Depressive symptoms, pain and disability for adolescent patients with juvenile idiopathic arthritis: results from the Childhood Arthritis Prospective Study

Abstract

Objectives: To determine if depressive symptoms assessed near diagnosis associate with future measures of pain, disability and disease for adolescent patients diagnosed with JIA.

Methods: Data were analysed from JIA patients aged 11-16 years recruited to the Childhood Arthritis Prospective Study, a UK-based inception cohort of childhood-onset arthritis. Depressive symptoms (using the 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 were collected. Associations between baseline measures (first visit to paediatric rheumatologist) were analysed using multiple linear regression. Linear mixed-effect models for change in the clinical measures of disease over 48 months were estimated including MFQ as an explanatory variable.

Results: Data from 102 patients were analysed. At baseline, median (IQR) age was 13.2 years (11.9-14.2 years) and 14.7% scored over the MFQ cut-off for major depressive disorder. At baseline, depressive symptoms significantly associated with all clinical measures of disease (P ⩽ 0.01). High baseline depressive symptoms scores predicted worse pain (P ⩽ 0.005) and disability (P ⩽ 0.001) 12 months later but not active and limited joint counts.

Conclusions: Adolescent patients with JIA and depressive symptoms had more active joints, pain and disability at the time of their first specialist appointment. The associations between baseline depression and both pain and disability continued for at least one year, however, this was not the case for active joint count.

Fig. 1

Inclusion criteria Patients were included in the data analysis if they met all criteria shown in the flow chart. Failure to meet any of these criteria resulted in exclusion. Polyarthritis refers to both RF positive and negative polyarthritis. No missing data refers to the following variables at baseline: age, gender, JIA category, MFQ score, DMARD use, MFQ score, active and limited joint counts, disability, pain and the patient’s general evaluation of disease. CHAQ: Child Health Assessment Questionnaire; MFQ: mood and feelings questionnaire; PGA: patient’s general evaluation; VAS: visual analogue scale.

Fig. 2

Change in clinical measures of disease and depressive symptoms over 48 months Linear mixed effects models are shown for change in clinical measures of disease and depressive symptoms over 48 months for adolescent patients with JIA. Disease activity measures explored were active joint count (A), limited joint count (B), PGE (C), disability (D), pain (E) and depressive symptoms (F). 95% CI is shown. CHAQ: Child Health Assessment Questionnaire; MFQ: mood and feelings questionnaire; PGA: patient’s general evaluation; VAS: visual analogue scale.

Fig. 3

Clinical measures of disease over 48 months for high and low depressive symptoms at baseline Linear mixed effects models are shown for change in clinical measures of disease over 48 months for adolescent patients with JIA: active joint count (A), limited joint count (B), disability (CHAQ; C), pain (D) and PGE (E). MFQ at diagnosis included in all models. Estimated disease activity for high (31 points, solid line) and low (2 points, dashed line) depressive symptoms shown with 95% CI. Z test for difference between estimated scores; *P < 0.05, **P < 0.01, ***P < 0.001. CHAQ: Child Health Assessment Questionnaire; MFQ: mood and feelings questionnaire; PGA: patient’s general evaluation; VAS: visual analogue scale.