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Choong N, Batthish M, Berard RA, Chédeville G, Feldman BM, Houghton KM, Huber AM, James S, Proulx-Gauthier JP, Rumsey DG, Schmeling H, Toupin-April K, Guzman J. Relationship of Fatigue, Pain Interference, and Physical Disability in Children Newly Diagnosed With Juvenile Idiopathic Arthritis. Arthritis Care Res (Hoboken) 2024. [PMID: 38769616 DOI: 10.1002/acr.25377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 04/18/2024] [Accepted: 05/14/2024] [Indexed: 05/22/2024]
Abstract
OBJECTIVE Our objectives were to quantify the relationships among fatigue, pain interference, and physical disability in children with juvenile idiopathic arthritis (JIA) and to test whether fatigue mediates the relationship between pain interference and physical disability in JIA. METHODS Patients enrolled within three months of JIA diagnosis in the Canadian Alliance of Pediatric Rheumatology Investigators (CAPRI) Registry between February 2017 and May 2023 were included. Their parents completed the Patient-Reported Outcomes Measurement Information System fatigue and pain interference short proxy questionnaires and the Childhood Health Assessment Questionnaire disability index at registry enrollment. Associations were assessed using Pearson correlations and multiple linear regression. Structural equation modeling (SEM) was used to test if fatigue mediates the relationship between pain interference and physical disability. RESULTS Among 855 patients (61.4% female, 44.1% with oligoarthritis), most reported fatigue and pain interference scores similar to those in the reference population, but 15.6% reported severe fatigue and 7.3% reported severe pain interference, with wide variation across JIA categories. Fatigue was strongly correlated with pain interference (r = 0.72, P < 0.001) and with physical disability (r = 0.60, P < 0.001). Pain interference (β = 0.027, P < 0.001) and fatigue (β = 0.013, P < 0.001) were both associated with physical disability after controlling for each other and potential confounders. SEM supported our hypothesis that fatigue partially mediates the relationship between pain interference and physical disability. CONCLUSION Our findings suggest both fatigue and pain interference are independently associated with physical disability in children newly diagnosed with JIA, and the effect of pain interference may be partly mediated by fatigue.
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Affiliation(s)
- Naomi Choong
- British Columbia Children's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Michelle Batthish
- McMaster Children's Hospital and McMaster University, Hamilton, Ontario, Canada
| | - Roberta A Berard
- London Health Sciences Centre and Western University, London, Ontario, Canada
| | - Gaëlle Chédeville
- McGill University Health Centre and McGill University, Montreal, Quebec, Canada
| | - Brian M Feldman
- The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Kristin M Houghton
- British Columbia Children's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Adam M Huber
- IWK Health Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sarah James
- British Columbia Children's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Dax G Rumsey
- Stollery Children's Hospital and University of Alberta, Edmonton, Alberta, Canada
| | - Heinrike Schmeling
- Alberta Children's Hospital and University of Calgary, Calgary, Alberta, Canada
| | - Karine Toupin-April
- University of Ottawa, Children's Hospital of Eastern Ontario Research Institute, and Institut du Savoir Montfort, Ottawa, Ontario, Canada
| | - Jaime Guzman
- British Columbia Children's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
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Huhtanen M, Mikola K, Kiukkonen A, Palotie T. Craniofacial structures, occlusal features, and TMD symptoms in juvenile idiopathic arthritis patients: a retrospective study. Eur J Orthod 2023; 45:88-95. [PMID: 35856467 DOI: 10.1093/ejo/cjac037] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Juvenile idiopathic arthritis (JIA) is a chronic inflammatory disease in which temporomandibular joint (TMJ) arthritis commonly occurs. It may be asymptomatic and could cause problems in the growing joints. Our aim was to evaluate the craniofacial structures, occlusal features and temporomandibular dysfunction (TMD) symptoms of patients with JIA. METHODS The study consisted of 195 JIA patients treated at the Department of Oral and Maxillofacial Diseases, Helsinki University Hospital (HUH), Finland between 2015 and 2019. We retrospectively screened their medical and dental records and classified them according to age at JIA diagnosis (<7 and ≥7 years). RESULTS Most of the patients had Angle Class I occlusion in both sides. Among all the patients, the mean overjet, and overbite were 3.3 mm and 2.4 mm, respectively. There were more open bite patients in the ≥7 years old group than in the <7 years old group (P = 0.010). Of all patients, 47% reported at least one TMD symptom. The TMD symptoms were more common in participants ≥7 years old than those <7 years old (P = 0.005). CONCLUSION Occlusal features and the incidence of malocclusions seem to have similar tendency among the JIA patients with systematic visits in rheumatologist and orthodontist as in the healthy population, except for open bite that is more common with JIA patients. While treating JIA patients, a well-functioning collaboration between paediatric rheumatologists and orthodontists is essential, as well as a clear screening protocol to detect potentially asymptomatic TMJ arthritis. Particular attention should be paid to children with JIA under school age.
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Affiliation(s)
- Mia Huhtanen
- Orthodontics, Department of Oral and Maxillofacial Diseases, Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Department of Oral and Maxillofacial Diseases, Helsinki University Hospital, Helsinki, Finland
| | - Katriina Mikola
- New Children's Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Anu Kiukkonen
- Orthodontics, Department of Oral and Maxillofacial Diseases, Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Department of Oral and Maxillofacial Diseases, Helsinki University Hospital, Helsinki, Finland.,Cleft Palate and Craniofacial Center, Department of Plastic Surgery, Helsinki University Hospital, Helsinki, Finland
| | - Tuula Palotie
- Orthodontics, Department of Oral and Maxillofacial Diseases, Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Department of Oral and Maxillofacial Diseases, Helsinki University Hospital, Helsinki, Finland
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de Oliveira RJ, Londe AC, de Souza DP, Marini R, Fernandes PT, Appenzeller S. Physical Activity Influences Health-Related Quality of Life in Adults with Juvenile Idiopathic Arthritis. J Clin Med 2023; 12:jcm12030771. [PMID: 36769423 PMCID: PMC9917453 DOI: 10.3390/jcm12030771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 12/04/2022] [Accepted: 12/30/2022] [Indexed: 01/20/2023] Open
Abstract
This cross-sectional study aimed to evaluate the impact of physical activity and physical fitness on the health-related quality of life (HQoL) of adult patients with Juvenile Idiopathic Arthritis (JIA). Fifty-nine JIA patients and sixty healthy individuals participated in this study. All individuals had the following evaluations performed: body composition (electrical bioimpedance), physical fitness (6 min walk test (6MWT)), physical activity level (International Physical Activity Questionnaire (IPAQ)), and HQoL (Quality of Life Questionnaire in relation to Health-Short Form (SF36)). Thirty-nine (66%) JIA patients were considered sedentary compared with 15 (25%) in the control group (p < 0.01). JIA patients had a lower HQoL compared with the control group in all variables studied (p < 0.05). JIA patients who were very physically active had better HQoL conditions in the categories of functional capacity (p = 0.001), limitations by physical aspects (p = 0.003), and emotional aspects (p = 0.002) compared with sedentary patients. JIA patients had more cardiovascular abnormalities and walked shorter distances compared with healthy controls in the 6MWT. In conclusion, we observed that HQoL was reduced in adults with JIA. A high percentage of JIA patients were sedentary with lower physical fitness, but physically active patients had a better HQoL than sedentary patients. The duration of physical activity, rather than intensity, influenced the mental aspects of HQoL.
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Affiliation(s)
- Rodrigo Joel de Oliveira
- Graduate Program in Child and Adolescent Health, School of Medical Sciences, University of Campinas (UNICAMP), Campinas 13083-970, Brazil
| | - Ana Carolina Londe
- Graduate Program in Child and Adolescent Health, School of Medical Sciences, University of Campinas (UNICAMP), Campinas 13083-970, Brazil
| | - Débora Pessoa de Souza
- Graduate Program in Child and Adolescent Health, School of Medical Sciences, University of Campinas (UNICAMP), Campinas 13083-970, Brazil
| | - Roberto Marini
- Department of Pediatrics, School of Medical Sciences, University of Campinas (UNICAMP), Campinas 3083-970, Brazil
| | - Paula Teixeira Fernandes
- Department of Sport Science, Faculty of Physical Education, University of Campinas (UNICAMP), Campinas 13083-851, Brazil
| | - Simone Appenzeller
- Department of Orthopedics, Rheumatology and Traumatology—School of Medical Sciences, University of Campinas (UNICAMP), Campinas 3083-970, Brazil
- Correspondence: ; Fax: +55-19-3289-1818
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Van Der Heijden H, Fatou B, Sibai D, Hoyt K, Taylor M, Cheung K, Lemme J, Cay M, Goodlett B, Lo J, Hazen MM, Halyabar O, Meidan E, Schreiber R, Jaimes C, Ecklund K, Henderson LA, Chang MH, Nigrovic PA, Sundel RP, Steen H, Upadhyay J. Proteomics based markers of clinical pain severity in juvenile idiopathic arthritis. Pediatr Rheumatol Online J 2022; 20:3. [PMID: 35033099 PMCID: PMC8761318 DOI: 10.1186/s12969-022-00662-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 01/01/2022] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Juvenile idiopathic arthritis (JIA) is a cluster of autoimmune rheumatic diseases occurring in children 16 years of age or less. While it is well-known that pain may be experienced during inflammatory and non-inflammatory states, much remains ambiguous regarding the molecular mechanisms that may drive JIA pain. Thus, in this pilot study, we explored the variability of the serum proteomes in relation to pain severity in a cohort of JIA patients. METHODS Serum samples from 15 JIA patients (male and female, 12.7 ± 2.8 years of age) were assessed using liquid chromatography/mass spectrometry (LC/MS). Correlation analyses were performed to determine the relationships among protein levels and self-reported clinical pain severity. Additionally, how the expression of pain-associated proteins related to markers of inflammation (Erythrocyte Sedimentation Rate (ESR)) or morphological properties of the central nervous system (subcortical volume and cortical thickness) implicated in JIA were also evaluated. RESULTS 306 proteins were identified in the JIA cohort of which 14 were significantly (p < 0.05) associated with clinical pain severity. Functional properties of the identified pain-associated proteins included but were not limited to humoral immunity (IGLV3.9), inflammatory response (PRG4) and angiogenesis (ANG). Associations among pain-associated proteins and ESR (IGHV3.9, PRG4, CST3, VWF, ALB), as well as caudate nucleus volume (BTD, AGT, IGHV3.74) and insular cortex thickness (BTD, LGALS3BP) were also observed. CONCLUSIONS The current proteomic findings suggest both inflammatory- and non-inflammatory mediated mechanisms as potential factors associated with JIA pain. Validation of these preliminary observations using larger patient cohorts and a longitudinal study design may further point to novel serologic markers of pain in JIA.
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Affiliation(s)
- Hanne Van Der Heijden
- grid.38142.3c000000041936754XDepartment of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, MA USA ,grid.5012.60000 0001 0481 6099Faculty of Psychology and Neuroscience, Section Neuropsychology & Psychopharmacology Maastricht University, Maastricht, The Netherlands ,grid.7177.60000000084992262Faculty of Science, Biomedical Sciences Neurobiology, University of Amsterdam, Amsterdam, The Netherlands
| | - Benoit Fatou
- grid.38142.3c000000041936754XDepartment of Pathology, Boston Children’s Hospital, Harvard Medical School, Boston, MA USA
| | - Diana Sibai
- grid.38142.3c000000041936754XDepartment of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, MA USA
| | - Kacie Hoyt
- grid.38142.3c000000041936754XDivision of Immunology, Boston Children’s Hospital, Harvard Medical School, Boston, MA USA
| | - Maria Taylor
- grid.38142.3c000000041936754XDivision of Immunology, Boston Children’s Hospital, Harvard Medical School, Boston, MA USA
| | - Kin Cheung
- BioSAS Consulting, Inc, Wellesley, MA USA
| | - Jordan Lemme
- grid.38142.3c000000041936754XDepartment of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, MA USA
| | - Mariesa Cay
- grid.38142.3c000000041936754XDepartment of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, MA USA
| | - Benjamin Goodlett
- grid.38142.3c000000041936754XDivision of Genetics and Genomics, Boston Children’s Hospital, Harvard Medical School, Boston, MA USA
| | - Jeffery Lo
- grid.38142.3c000000041936754XDivision of Immunology, Boston Children’s Hospital, Harvard Medical School, Boston, MA USA
| | - Melissa M. Hazen
- grid.38142.3c000000041936754XDivision of Immunology, Boston Children’s Hospital, Harvard Medical School, Boston, MA USA
| | - Olha Halyabar
- grid.38142.3c000000041936754XDivision of Immunology, Boston Children’s Hospital, Harvard Medical School, Boston, MA USA
| | - Esra Meidan
- grid.38142.3c000000041936754XDivision of Immunology, Boston Children’s Hospital, Harvard Medical School, Boston, MA USA
| | - Rudy Schreiber
- grid.5012.60000 0001 0481 6099Faculty of Psychology and Neuroscience, Section Neuropsychology & Psychopharmacology Maastricht University, Maastricht, The Netherlands
| | - Camilo Jaimes
- grid.38142.3c000000041936754XDepartment of Radiology, Boston Children’s Hospital, Harvard Medical School, Boston, MA USA
| | - Kirsten Ecklund
- grid.38142.3c000000041936754XDepartment of Radiology, Boston Children’s Hospital, Harvard Medical School, Boston, MA USA
| | - Lauren A. Henderson
- grid.38142.3c000000041936754XDivision of Immunology, Boston Children’s Hospital, Harvard Medical School, Boston, MA USA
| | - Margaret H. Chang
- grid.38142.3c000000041936754XDivision of Immunology, Boston Children’s Hospital, Harvard Medical School, Boston, MA USA
| | - Peter A. Nigrovic
- grid.38142.3c000000041936754XDivision of Immunology, Boston Children’s Hospital, Harvard Medical School, Boston, MA USA
| | - Robert P. Sundel
- grid.38142.3c000000041936754XDivision of Immunology, Boston Children’s Hospital, Harvard Medical School, Boston, MA USA
| | - Hanno Steen
- Department of Pathology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA. .,Neurobiology Program, Boston Children's Hospital, Boston, MA, USA. .,Precision Vaccines Program, Boston Children's Hospital, Boston, MA, USA.
| | - Jaymin Upadhyay
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA. .,Department of Psychiatry, McLean Hospital, Harvard Medical School, MA, Belmont, USA.
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Kosola S, Relas H. Patients with psychiatric diagnoses have lower quality of life than other patients with juvenile rheumatic disease: a prospective study. Rheumatology (Oxford) 2021; 60:5560-5566. [PMID: 33591311 PMCID: PMC8643440 DOI: 10.1093/rheumatology/keab150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 02/05/2021] [Indexed: 01/02/2023] Open
Abstract
Objectives Transition of adolescents with chronic diseases from paediatric healthcare to adult care requires attention to maintain optimal treatment results. We examined changes in health-related quality of life (HRQoL) and disease activity among JIA patients with or without concomitant psychiatric diagnoses after transfer to an adult clinic. Methods We prospectively followed 106 consecutive patients who were transferred from the New Children’s Hospital to the Helsinki University Hospital Rheumatology outpatient clinic between April 2015 and August 2019 and who had at least one follow-up visit. HRQoL was measured using 15D, a generic instrument. Results The patients’ median age at transfer was 16 years and disease duration 4.0 years. Patients were followed for a median of 1.8 years. Disease activity and overall HRQoL remained stable, but distress (dimension 13 of 15D) increased during follow up (P=0.03). At baseline, patients with at least one psychiatric diagnosis had lower overall 15D scores [mean 0.89 (s.d. 0.14) vs 0.95 (s.d. 0.05), P <0.01] and higher disease activity [DAS28mean 1.88 (s.d. 0.66) vs 1.61 (s.d. 0.31), P = 0.01] than patients without psychiatric diagnoses. The difference in overall 15D persisted over the study period. Conclusion Transition-phase JIA patients with psychiatric diagnoses had lower HRQoL than other JIA patients. Despite reduced disease activity and pain, HRQoL of patients with psychiatric diagnoses remained suboptimal at the end of follow-up. Our results highlight the necessity of comprehensive care and support for transition-phase JIA patients.
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Affiliation(s)
- Silja Kosola
- Pediatric Research Center, Children's Hospital, Helsinki University Hospital and University of Helsinki, PL 435, 00029 HUS, Finland
| | - Heikki Relas
- Rheumatology, Helsinki University Hospital and University of Helsinki, PL 372, 00029 HUS, Finland
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Pain Phenotypes in Rare Musculoskeletal and Neuromuscular Diseases. Neurosci Biobehav Rev 2021; 124:267-290. [PMID: 33581222 DOI: 10.1016/j.neubiorev.2021.02.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 01/18/2021] [Accepted: 02/03/2021] [Indexed: 12/11/2022]
Abstract
For patients diagnosed with a rare musculoskeletal or neuromuscular disease, pain may transition from acute to chronic; the latter yielding additional challenges for both patients and care providers. We assessed the present understanding of pain across a set of ten rare, noninfectious, noncancerous disorders; Osteogenesis Imperfecta, Ehlers-Danlos Syndrome, Achondroplasia, Fibrodysplasia Ossificans Progressiva, Fibrous Dysplasia/McCune-Albright Syndrome, Complex Regional Pain Syndrome, Duchenne Muscular Dystrophy, Infantile- and Late-Onset Pompe disease, Charcot-Marie-Tooth Disease, and Amyotrophic Lateral Sclerosis. Through the integration of natural history, cross-sectional, retrospective, clinical trials, & case studies we described pathologic and genetic factors, pain sources, phenotypes, and lastly, existing therapeutic approaches. We highlight that while rare diseases possess distinct core pathologic features, there are a number of shared pain phenotypes and mechanisms that may be prospectively examined and therapeutically targeted in a parallel manner. Finally, we describe clinical and research approaches that may facilitate more accurate diagnosis, monitoring, and treatment of pain as well as elucidation of the evolving nature of pain phenotypes in rare musculoskeletal or neuromuscular illnesses.
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Cunningham N, Reid M, Fabricius J, Danguecan A, Ardalan K, Knight A. Anxiety and depression in childhood rheumatologic conditions: A topical review. INDIAN JOURNAL OF RHEUMATOLOGY 2021. [DOI: 10.4103/injr.injr_127_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
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Re-conceptualizing functional status through experiences of young adults with inflammatory arthritis. Rheumatol Int 2019; 40:273-282. [PMID: 31300847 DOI: 10.1007/s00296-019-04368-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 07/03/2019] [Indexed: 12/13/2022]
Abstract
The objective of this study is to assess the impact of inflammatory arthritis on young adults' activity participation using quantitative and qualitative methods to advance the field's conceptualization of functional status. Young adults diagnosed with juvenile idiopathic arthritis or rheumatoid arthritis completed (1) the Health Assessment Questionnaire-Disability Index to determine functional status and (2) the day reconstruction method to explore experiential dimensions of function, including functional performance, functional satisfaction, and severity of arthritis symptoms during activities on the previous day. Bivariate analyses were conducted to examine relationships between functional status, experiential variables, and demographic variables. Open-ended questions were provided for participants to report ways that arthritis affected their participation that were not otherwise reflected within survey questions; responses were numerically coded using summative content analysis. Among 37 participants (24.8 ± 3.3 years old), 70% reported moderate-to-severe disability. On average, participants experienced pain, stiffness, or fatigue for more than 50% of their waking hours. Functional status significantly correlated with functional performance (r = - 0.39, p = 0.02) and satisfaction (r = - 0.39, p = 0.02), yet did not correlate with stiffness or fatigue severity or duration of symptoms throughout the day. Participants described strategies that improved their ability to participate in certain activities but reduced their overall quality of activity engagement and caused emotional distress. Young adults with arthritis may experience more significant functional limitations than previously reported. Traditional measures of functional assessment may not capture experiential components of activity that affect participation, such as severity of stiffness or fatigue or the duration of symptoms throughout the day.
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