Quality of life and long-term damages in young adults with juvenile idiopathic arthritis in Ukraine

Abstract

Aim. The aim of our study was to evaluate the quality of life, psychological and physical health of patients with articular and extra-articular damages of JIA using SF-36, HAQ, PHQ-9, and JADI questionnaires in young adults with JIA during the transition healthcare in Ukraine. Materials and Methods. The cross-sectional study of 89 young adults aged 16 to 22 years with a history of JIA, regardless of the active inflammation presence at the time of the survey. The study was performed at the Oleksandrivsky Сentral Clinical Hospital in Kyiv, Ukraine in the period between April 2015 and February 2017. 25 age- and sex-matched controls (without rheumatic disease) were included. There was performed an evaluation of the age at disease onset, disease duration, JADAS, received therapy, quality of life by the Short-Form-36 questionnaire (SF36), the functional state of the HAQ, long-term JIA damage indices JADI-A and JADI-E, PHQ-9, and Beck depression scale. Results and Discussion. Juvenile idiopathic arthritis had a significant impact on the physical scales of quality of life. Patients with JIA had worse (p<0.001) physical health in comparison with the control group. The pain was the most important factor affecting the quality of life in cases of juvenile idiopathic arthritis. The indices responsible for the physical (p<0.001) and role (p<0.05) functioning and bodily pain (p<0.001) were decreased, compared with the control group. However, the indicators responsible for psychological function in patients with JIA did not differ from the control group. The analysis of functional activity revealed a strong negative effect of the disease on physical functioning (p<0.001), physical role functioning (p<0.001), bodily pain (p<0.001), general health (p<0.001), vitality (p<0.001), social role functioning (p<0.001), and mental health (p<0.001), which are included in the concept of physical (p<0.001) and mental (p<0.05) health. In the analysis of functional activity correlation with HAQ, strong negative effects on physical functioning (r=-0.56, p<0.001), role function (r=-0.33, p<0.001), bodily pain (r =-0,60, p<0.001), general health (r=-0,40, p=0.01), vitality (r=-0,46, p<0.001), social functioning (r =-0.48, p<0.001) and mental health (r=-0.42, p<0.001) that are included in the concept of physical (p<0.001) and mental (p<0.05) health, were observed. Articular long-term damages (JADI-A) have a predominantly negative effect on the patient's physical health (r=-0,27, p<0,05) and on the indices associated with it: physical functioning (r=-0,24, p<0.05), bodily pain (r=-0.24, p<0.05), general health (r=-0.24, p<0.05), vitality (r=- 0.19, p <0.05), social functioning (r=-0.27, p<0.05), and mental health (r=-0.22, p<0.05). While the extra-articular long-term damages - JADI-E also have a predominantly negative effect on the patient's physical health (r=-0.22, p<0.05) and on the indexes associated with it: physical functioning (r=-0,28, p<0,05), bodily pain (r=-0,20, p<0,05), general health (r=-0,23, p<0,05), mental health (r=-0.23, p<0.05), as well as a positive association Beck depression scale (r=0,28, p<0.05) and PHQ-9 (r=0.28, p<0.05). Conclusion. In our transitional cohort of Ukrainian patients at the era of biological therapies, juvenile idiopathic arthritis had a larger effect on the physical than mental SF-36 subscale. The long-term effects of articular and extra-articular damages in adult adolescents have a negative impact on the quality of life, in particular, the articular damages have negative correlation with physical functioning, pain intensity, general health status, vitality, social functioning, and mental health. Extra-articular damages also have a predominantly negative effect on physical health and on the indexes associated with it: physical functioning, bodily pain, general health, mental health, and positive correlation with anxiety (HAM-A scale), development of depression (Beck depression scale), and patient health assessment (PHQ-9). Prevention of extra-articular damages is important, because they correlate not only with physical but also with mental health of young adults with JIA, that may affect further adaptation of young people in society.

Keywords

• jia, adults, long term damages, jadi-a, jadi-e, quality of life, mental health