Quality of life problems in children with juvenile idiopathic arthritis and its subtype associated with uveitis (literature review and own research)

Abstract

Background. The problem of the quality of life (QoL) is relevant nowadays, especially for patients with chronic diseases, including juvenile idiopathic arthritis (JIA) and the subtype of JIA associated with uveitis (JIA-u). The purpose was to carry out a literature review on the QoL in children with JIA and JIA-u, with an analysis of existing tools, the possibility of their use in children, and to assess the QoL indicators of children with JIA, who were treated in a specialized department of the hospital. Materials and methods. The search was performed in the PubMed, Medline, and Google databases using the keywords: JIA, rheumatoid arthritis, uveitis, JIA-u, arthritis with uveitis, QoL, QoL in children. Inclusion criteria were as follows: publication after 2010, use of questionnaires to assess QoL, the sample of patients over 30 people. The type of instrument for assessing QoL, the sample nature, and the QoL indicators of patients were analyzed. The study was carried out at the premises of the State Institution “Institute for Children and Adolescents Health Care of the National Academy of Medical Sciences of Ukraine” and involved 41 children with JIA (22 with polyarticular, and 19 with oligoarticular variants): 25 girls and 16 boys aged 3–17 years with disease duration of 40.2 ± 6.2 months. Thirty-six of them received methotrexate, and 5 — sulfasalazine. The disease activity was assessed by the Juvenile Arthritis Disease Activity Score (JADAS27) and the functional state — by the Childhood Health Assessment Questionnaire (CHAQ). For quality of life assessment, the Pediatric Quality of Life InventoryTM validated for Ukraine was used. Results. The analysis included 73 foreign scientific papers from 2011 to 2021, among which 11 are fully devoted to the assessment of QoL in children with JIA, and 62 partially cover this topic in children and adults with arthritis. In Ukraine, these issues are not discussed enough (6 articles on the evaluation of QoL in children), the factors for its deterioration remain unclear. The level of activity according to JADAS27 in children in subgroups with both poly- and oligoarticular variants was high (11.20 ± 7.04 and 8.9 ± 4.2 points), and the functional state (on CHAQ) — 0.19 ± 0.17. In children with JIA, QoL indicators are reduced, especially on the scales of emotional and school functioning, and closely correlate with disease activity (r = 0.784, p < 0.05). Conclusions. The analysis of the conducted studies showed that decreased disease activity is not accompanied by the QoL indicators optimization, which remain reduced. Recently, the situation with the QoL assessment in domestic medicine has been improving, relevant questionnaires are being actively introduced. However, the ambiguity of the results in world medicine and the presence of a small number of works on this topic determine the urgency of the problem of QoL in children with JIA in Ukraine.

Systemic juvenile idiopathic arthritis in the pediatric practice of Donetsk region

“…Clinical manifestations of sJIA corresponded to literature data (Lee & Schneider, 2018;Albaker, 2020;Pawlocik et al, 2023). The onset of the disease in our patients, as in literature data (Bogmat & Shevchenko, 2017;Boiko, 2019;Koniushevska et al, 2022), was manifested by acute, hectic fever, skin syndrome, lymphadenopathy, polyserositis, and hepato-and splenomegaly, all children had a high level of laboratory activity of the disease, only one girl had a subacute onset of the disease.…”

“…Juvenile idiopathic arthritis (JIA) is a heterogeneous group of diseases of unclear etiology, characterized by a complex autoaggressive pathogenesis, with a severe, chronic, steadily progressing course, which begins before the age of 16, leading to destructive and inflammatory changes in the joints that last more than 6 weeks provided that other joint pathology is excluded, with early disability of the sick child and a decrease in the quality of life (Baranov & Alekseeva, 2016;Petty et al, 2016;Bogmat & Shevchenko, 2017).…”

“…Nonsteroidal anti-inflammatory drugs (NSAID), corticosteroids, and immunosuppressants are used to treat sJIA (Ringold et al, 2013;Kaleda et al, 2019;Onel et al, 2022). But NSAID and GCS do not control the course of JIA and do not prevent the development of bone-cartilage destruction (Bogmat & Shevchenko, 2017;Koniushevska et al, 2022). Traditional cytostatics methotrexate (MTX), which has acquired the status of the "gold standard" of basic therapy, the "number one" drug for the treatment of JIA, is not effective in sJIA with active systemic manifestations without arthritis (Grevich & Shenoi 2017;Ferrara et al, 2018;Albaker, 2020).…”

“…(Baranov & Alekseeva, 2016;Nigrovic et al, 2018;Oshljanskaja, 2018). Steroid resistance or steroid dependence often develops (Ringold et al, 2013;Bogmat & Shevchenko, 2017;Grevich & Shenoi, 2017). But despite everything, it is still impossible to completely abandon the use of GCS in case of sJIA (Bogmat & Shevchenko, 2017;Kimura et al, 2017;Albaker, 2020).…”

“…The problem of resistance to the IL-6 blocker -tocilizumab (TCZ, Actemra) exists in 10% of patients, which requires the prescription of IL-1 blockers (Nigrovic et al, 2018;Ruperto et al, 2018;Song & Lee, 2021). But neither anakinra nor canakinumab is registered in Ukraine (Bogmat & Shevchenko, 2017;Oshljanskaja, 2018). Until now, the optimal approach to the treatment of sJIA is unknown, especially taking into account the different initial characteristics of the patient.…”