Participation in school and physical education in juvenile idiopathic arthritis in a Nordic long-term cohort study

Ellen Nordal,For The Nordic Study Group Of Pediatric Rheumatology (Nosper) ,Lillemor Berntson,Marite Rygg,Marek Zak,Mia Glerup,Maria Ekelund,Kristiina Aalto,Ellen Dalen Arnstad,Nils Thomas Songstad,Susan Nielsen,Suvi Peltoniemi,Anders Fasth,Troels Herlin,Veronika Rypdal

doi:10.1186/s12969-019-0341-6

Abstract

BackgroundThe aim of the study was to describe school attendance and participation in physical education in school among children with juvenile idiopathic arthritis (JIA).MethodsConsecutive cases of JIA from defined geographical areas of Finland, Sweden and Norway with disease onset in 1997 to 2000 were followed for 8 years in a multi-center cohort study, aimed to be as close to population-based as possible. Clinical characteristics and information on school attendance and participation in physical education (PE) were registered.ResultsParticipation in school and in PE was lowest initially and increased during the disease course. Eight years after disease onset 228/274 (83.2%) of the children reported no school absence due to JIA, while 16.8% reported absence during the last 2 months due to JIA. Full participation in PE was reported by 194/242 (80.2%), partly by 16.9%, and none by 2.9%. Lowest participation in PE was found among children with ERA and the undifferentiated categories. Absence in school and PE was associated with higher disease activity measures at the 8-year visit. School absence > 1 day at baseline predicted use of disease-modifying anti-rheumatic drugs, including biologics (DMARDs) (OR 1.2 (1.1–1.5)), and non-remission off medication (OR 1.4 (1.1–1.7) 8 years after disease onset.ConclusionSchool absence at baseline predicted adverse long-term outcome. In children and adolescents with JIA participation in school activities is mostly high after 8 years of disease. For the minority with low participation, special attention is warranted to promote their full potential of social interaction and improve long-term outcome.

Highlights

The aim of the study was to describe school attendance and participation in physical education in school among children with juvenile idiopathic arthritis (JIA)
We report data at baseline, one-year, three-year and eight-year visits, but because some children had not started school at baseline and some had graduated at the 8-year visit, prediction analyses of baseline school absence on adverse longterm outcome was performed only for the individuals with information available at both time points
99 Swedish and Norwegian children aged 6 years or more with information on participation in school and/or physical education (PE) were included in analyses at the baseline visit median 6 (IQR 6–8) months after disease onset, since the Finnish children (n = 138) lacked information on participation in the first years of the study, and the Danish children (n = 93) lacked all information on participation

Summary

Introduction

The aim of the study was to describe school attendance and participation in physical education in school among children with juvenile idiopathic arthritis (JIA). School provides a basic arena for developing a broad range of cognitive and social skills. Physical education in school aims to provide physical activity, and to Nordal et al Pediatric Rheumatology (2019) 17:44 teach the young person an active life style and increase lifelong physical fitness [7]. Limited reports exist on participation in school and in physical education in JIA, and most reports are conveniencesampled, recruited from hospital cohorts, cross-sectional or with short follow-up time, and the studies are often small [3, 9,10,11]

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