Assessing Quality of Life, Mental Health in Children With Juvenile Idiopathic Arthritis and Uveitis

A diagnosis of noninfectious uveitis has a significant impact on vision-related quality of life (VRQOL) and vision-related functioning (VRF) in children with juvenile idiopathic arthritis (JIA), according to study results published in Arthritis Care & Research.

Because limited data are available on QOL, mental health, physical disability, and VRF of children with uveitis, the objective of the current study was to conduct a comprehensive assessment of children with JIA, children with JIA and uveitis (JIA-U), and children with other uveitis diagnoses.

The multicenter, cross-sectional study included patients with JIA, JIA-U, or noninfectious uveitis, from 4 sites in the United States. Patients and parents completed disease and demographic information questionnaires, as well as patient-reported outcome measures (PROMs). Assessment of VRF and VRQOL was based on the Effects of Youngsters’ Eyesight on Quality of Life (EYE-Q) questionnaire; general health-related QOL was assessed using the Pediatric Quality of Life Inventory (PedsQL); anxiety and depression were assessed using the Revised Childhood Anxiety and Depression Scale (RCADS); and physical functioning was determined using the Childhood Health Assessment Questionnaire (CHAQ).

The study cohort included 549 patients, including 332 with JIA only, 124 with JIA-U, and 93 with other uveitis diagnoses. Compared with children with JIA only, those with JIA-U had significantly worse VRF (91.4 vs 86.0, P =.006) and VRQOL scores (82.0 vs 70.4, P <.001) for the parent report. Total EYE-Q scores were significantly worse in children with JIA-U compared with those with JIA only (82.1 vs. 89.7, P <.001).

Among children with uveitis, total EYE-Q scores were better in all patients with anterior uveitis (JIA-U and uveitis only) compared with those with nonanterior disease. In addition, among patients with anterior uveitis, there were less ocular complications and worse CHAQ and PedsQL physical summary scores.

Comparison of PROMs in children with anterior uveitis by the presence of JIA revealed worse PedsQL physical summary in children with JIA-U compared with those with anterior other uveitis by parent (80.3 vs 91.0, P =.013) and child report (82.3 vs 92.6, P =.008). Patients with other uveitis with anterior disease had better physical functioning compared with those with JIA-U by parent (0.05 vs 0.26, respectively; P =.017) and child report (0.09 vs 0.32; P =.046).

Physical functioning, according to CHAQ scores, did not differ significantly between patients with JIA-U and those with JIA only. There were no significant differences in RCADS scores between those with JIA, JIA-U, or other uveitis diagnoses. The EYE-Q Total and VRF scores were worse by parent report among uveitis patients with bilateral disease compared with those with unilateral disease.

The study had several limitations, including missing data on visual acuity, the questionnaires not being administered on the day of the eye exam, and potential treatment or physician practice differences.

“We provide a comprehensive outcome assessment of children with JIA, JIA-U, and other uveitis diagnoses. Differences in QOL and function were noted based on underlying disease. Our results support the addition of a vision-specific measure to better understand the impact of uveitis,” the researchers concluded.

Reference

McDonald J, Cassedy A, Altaye M, et al. Comprehensive assessment of quality of life, functioning and mental health in children with juvenile idiopathic arthritis and non-infectious uveitis. Arthritis Care Res (Hoboken). Published online January 9, 2021. doi:10.1002/acr.24551