Public Release: 

Depression linked to disease activity and disability in adolescents with arthritis

Study reinforces the importance of psychological assessment and support

European League Against Rheumatism

London, United Kingdom, June 9, 2016: The results of a study presented today at the 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.4

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.

Abstract Number: OP0300

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NOTES TO EDITORS:

For further information on this study, or to request an interview with the study lead, please do not hesitate to contact the EULAR congress

Press Office in the London Suite at ExCel London during EULAR 2016 or on:

Email: eularpressoffice@cohnwolfe.com

Onsite tel: +44 (0) 7725 915 492 / +44 (0) 7786 171 476

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About EULAR

The European League Against Rheumatism (EULAR) is an umbrella organisation which represents scientific societies, health professional associations and organisations for people with Rheumatic Musculoskeletal Diseases (RMD) throughout Europe.

EULAR aims to promote, stimulate and support the research, prevention, and treatment of RMD and the rehabilitation of those it affects.

EULAR underlines the importance of combating rheumatic diseases not only by medical means, but also through a wider context of care for rheumatic patients and a thorough understanding of their social and other needs. EULAR is supported in this mission by its 45 scientific member societies, 36 PARE (People with Arthritis/Rheumatism in Europe) organisations, 22 HPR (Health Professionals in Rheumatology) associations and 23 corporate members.

The EULAR Annual European Congress of Rheumatology is the foremost international medical meeting announcing the latest research on rheumatic and musculoskeletal diseases. EULAR 2016 is expected to attract over 14,000 delegates from around 120 countries. Most if not all professions working in the vast field of RMD will be represented.

To find out more about the activities of EULAR, visit: http://www.eular.org

References

1.EULAR 2016; London: Abstract OP0300

2. Margaretten M, Julian L, Katz P, Yelin E. Depression in patients with rheumatoid arthritis: description, causes and mechanisms. International journal of clinical rheumatology. 2011; 6(6): 617-623

3. Tarakci E, Yeldan I, Kaya Mutlu E, et al. The relationship between physical activity level, anxiety, depression, and functional ability in children and adolescents with juvenile idiopathic arthritis. Clin Rheumatol. 2011; 30 (11): 1415-20

4. Hyrich KL, Lal SD, Foster HE, et al. Disease activity and disability in children with juvenile idiopathic arthritis one year following presentation to paediatric rheumatology. Results from the Childhood Arthritis Prospective Study. Rheumatology (Oxford, England). 2010; 49(1): 116-122 (childhood arthritis prospective study)

5. Symmons DP, Jones M, Osborne J, et al. Pediatric rheumatology in the United Kingdom: data from the British Pediatric Rheumatology Group National Diagnostic Register. J Rheumatol; 1996; 23 (11) : 1975-1980

6. Son SE, Kirchner JT. Depression in children and adolescents. American Family Physician. 2000; 62: 2297-308

7. Roberts RE, Roberts CR, Chen YR. Ethnocultural differences in prevalence of adolescent depression. Am J Community Psychol. 1997; 25(1): 95-110

8. Sund AM, Larsson B, Wichstrøm L. Prevalence and characteristics of depressive disorders in early adolescents in central Norway. Child and Adolescent Psychiatry and Mental Health. 2011; 5: 28

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