Health status of adults with chronic arthritis since childhood : a clinical, functional and psychosocial assessment

This research assessed the health status of patients with juvenile idiopathic arthritis (JIA) who continue to require rheumatological support into adulthood. Features of JIA such as onset in childhood, chronicity, disability and pain suggest a possible increased risk of psychological problems. 259 adults with JIA were traced, 246 (95%) agreed to participate in the study, whilst 13 (5%) declined. Patients’ clinical, functional and psychological status was documented using interview, examination, complete notes review and psychological questionnaires. The mean disease duration was 28.3 years, the mean patient age was 35.4 years and the mean age at onset was 7.1 years. 43.3% of all patients had active arthritis clinically and 54.4% on laboratory measures (CRP). Clinical inflammation was less common in systemic onset JIA. 42.9% of all patients had severe disability (HAW score>1.5). 40% of all patients used mobility aids, and 48% lived in houses with no stairs or a stair lift/rail. 60% of the study group had difficulty using public transport. 29.9% of patients were unemployed as a direct result of their JIA, despite a high proportion (34.8%) of patients who went onto tertiary education. These results raise important questions regarding the provision of career guidance for adolescents with JIA and the return to work of disabled patients. 25.1% of patients had encountered discrimination in the workplace. Fewer patients (42.8%) were in stable relationships compared to their siblings (55.3%). 27.5% of patients had children. 23% of all known pregnancies ended in miscarriage. 78.9% of all women having a caesarean had either reduced hip mobility or short stature. JIA had a detrimental effect on body image in 50.7% of patients but relationships were affected in only 28.2%. 83.3% of patients were sexually active or had previous sexual experience. 58.3% of these had disease related sexual problems.