One in seven adolescents with juvenile inflammatory arthritis (JIA) experience significant depressive symptoms at diagnosis. Depressive symptoms associate with worse disease and pain at diagnosis with disability over the next three years. These data were presented during a PReS Session at the EULAR Annual Congress 2016 in London.
Previous studies have shown that depression is more common in adolescents with JIA compared to healthy peers. Depression in adolescence has been proved to be associated with disease severity in adolescents with JIA. ‘However, the association between depression and disease severity from initial assessment over a 48- month follow-up period has never been explored in this vulnerable age group with JIA’, Dr Ioannou (University College London) explained on behalf of the Childhood Arthritis Prospective Study (CAPS).
Data from 102 juvenile inflammatory arthritis patients in the CAPS were used to answer this question. CAPS is a nationwide cohort of childhood onset arthritis. Patients are recruited within 6 months of disease onset and the first study visit is identified as ‘baseline’. Patients were included in this analysis if they were aged 11-16 at baseline. Depressive symptoms were assessed using the Mood and Feelings Questionnaire (MFQ) and the associations at baseline were analysed using Spearman’s correlation. Separate piecewise linear mixed-effect models for change in active joint count and disability (Childhood Health Assessment Questionnaire (CHAQ)) over 48 months was estimated. A change point at 12 months allowed for different rates of change between 0-12 months and 12-48 months. MFQ score at baseline was included as a covariate.
At baseline, mean age of the 102 participants was 12.7 years (SD1.4) and 15.7% were taking Disease-modifying antirheumatic drugs (DMARDS). It was found that one in seven out of the population of 102 adolescents with JIA had significant symptoms of depression. This is a much higher prevalence of depressive symptoms than reported in other studies in Europe and the U.S (3-8%). The adolescents with more depressive symptoms at their first visit were found to have a significantly higher number of inflamed joints, a higher number of joints with restricted movement, a higher patient rating of disease severity, more pain and more disability.
All of these symptoms rapidly decreased during the first 12 months of treatment and then stabilised. After the first year, depressive symptoms at the first visit were no longer associated with future inflamed joint count, restricted joint count and patient rating of disease severity, but remained associated with future higher level of ongoing disability and pain. "These findings highlight the importance of psychological health assessment for adolescent patients with JIA and underlines the need for psychological support fully integrated into their routine care", Dr. Ioannou concluded.
ASCO Annual Meeting 2016