Population-based study of outcomes of patients with juvenile idiopathic arthritis (JIA) compared to non-JIA subjects

Abstract

Objective Evaluate healthcare utilization and occurrence of comorbidities in a population-based cohort of patients of juvenile idiopathic arthritis (JIA) with an age- and sex-matched comparator group. Methods Prevalent cases of JIA in 1994–2013 were identified in Olmsted County, Minnesota along with age- and sex-matched non-JIA comparators. Surgeries, hospitalizations, pregnancies, and comorbidities were identified by medical record review. Poisson methods were used to generate rate ratios (RR) with 95% confidence intervals (CI) to compare outcomes between JIA and non-JIA cohorts separately during childhood (age<18 years) and adulthood (age≥18 years). Results Eighty-nine JIA and 89 non-JIA comparators were identified (64% female; mean [SD] age 8.6[5.1] years at JIA incidence/index date and mean follow-up in childhood 6.3[4.4] years for JIA; similar for comparators). Thirty-eight pairs had follow-up into adulthood with mean follow-up of 8.0[5.5] years for JIA. Children with JIA were more likely to have joint surgery (RR:3.93, 95%CI:1.18–24.94), non-joint surgery (RR:1.90, 95%CI:1.05–3.67), and hospitalizations (RR:2.25, 95%CI:1.04–5.53) than non-JIA comparators. As adults only joint surgeries remained significantly different (RR:8.5, 95%CI:2.27–120.1). Depression during childhood was more common in JIA (RR:2.49, 95% CI:1.01–6.13). There were no differences in educational achievement, employment status or pregnancy outcomes between the 2 groups. Conclusions In a population-based cohort, inpatient healthcare utilization is higher for patients with JIA including surgery and hospitalization during childhood but not extending into adulthood. Understanding long-term comorbidities and healthcare needs for patients with JIA is necessary to provide comprehensive care.

Depression and medication nonadherence in childhood-onset systemic lupus erythematosus

“…Again, this estimate is similar to that reported in previous studies where the prevalence of suicidal ideation in pediatric patients with SLE ranges between 14-34%. 14,25,26 These prevalences are disproportionately higher than those observed in healthy controls 14,27,28 and those reported for children with special health care needs and other chronic diseases such as Type I diabetes mellitus and asthma. 29–31 Although none of the participants in this study posed an immediate suicide risk, the results support a need for increased awareness and capacity to identify and intervene in patients with cSLE, who appear to be at particular risk for depression and suicidal ideation.…”

Outcome in juvenile idiopathic arthritis: a population-based study from Sweden

“…Data on the rates of joint corrective surgery is sparse, but in a study on prevalent cases of JIA in Minnesota (USA) 1994–2013, 7% of the children with JIA had to undergo joint surgery during childhood with the same number needing it in adulthood [15]. In an older observational study on adult patients with JIA followed over a median time of 19 years, 28.5% had undergone joint surgery, with a majority needing joint replacement.…”

Gaps in Mental Health Care for Youth With Rheumatologic Conditions: A Mixed Methods Study of Perspectives From Behavioral Health Providers

“…Mental health disorders are common in adolescents and young adults with rheumatologic conditions such as juvenile idiopathic arthritis, systemic lupus erythematosus, and juvenile dermatomyositis. Studies report high prevalence rates of depression, anxiety, and other mental disorders among these youth ranging from 15% to 65% , including a high risk of suicidal ideation . Studies also suggest that youth with rheumatologic conditions may have higher rates of unmet mental health needs compared to peers with other chronic diseases , and that they are more severely affected by depression in adulthood than those in the general population and those with adult‐onset rheumatologic conditions .…”