Academic Performance Lower Among Children With Chronic Rheumatic Diseases

Researchers compared the grade 12 test results of patients with childhood-onset chronic rheumatic diseases and healthy participants, and determined the factors associated with these test scores.

Patients with chronic rheumatic diseases were found to have poorer grade 12 standardized test scores, independent of sociodemographic factors and mental health comorbidities, according to study results published in The Journal of Rheumatology.

In the current population-based retrospective cohort study, researchers identified children with juvenile arthritis with onset before 16 years and systemic autoimmune rheumatic diseases (including systemic lupus erythematosus, idiopathic inflammatory myositis, systemic sclerosis, and Sjogren syndrome) diagnosed before 17 years. Data were collected from the Manitoba Centre for Health Policy database for birth cohorts between January 1979 and December 1998. Patients with rheumatic diseases were matched by age, sex, and postal codes with those who were healthy.

Medical records were linked to grade 12 language arts achievement index (LAI) and math achievement index (MAI) scores (primary outcomes). Sociodemographic factors and mental health conditions were tested for their associations with school scores using multivariable linear regression.  

The cohort of patients with chronic rheumatic diseases (n=541) had significantly lower LAI and MAI scores compared with the healthy participants (n=2713). A greater percentage of children with chronic rheumatic diseases vs healthy individuals did not participate or failed the tests in the language arts (51% vs 41%; P <.001) and math (61% vs 55%; P =.017) tests. More children with chronic rheumatic diseases vs healthy participants were not enrolled in grade 12 by age 17 years (33% vs 25%; P <.001).

In the multivariable analysis, chronic rheumatic disease, lower socioeconomic status, younger maternal age at first childbirth, family income assistance, involvement with child welfare services, and mental health morbidities were associated with poorer LAI and MAI scores.

Limitations of the study included the inability to examine ethnocultural factors and parent educational attainment, use of an area-based socioeconomic status measure instead of an individual-level measure for socioeconomic status, and the inability to report on all types of juvenile arthritis due to small sample sizes.

The researchers concluded, “While [chronic rheumatic disease] was adversely associated with education performance, the relative magnitude of effect was smaller than sociodemographic factors. Pediatric rheumatologists and other healthcare providers should take all these factors into consideration and seek to evaluate for potential problems in school performance in [children with chronic rheumatic diseases] who have a high-risk profile.”


Lim LSH, Ekuma O, Marrie RA, et al. A population-based study of grade 12 academic performance in adolescents with childhood-onset chronic rheumatic diseases. J Rheum. Published online November 1, 2021. doi:10.3899/jrheum.201514