Психоемоційний стан у молодих дорослих з ювенільним ідіопатичним артритом

Abstract

Aim. To determine emotional state in adults with juvenile idiopathic arthritis (JIA) using questionnaires/ Material and Methods. Patients diagnosed with JIA (N=106) aged over 18 years were examined on the basis of the Alexander Municipal Clinical Hospital, Kyiv, Ukraine. The diagnosis was verified according to the classification criteria of the International League of the Association of Rheumatologists. The study did not include patients with organic pathology of the brain, encephalopathy associated with hypertension, diabetes mellitus, and chronic renal failure. Clinical examination included count of swollen and painful joints; count of joints requiring prosthetics in consequence of destructive changes; assessment of disease activity with regard to administered anti-rheumatic drugs; assessment of quality of life and health with the questionnaires SF-36, HAQ, PHQ-9; evaluation of anxiety by Beck and Hamilton (HAM-A) questionnaires; evaluation of depression by Beck questionnaire surveys and Chaban questionnaire on self-evaluation of anxiety and depression; and determining the social factors that appear to affect health. Results and Discussion. All patients were divided into two groups, depending on the need for prosthetic joints regardless of JIA clinical variants. Group I included 20 patients aged 24,20±8,7 years, with the need of one or more prosthetics joints as a result of JIA. The second group included 86 patients who did not require prosthetic joints, with mean age 23,18±6,18 years. In group I, a longer disease duration (p=0.025), more deformed joints (p<0.001), more frequent cervical spine damage (p=0.015), arthritis of hands joints (p=0.008), lesions of tendons (p=0.037), more systemic manifestations of JIA (p=0.003), higher ESR (p=0.001) and DAS 28 (p<0,0001) were found;  they also received more aggressive therapy, including longer course of glucocorticoids (GC) (81.74 months) than the patients in group II (15.34 months) (p<0.0001) and a higher cumulative dose of GC (p = 0.001). The patients' physical condition according to the SF-36 was 33,92±14,0 in  group I vs 43,74±13,62 in group II, indicating a lower level of physical health (p<0.001) and poorer functional status by HAQ (p=0.034). However, the patients' psychological health by the SF-36 did not differ in two groups (p=0.832), although the PHQ-9 questionnaire showed that the patients in group I revealed moderate severity depression (11,17±6,19) vs light ("subclinical") depression (6,4±6,02) in group II (p=0.019), which is also confirmed by the self-evaluation scale for depression, where a tendency towards depression was found in group I (9,0±6,39) compared to no signs of depression (4,5±3,98) in group II (p=0.018). According to the questionnaire on psychosomatic disorders, higher need for medical psychologist's consultation (8,5±6,35) was found in  group I (p=0.013) than in group II (4,08±3,56). However, in anxiety assessment, the difference was not detected by any questionnaires in both groups of patients, although the anxiety level was higher in group I. Conclusions. Patients with JIA with destructive changes in the joints have higher tendency towards psycho-emotional disorders that require medical consultations of a psychologist or a  psychosomatic medicine professional. Active and early treatment of JIA using modern methods, including biological therapy, allow to prevent destructive changes in the joints, that in its turn reduces psycho-emotional disorders in adult patients with JIA. Patients with aggressive destructive course of JIA need higher social adjustment, which causes a need to include medical psychologists in the team of doctors (along with rheumatologists, podiatrists, rehabilitation professionals, and ophthalmologists) who treat adults with JIA.&nbsp