Depressive Symptoms Predict Future Pain, Disability in Adolescent JIA

In adolescents with juvenile idiopathic arthritis (JIA), baseline depressive symptoms were associated with pain and disability, but not with other active disease indicators, through 48 months of follow-up, according to results of the Childhood Arthritis Prospective Study inception cohort published in Rheumatology.

Although adolescent patients with JIA suffer mood disturbances more frequently compared with the general population, the association between mood and clinical findings remains unclear. The Childhood Arthritis Prospective Study was the first longitudinal analysis of adolescents with JIA to examine the association. Researchers hypothesized that depressive symptoms would correlate with clinical disease measures at baseline and predict future clinical outcomes.

A total of 102 biologic-naive patients (median age, 13.2 years; 56.9% girls) diagnosed with polyarthritis (30.4%), oligoarthritis (52.0%), or enthesitis-related arthritis (17.6%) were assessed at baseline, 6 months, and every year for up to 5 years. Investigators used the Mood and Feelings Questionnaire (MFQ) to evaluate depressive symptoms and the Childhood Health Assessment Questionnaire to rate disability; other measures collected at each visit included active and limited joint counts, pain by visual analogue scale (VAS), and patient’s general evaluation of disease.

At the first visit, depressive symptoms were highly prevalent, with 14.7% of participants qualifying for major depressive disorder (MDD) on the MFQ (≥27). Baseline depressive symptoms were significantly associated with pain, disability, active joint count, limited joint count, and patient’s general evaluation (P <.001 for all); these correlations remained significant after adjusting for possible confounders. Girls displayed higher initial depressive symptoms than boys (P <.05), as did those with polyarthritis (P <.001).

At 12 months, elevated baseline depressive symptoms predicted increased pain (P ≤.005) and disability (P ≤.001), and to a lesser extent, patient general evaluation scores. These associations with pain and disability persisted through 48 months of follow-up. However, depressive symptoms at baseline did not predict future active or limited joint counts at either 12 or 48 months.

Study limitations included a lack of sensitivity on the MFQ for participants with milder depressive symptoms and inability to analyze age, sex, JIA subset, or medication use as potential confounding variables.

Baseline depressive symptoms correlated with pain and disability at 1 through 4 years, but were not associated with joint activation or limitation, despite an initial association. Because of the high MDD prevalence in this population, the authors noted that, “this finding justifies actively screening for depressive symptoms in routine clinical practice.” They suggested that future research involve psychological intervention studies to further clarify relationships, identify treatment targets, and improve clinical outcomes for adolescents with JIA.

Please see original study for a full list of funding disclosures.

Reference

Hanns L, Cordingley L, Galloway J, et al. Depressive symptoms, pain and disability for adolescent patients with juvenile idiopathic arthritis: results from the Childhood Arthritis Prospective Study [published online April 25, 2018]. Rheumatology (Oxford). doi:10.1093/rheumatology/key088