Pain, stiffness, and fatigue in juvenile polyarticular arthritis: Contemporaneous stressful events and mood as predictors

• Published in: Arthritis and rheumatism Vol. 52; no. 4; pp. 1196 - 1204
• Main Authors: Schanberg, Laura E., Gil, Karen M., Anthony, Kelly K., Yow, Eric, Rochon, James
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 01.04.2005; Wiley
• Subjects: Adolescent; Affect; Arthritis, Juvenile - complications; Arthritis, Juvenile - physiopathology; Arthritis, Juvenile - psychology; Bacterial arthritis and osteitis; Bacterial diseases; Biological and medical sciences; Child; Disease Progression; Diseases of the osteoarticular system; Fatigue - etiology; Fatigue - physiopathology; Female; Human bacterial diseases; Humans; Infectious diseases; Male; Medical sciences; Miscellaneous. Osteoarticular involvement in other diseases; Pain - etiology; Pain - physiopathology; Quality of Life; Range of Motion, Articular - physiology; Severity of Illness Index; Stress, Psychological; Human; Pain; Diseases of the osteoarticular system; Adolescent; Fatigue; Arthritis; Stiffness; Predictive factor
• ISSN: 0004-3591; 1529-0131
• DOI: 10.1002/art.20952

Objective To analyze patterns of stress, mood, disease symptoms, and activity reduction in children with polyarticular arthritis, using a prospective daily diary method. Methods For a 2‐month period, 51 children with polyarticular arthritis (mean age 12.4 years, 65% female) completed daily diaries that included measures of symptoms of pain, stiffness, and fatigue, as well as stress, mood, and activity reduction. Functional status and disease activity were assessed at the initial and followup evaluations with use of the Childhood Health Assessment Questionnaire, physician global assessment, joint count, and laboratory testing. Results Children reported having pain, stiffness, and fatigue on >70% of days, with significant variability in symptom levels. Results revealed significant same‐day relationships between stress, mood, and disease symptoms, after controlling for covariates. Specifically, daily fluctuations in both stress and mood were predictive of increased pain, stiffness, and fatigue. Increases in daily stress, mood, and disease symptoms were also significantly related to decreased participation in social activities on a day‐to‐day basis. Only mood and stiffness were predictors of a cutback in school attendance. Conclusion Stress and mood are important predictors of daily disease symptoms in children with polyarticular arthritis. Moreover, daily fluctuations in stress, mood, and disease symptoms are predictive of aspects of daily function, including participation in school and social activities. Thus, health care providers should solicit daily symptom reports when making decisions regarding clinical management. Nonpharmacologic interventions such as cognitive‐behavioral therapy and stress management may be useful adjuvant therapy when treating the disease symptoms of children with polyarticular arthritis.