The state of physical functionning of patients with juvenile idiopathic arthritis in the assessment of quality of life

Abstract

Summary. Juvenile idiopathic arthritis is a severe chronic childhood disease that affects not only the joints but is also accompanied by various comorbid conditions, among which eye damage (uveitis) is the most common. In addition to a significant impact on the general condition of the child, this disease also affects the main indicators of quality of life: physical activity, emotional activity, activity in educational institutions, and the social sphere. During the period of active study of Juvenile idiopathic arthritis patients quality of life, a decrease in its overall level is noted due to almost all components, but physical activity shows the lowest values in some studies, which is associated with joint damage, activity, and duration of the disease.

Objective. To determine the state of physical functioning and assess the overall level of quality of life in patients with JIA, considering the subtype of the disease duration and the therapy complex.

Materials and Methods. The study was carried out at SI "Institute for Children and Adolescents Health Care of the NAMS of Ukraine", Kharkiv, from November 2020 till November 2021. There 118 patients with juvenile idiopathic arthritis were examined, including 47 with polyarticular, 43 with oligoarticular, 28 with uveitis-associated subtypes. The investigation involved 77 girls and 41 boys in age from 2 till 18 years old. The therapy by methotrexate was provided in 111 patients, among them 30 had methotrexate with immunobiological therapy (29 adalimumab, 1 – tocilizumab), 6 – sulfasalazine. The disease duration due to disease subtype was in children with polyarthritis – (49,2±6,7), oligoarthritis – (35,4±4,2), uveitis-associated subtypes of juvenile idiopathic arthritis – (76,8±10,2) months. Disease activity was assessed using the Juvenile Arthritis Disease Activity Score 27-joint reduced count questionnaire, functional state according to he Child Health Assessment Questionnaire and quality of life according to PedsQLTM 4.0 Generic Core Scales.

Results. It was found that high juvenile idiopathic arthritis activity was observed in 31 (26.2%) patients, equally often in all subgroups of children. Index functional state did not show a significant decrease either in the whole group or in each of the arthritis subgroups. The overall indicator of quality of life in children with juvenile idiopathic arthritis was reduced in the whole group (71.2±1.4 and 72.9±1.4 per week and month). There was no significant difference between the quality of life indicators of boys and girls. at the same time, physical activity indicators were the lowest in the group with polyarticular juvenile idiopathic arthritis, regardless of gender and age of children, and especially low in children with polyarthritis in the first year of the disease. They also turned out to be worse in children with uveitis-associated subtypes of juvenile idiopathic arthritis with the disease from one to three years. The highest level of the physical component of quality of life was observed in children with oligoarthritis older than 14 years and in children under 8 years of age in the uveitis-associated subtypes of juvenile idiopathic arthritis group. There was no significant effect on the physical indicators of quality of life of the start treatment timing. (р≤0,05).

Conclusions. A decrease in quality of life and its physical component is typical for children with different types of juvenile idiopathic arthriti (oligoarticular, polyarticular, and uveitis-associated subtypes of juvenile idiopathic arthritis). It has been established that children with polyarticular subtype of arthritis have the greatest decrease in quality of life and physical functioning.