not meet the global recommendations on PA, further research should address especially patients with inactive or minimal active disease who have previously largely refrained from PA. In order to derive adequate strategies, future work is warranted to comprehensively and objectively measure PA behavior in this population.References[1] Finger JD, et al. Körperliche Aktivität von Kindern und Jugendlichen in Deutschland - Querschnittergebnisse aus KiGGS Welle 2 und Trends. Journal of Health Monitoring 2018;3:24–31.AcknowledgementThe National Paediatric Rheumatological Database has been fund...
BackgroundPatients with juvenile idiopathic arthritis (JIA) may have a different body composition associated with reduced muscle mass and increased fat mass [1]. They display decreased physical fitness, perform less strenuous physical activities, and spend more time sleeping than do healthy children. A lower level of physical activity is associated with deconditioning and functional deterioration, favoring an inactive lifestyle. The risk of overweight might be further increased by the glucocorticoid treatment.ObjectivesSince obesity can increase inflammatory processes, cause early atherosclerotic changes and promote metabolic disorders, the objectives were a) to determine the prevalence of overweight and obesity in children and adolescents with JIA, and b) to examine the association between overweight and health-related parameters in this population.MethodsA cross-sectional analysis of physicians’ recorded body weights and heights of patients with JIA enrolled in the NPRD in the year 2016 was performed. Overweight was defined as BMI >90th sex- and age-specific percentile and obesity as BMI >97th percentile. For comparison with data from the general German population [2], patients aged 3 to 17 years were considered. A linear regression model was used to explore the association between overweight and both clinical as well as self-reported outcomes.ResultsIn total, data from 6.860 children and adolescents with JIA (age 11.5 ± 4 years, disease duration 4.6 ± 3.6 years, 67% girls, 39% persistent oligoarthritis) were analyzed. Overweight was found in 14% (including 6% obesity) of JIA cases. Comparative data from the German general population report an overweight prevalence of 15% (including 6% obesity). In contrast to the general population, overweight rates in JIA differed between girls and boys (girls 14% vs. boys 16%, p<0.05). Patients with psoriatic arthritis (20%) and systemic JIA (18%) showed the highest overweight rates. In multivariate analyses, age (OR 1.06; 95%CI: 1.04-1.09), male sex (OR 1.21; 95%CI: 1.01-1.44), functional limitations (OR 1.29; 95%CI: 1.04-1.59), as well as therapy with biological DMARDs (OR 1.48; 95%CI: 1.22-1.80) and systemic glucocorticoids (OR 1.40; 95%CI: 1.14-1.71) were significantly associated with overweight.ConclusionThe prevalence of overweight and obesity in young patients with JIA is similar to that of children and adolescents in the general population. The overweight rate increases with age and is strongly associated with functional restrictions and treatment with glucocorticoids. The role of overweight in the long-term outcome of JIA is an issue that still needs to be addressed.References[1] Grönlund MM, et al. Juvenile idiopathic arthritis patients with low inflammatory activity have increased adiposity. Scand J Rheumatol 2014;43:488–92.[2] Schienkiewitz A, et al. Übergewicht und Adipositas im Kindes- und Jugendalter in Deutschland. Journal of Health Monitoring 2018; 3:16–23.AcknowledgementThe National Paediatric Rheumatological Database has been funded by the German Children A...
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.