Study finds link between depression, disease activity and disability in adolescents with JIA

European League Against Rheumatism Annual Congress (EULAR 2016) confirmed a clear association between depression symptom severity and the level of disease activity and disability in adolescent patients with juvenile inflammatory arthritis (JIA). These findings highlight the importance of psychological health assessment for adolescents with JIA and underline the need for psychological support to be fully integrated into their routine care.

"We already know there is an association between depression and disease severity in rheumatoid arthritis. Children with JIA have also been shown to have depression, and this is associated with disability," said Dr John Ioannou lead author from University College London, UK. "However, there has been much less work looking at depression in adolescents with JIA. Specifically, the association between depression and disease severity from initial assessment over a 48 month follow-up period has never been explored in this vulnerable age group with JIA," Dr Ioannou explained.

Inflammatory arthritis is a chronic debilitating disease of childhood and adolescence. In the UK each year, an estimated 10 out of every 100,000 children will develop an inflammatory arthritis, with many subsequently being diagnosed with JIA, the most common chronic paediatric rheumatic disease. Although the disease course can be variable, with periods of activity followed by remission, previous studies have shown that up to 70% of children continue to report disability and limitation of their activities into adulthood, and the proportion is likely to be higher in those with adolescent-onset JIA.

Within this national collaborative study, undertaken by Laura Hanns as her PhD project, it was found that one in seven out of a population of 102 adolescents with JIA, on being recruited into the Childhood Arthritis Prospective Study within six months of the onset of their disease, were found to have significant symptoms of depression. Depressive symptoms were assessed using the Mood and Feelings Questionnaire (MFQ).

Those adolescents with more depressive symptoms at their first visit were found to have a significantly higher number of inflamed joints, a higher number of joints with restricted movement, a higher patient rating of disease severity, more pain and more disability. All of these symptoms rapidly decreased during the first 12 months of treatment and then stabilised. After the first year, depressive symptoms at the first visit were no longer associated with future inflamed joint count, restricted joint count and patient rating of disease severity, but remained associated with future higher level of ongoing disability and pain.

In contrast, in most epidemiological studies, the prevalence of depression among the general population of adolescents is less than half the figure found in this study of adolescents with JIA. Depression has been reported to affect between four and eight percent of adolescents in the US. , A review of several European studies has shown relatively large variations in prevalence rates and gender differences with the prevalence of major depression ranging from a 1-year prevalence of 3.4% among 14-17-year olds in Germany and of 5.8% among 16-17-year olds in Sweden to a 6-month prevalence of 1.9% among 15-year-olds in the UK, 2.7% among 13-18-year olds in The Netherlands, and 5.0% among 13-15-year olds in Switzerland, and a 2-month prevalence of 2.6% among adolescents in Norway.