Profiling Behavioral and Psychological Symptoms in Children Undergoing Treatment for Spondyloarthritis and Polyarthritis

Abstract

Objective Few studies examine psychopathology in different juvenile idiopathic arthritis (JIA) subtypes and disease activity states. We aimed to 1) Evaluate emotional and behavioral symptoms in children with spondyloarthritis (SpA) and polyarticular arthritis (PolyA) as compared to a national normative population using the Child Behavior Checklist (CBCL), and 2) Evaluate the relationship between CBCL scores and disease activity. Methods JIA patients aged 6-17 years with SpA or PolyA were recruited from our Pediatric Rheumatology clinic from April 2018 to April 2019 and the CBCL and Juvenile Arthritis Disease Activity Score (cJADAS10) were completed. Primary outcome measures were CBCL total competence, internalizing, externalizing and total problems raw scores. We compared outcomes from each group to national CBCL normative data. To investigate the relationship between CBCL scores and disease activity, we ran a generalized linear regression model for all arthritis patients with cJADAS10 as the main predictor. Results There were 111 patients and 1753 healthy controls. Compared to healthy controls, SpA or PolyA patients had worse total competence and internalizing scores. Higher cJADAS10 scores were associated with worse total competence, worse internalizing, and higher total problems scores. Most of these differences reached statistical significance (p<0.01). Self-harm/ suicidality was almost four-fold higher in patients with PolyA than healthy controls (OR 3.6, 95% CI 1.3-9.6, p=0.011). Conclusion Our study shows that SpA and PolyA patients with more active disease have worse psychological functioning in activities, school and social arenas and more internalized emotional disturbances suggesting the need for regular mental health screening by rheumatologists.

Facing Pediatric Rheumatic Diseases: The Role of Disease Activity and Parental Emotion Regulation Strategy in Parents’ and Children’s Psychological Adjustment

“…Chronic illnesses, especially in childhood, inevitably involve the entire family system, causing repercussions on daily life, school, and social activities, and may affect the well-being of parents and children. In particular, PRDs are characterized by symptoms of exacerbation (active PRD) and remission (inactive PRD) that could result in different psychological reactions in both parents and children [15,28,29]. Our data showed that parents' psychological adjustment was not associated with disease activity, whereas children's higher emotional and hyperactivity-inattention symptoms were reported by parents of children with active PRDs compared to parents of children with inactive PRDs.…”

The impact of comorbidities in patients with spondyloarthritis

“…17 PatientswithjuvenileSpAareathigher riskforpsychopathology,becauseoftheworseself-reportedpain, physical functioning, remission rates and quality of life. 18 As reportedbefore,childrenwithchronicmedicalconditionsaretwiceas likelytopresentwithsuicideriskthanhealthycontrols. 19 Ontheotherhand,SpAmaycausevision-threateningdiseases, Accurate assessment is the first and important step of management.Astherewashigherprevalenceandseverityofcoronary atherosclerosis in patients with SpA, 22 CVD risk assessment was recommendedatleastonceevery5 years.Nevertheless,traditional CV risk assessment underestimates CV risk.…”

“…Release of inflammatory cytokines and also mobilization of immune cells may access the brain and alter behavior 17 . Patients with juvenile SpA are at higher risk for psychopathology, because of the worse self‐reported pain, physical functioning, remission rates and quality of life 18 . As reported before, children with chronic medical conditions are twice as likely to present with suicide risk than healthy controls 19 …”

Risk of Psychiatric Disorders in Juvenile Idiopathic Arthritis: Population‐ and Sibling‐Controlled Cohort and Cross‐Sectional Analyses

“…However, looking at the existing literature, studies have shown that children and adolescents with chronic diseases more often suffer from psychiatric disorders than their healthy peers ( 29 , 30 , 31 , 32 , 33 ). In patients with JIA, most of the previous studies have highlighted an increased risk in specific outcomes, such as depression and anxiety, compared with the GP ( 13 , 15 , 16 , 34 , 35 , 36 , 37 ), although few other studies have not ( 12 , 14 , 17 , 38 ). Interestingly, for two studies among these latter, the comparator group included only family members ( 14 , 38 ).…”

“…Studies of psychosocial effects of JIA to date reflect different study periods, designs, and study end points for which heterogeneous measurements of outcomes have been used but generally point to a reduced psychosocial well‐being among individuals with JIA, including anxiety, distress, and depressive disorders ( 11 ), though results are not unanimous ( 12 , 13 , 14 , 15 , 16 , 17 ).…”