Children with spondyloarthritis (SpA) and polyarticular arthritis (PolyA) with active disease have higher levels of behavioral and emotional symptoms, suggesting the need for routine mental health screenings by rheumatologists, according to study results published in The Journal of Rheumatology.

The link between rheumatologic and psychiatric disorders has been reported in adult patients but it is not well understood among children.

Researchers studied the mental health of pediatric patients with SpA and PolyA compared with healthy control participants.

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Disease activity was measured using the Juvenile Arthritis Disease Activity Score (cJADAS10). Behavioral and emotional symptoms were assessed using the Child Behavior Checklist (CBCL), which scores total competence, internalizing problems, externalizing problems, and total problems. Patient CBCL scores were compared with CBCL scores from a national normative population using generalized linear regression models, after controlling for age and sex. Within the patient group, linear regression models were also used to evaluate the relationship between CBCL and disease activity.

The cross-sectional study included patients with SpA or PolyA aged between 6 and 17 years. In total, data from 111 patients (53 with SpA and 58 with PolyA) and 1753 healthy control participants were analyzed.

The percentage of patients with scores in the “abnormal” range with regard to total competence, internalizing problems, externalizing problems, and total problems were 4%, 11%, 0%, and 4% in the SpA group and 2%, 16%, 3%, and 7% in the PolyA group, respectively. In the normative population, approximately 4% to 5% of individuals had scores in the “abnormal” ranges.

Using linear regression, the differences in age- and sex-adjusted scores between patients and the normative population were small. Patients with arthritis had lower total competence and higher internalizing problems scores, but this was only significant for patients with PolyA. Externalizing problems scores were not affected by disease activity. Scores for self-harm behaviors/suicidality were nearly 4-fold higher in patients with PolyA compared with the normative population (odds ratio [OR], 3.6; 95% CI, 1.3-9.6; P =.011).

Higher disease activity, as measured by cJADAS10, was associated with lower total competence and higher internalizing problems and total problems scores, though not all of these differences achieved statistical significance (P <.01).

Limitations of the study included low disease activity scores because of medication usage among patients, potential underestimation of symptoms by parents completing the CBCL, possible confounding due to incomplete socioeconomic data, and an inability to determine a causal relationship between disease activity and psychopathology due to the cross-sectional study design.

The researchers concluded, “Since [patients with] SpA and PolyA 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. Especially of concern is that [patients with] PolyA are at an increased risk of self-harm/suicidality. These results emphasize the importance of mental health screening in pediatric patients with arthritis, especially when their disease is active, and it highlights the need for further studies into the mechanisms driving this psychopathology to better identify and treat psychiatric comorbidities.”


McHugh A, Chan A, Herrera C, et al. Profiling behavioral and psychological symptoms in children undergoing treatment for spondyloarthritis and polyarthritis. J Rheumatol. Published online February 1, 2022. doi:10.3899/jrheum.210489