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Depressive symptoms predict future disability, pain in adolescent JIA patients

25 May 2018

In adolescent juvenile idiopathic arthritis (JIA) patients, depressive symptoms are prevalent and predictive of future pain and disability, a study has found.

The study included 102 JIA patients (median age 13.2 years; 56.9 percent female). Assessments included depressive symptoms (Mood and Feelings Questionnaire [MFQ]), active and limited joint count, disability score (Childhood Health Assessment Questionnaire), pain visual analogue scale, and patient’s general evaluation visual analogue scale.

At baseline, a significant number of patients had low mood, with 14.7 percent scoring over the MFQ cutoff for major depressive disorder. Multiple linear regression revealed that baseline depressive symptoms were significantly associated with all clinical measures of disease (p0.01).

Of note, high baseline depressive symptoms scores emerged as predictors of worse pain (p0.005) and disability (p0.001), but not active and limited joint counts, at 12 months after index consultation.

Findings of the present study support active screening for depressive symptoms in routine clinical practice, as well as underscore the need for a psychological intervention study with the aim of improving long-term outcomes for adolescents with JIA.

According to researchers, the association between active inflammatory disease and depressive symptoms may be partially explained by the inflammatory theory of depression, which states that depression can be triggered by peripheral inflammation. This indicates that patients with chronic inflammatory diseases, including JIA, may have increased susceptibility to depression.

However, researchers also acknowledged that the directionality behind the association between inflammation and depression, while unclear, is likely to be multifactorial and bidirectional.

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Despite comparable efficacies, triamcinolone injections appear to be slightly superior over 5-fluorouracil injections for inducing keloid remission, a recent trial has found.
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