Emotional component of quality of life in patients with juvenile idiopathic arthritis

Abstract

For children with juvenile idiopathic arthritis (JIA), the quality of life (QoL) emotional component is influenced by numerous factors: the arthritis subtype, disease duration, and activity, patient’s treatment, patient’s physical condition, and pain level, also his age, and sex. However, it’s important to determine the emotional component in the structure of QoL in children with different JIA subtypes (polyarthritis, oligoarthritis, and uveitis-associated arthritis) and features of psychological adaptation in modern conditions. Purpose - to determine both the emotional component of QoL in patients with JIA and their emotional condition considering the disease subtype, its duration, and the therapy complex. Materials and methods. The study was carried out at the SI «Institute for Children and Adolescents Health Care of the NAMS of Ukraine», Kharkiv, from November 2020 to November 2021. The assessment was provided by JADAS27, functional state by CHAQ, QoL according to PedsQLTM 4.0 Generic Core Scales, and emotional state according to the Montgomery-Asberg scale (MADRS) for depression assessment and clinical indicators. Statistical processing of the material was carried out using parametric and non-parametric methods, the critical level of significance for statistical testing hypotheses comparing groups was set at 0.05. Results. The 118 patients with JIA were examined, of them 47 patients with polyarticular, 43 patients with oligoarticular, and 28 patients with JIA-u subtypes. The study involved 77 girls and 41 boys aged 2 to 18 years (133.3±4.6 months). The majority (112 patients) received methotrexate therapy, 30 of them - methotrexate in combination with immunobiological therapy, 6 - sulfasalazine. The overall QoL in the group of children with JIA was at the level of 70.9±1.4 points for the last month and 72.6±1.4 points for the last week without significant difference, and the emotional component in the group as a whole was significantly higher for the last month - 73.1±1.6 points, while during the hospital stay it decreased to 66.3±1.7 points (p≤0.05). According to the results of the assessment of emotional state by the MADRS questionnaire, children aged 8 years and older did not have a depressive episode - 6.02±0.72 points. No significant differences were observed for HRQoL and emotional component in groups with different variants of arthritis and depending on age. However, certain results with a decrease in QoL and emotional state were observed in children with polyarthritis and uveitis-associated variant of JIA. The duration of the disease and treatment affected the QoL and emotional state, especially in the first year (QoL = 62.5±3.8 points for the last month). Correlations between MADRS and emotional state according to PedsQL were indirect and strong both for the last week and for the last month (r=-0.821; r=-0.784; p≤0.05). MADRS and total PedsQL scores also had indirect, medium strength correlations for the study periods (r=-0.558; r=-0.528; p≤0.05). Conclusions. At the beginning of the disease children with JIA have the reduction of QoL indicators with the emotional component. Such results depend on the course of JIA, which predicts the formation of emotional depressive disorders in some of them. The first year of the disease is the most vulnerable for children with polyarthritis, and for children with JIA-u increased disease duration enhances symptoms of emotional disturbances. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.