Children with arthritis exhibit greater internal, psychological disturbances
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Children with spondyloarthritis and polyarticular arthritis demonstrate greater internalized disturbances and worse psychological functioning in school and social arenas, according to data.
“Arthritis patients, especially during times of active disease, may be experiencing increased psychological symptoms,” Anne McHugh, MD, a pediatric rheumatologist at Dayton Children's Hospital, in Ohio, told Healio. “Often these are in patients without a known history of mental health disorders.”
To assess psychopathology in various juvenile idiopathic arthritis (JIA) subtypes and disease activity states, McHugh and colleagues conducted a cross-sectional study comparing emotional and behavioral trends among children with spondyloarthritis and polyarticular arthritis (PolyA) with the national normative population.
The researchers recruited patients aged 6 to 17 years with SpA or PolyA from April 1, 2018, to March 31, 2019. Each patient completed the Child Behavior Checklist (CBCL) and the Juvenile Arthritis Disease Activity Score (cJADAS10) to examine their mental health and internal and external symptoms of JIA. The researchers compared participants’ CBCL scores with those of the national population to identify differences in outcomes, including obsessive-compulsive disorder problem score, self-harm levels and individual syndrome scores under internalizing problems and externalizing problems scores.
The final cohort included 111 patients, 53 with SpA and 58 with PolyA. There were 1,753 healthy controls.
According to the researchers, patients with SpA and PolyA had worse total competence and internalizing scores, with talk of self-harm and suicide nearly fourfold higher in the PolyA group than the normative population (OR = 3.6; 95% CI, 1.3-9.6).
In addition, the researchers noted that 11% of patients with SpA and 16% of patients with PolyA demonstrated borderline or a clinical range of abnormalities in internalizing symptoms, compared with 5% of healthy controls.
“Importantly, higher disease activity was associated with lower total competence and higher internalizing and total problems scores,” McHugh and colleagues wrote. “These findings underscore the importance for clinicians to screen children with arthritis for social, school and activity competencies and internalized emotional disturbances, especially during periods of higher disease activity.”
According to the researchers, the data support previous findings that children with JIA are at risk for internalizing symptoms and functional impairment, yet both groups primarily experienced internalizing effects such as depression and anxiety compared with somatic symptoms like headaches and nausea, which dominated in previous studies. Additionally, most patients with JIA in the study had low cJADAS10 scores, indicating minimal disease activity. This suggests that it is necessary to treat juvenile arthritis aggressively “beyond the goal of joint and physical function” due to the finding that psychopathology is worse with higher arthritis activity, the researchers wrote.
“This study adds to the growing body of literature indicating that children with arthritis may be at increased risk for psychiatric problems,” McHugh and colleagues wrote. “Specifically, this study indicates pediatric patients with SpA and PolyA have functional impairments and more internalizing symptoms, especially those with higher cJADAS10 scores. Since these SpA and PolyA patients have more internalizing symptoms and less overt (ie, externalizing symptoms), this poses a challenge for clinicians to identify mental health problems without formal screening procedures.”
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