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VIDEO: Depression worsens newly diagnosed juvenile idiopathic arthritis

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JIA patients need psychological support

Prior study results showed that about a third of adult patients with rheumatoid arthritis are depressed. There seems to be a vulnerability to depression among patients diagnosed with inflammatory arthritis. It makes sense that chronic arthritis can cause depression as it is a painful, debilitating, and long-term disease that is often nonremitting.

Mitchel L. Zoler/Frontline Medical News

Susan Barlett, Ph.D.

Good evidence also suggests that people who are depressed are more vulnerable to develop rheumatoid arthritis or other autoimmune diseases.

The important new findings reported by Dr. Ioannou and his associates underscore the importance of providing psychological support to adolescents newly diagnosed with juvenile idiopathic arthritis. Among its many effects, depression is one of the few robust predictors of nonadherence to medical treatments by patients. Patients who are depressed are less likely to take their medications as prescribed. Depressed patients are also more likely to smoke because tobacco smoking can produce some depression relief. But smoking also contributes to the development and worsening of rheumatoid arthritis and likely other forms of inflammatory arthritis.

Susan Bartlett, Ph.D., is a psychologist and clinical epidemiologist at McGill University, Montreal, who specializes in chronic diseases including arthritis. She had no disclosures. She made these comments during a press conference.




LONDON – Depression is relatively common among teenagers newly diagnosed with juvenile idiopathic arthritis, and adolescents with both disorders appeared to have a less complete response to their treatment in a study of 102 patients.

Juvenile idiopathic arthritis (JIA) that first manifests when a patient is a teenager comes at a “vulnerable time” that can drive the development and worsening of depression, and depression can potentially exacerbate inflammation and also interfere with treatment compliance, Dr. John Ioannou said at the European Congress of Rheumatology,

Depression and JIA can produce a “vicious cycle in which depression exacerbates the disease and the disease exacerbates depression,” explained Dr. Ioannou, a rheumatologist at University College Hospital in London.

Although no study results have yet identified an effective intervention for depression identified in teenagers with newly diagnosed JIA, the immediate message from these new findings is that clinicians must assess the psychological health of adolescents with JIA both when they are first diagnosed as well as at subsequent visits, and if depression is found it requires some sort of intervention, Dr. Ioannou said in an interview.

He and his associates studied 102 patients from the United Kingdom, who were newly diagnosed with JIA and were 11-16 years old at baseline and enrolled in the Childhood Arthritis Prospective Study (CAPS), a nationwide cohort of patients with childhood-onset arthritis of various types. The average age of the group they studied was just under 13 years old, 57% were girls, 52% had persistent oligoarticular arthritis, 30% had polyarticular arthritis, and 18% had enthesitis-related arthritis. All patients underwent assessment at baseline for depression using the Mood and Feelings Questionnaire and 15 (15%) had a score that flagged them as having “probable” depression.

This depression prevalence is about three- to fourfold higher than for an otherwise healthy group of similarly aged adolescents, Dr. Ioannou said.

At baseline, the subgroup of teens with depression had a significantly higher number of inflamed joints, restricted joints, and also more overall pain and disability as measured on the Childhood Health Assessment Questionnaire.

The 102 teens with JIA underwent follow-up assessment 1-3 years later, after they had received ongoing treatment for their JIA. At follow-up, standard JIA treatment had largely resulted in resolution of joint inflammation and movement restriction among all patients, including those with depression at baseline. However the adolescents who had both JIA and depression at entry continued to have significantly more pain and disability at follow-up than did the nondepressed JIA patients, suggesting a link between depression and refractory pain and disability in JIA patients, the researchers reported.

“We need to ensure that psychological assessments and support are available to all young people diagnosed with JIA, and that this is fully integrated into routine care” for newly diagnosed JIA patients, Dr. Ioannou said. He had no disclosures.

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