Depression associated with disease activity and disability in adolescent juvenile inflammatory arthritis patients
Almost 15 percent of adolescents diagnosed with juvenile inflammatory arthritis (JIA) have depressive symptoms at diagnosis which is linked to pain and disability up to 3 years later, according to a study presented at the European League Against Rheumatism Annual Congress (EULAR 2016) held in London, UK.
“Around one in seven teenagers [almost 15 percent] who are diagnosed with JIA report quite significant depression symptoms,” said study author Dr. John Ioannou, consultant in adolescent and adult rheumatology at University College London Hospital (UCLH), London, UK who presented the results. [EULAR 2016, abstract OP0300]
When controlled for age, gender, type of JIA, and treatment, teenagers with more depressive symptoms at diagnosis had more pain and disability, more inflamed and restricted joints, and higher patient scores (rating of disease severity) than teenagers with lesser depression symptoms at diagnosis.
When these patients were examined 1 to 3 years later, patient scores and number of inflamed and restricted joints no longer differed between those with low and high depressive symptoms at diagnosis. However, teenagers who had high depressive symptoms at diagnosis still had more pain and disability.
“[This] implied that treatment worked in terms of controlling inflammation in the joints,” said Ioannou. “However, what continued to differ between the two groups was the level of pain and disability. Those teenagers who presented with high depressive symptoms at diagnosis, in the future, continued to complain of more pain and more disability compared to teenagers who presented with low depressive symptoms at diagnosis,” he said.
Researchers set out to investigate the association between depressive symptoms and disease activity at onset and at follow-up. Data was obtained from 102 JIA patients from the Childhood Arthritis Prospective Study (CAPS), a UK nationwide cohort of childhood onset arthritis. Patients were recruited within 6 months of disease onset and were aged 11-16 years at baseline (determined as the first study visit).
Fifty two percent of patients had persistent oligoarticular arthritis, 30.4 percent had polyarticular arthritis, and 17.6 percent had enthesitis related arthritis. Almost 16 percent of patients were on disease-modifying antirheumatic drugs (DMARDs). Depressive symptoms were assessed using the Mood and Feelings Questionnaire (MFQ).
According to Ioannou, study results demonstrate that depression is prevalent in teenagers who are diagnosed with JIA, and that depressive symptoms in teenagers diagnosed with JIA are associated with worse disease.Despite controlling joint inflammation, depressive symptoms in adolescent JIA patients continue to be associated with pain and disability in the future, said Ioannau. “This research supports the view that psychological assessment and support, when appropriate, should be available for all young people diagnosed with JIA and this should be fully integrated into their routine care,” he said.