(HealthNewsDigest.com) – CHICAGO – Depression, anxiety, and physical impairment are more prevalent in children with arthritis who have high adverse childhood experiences, according to new research findings presented this week at the 2018 ACR/ARHP Annual Meeting (Abstract #914). Children with arthritis also have a higher prevalence of adverse childhood experiences according to the study’s nationwide survey data.
Juvenile arthritis, also known as juvenile idiopathic arthritis (JIA), is used to describe a child with chronic (long-term) arthritis. JIA may involve one or more joints and can also cause silent eye inflammation. Several types of arthritis fall under the JIA heading, and it’s estimated that around 300,000 children in the United States have been diagnosed with the condition.
Researchers at the Children’s Hospital at Montefiore in Bronx, NY, the University of Minnesota, Minneapolis, MN, and Northwestern University, Chicago, IL explored the relationship between adverse childhood experiences and arthritis, and how these experiences may be associated with health-related outcomes in these children. The study defined adverse childhood experiences as abuse, neglect, and household dysfunction that occur in childhood (before someone turns 18 years old). Specific experiences taken into consideration were food/housing security, death of parent, divorce/separation, incarceration of a parent, witnessing physical abuse in the home or violence in the neighborhood, alcohol/drug abuse at home, racial/ethnic discrimination, and mental illness in the home.
“There is growing literature and increasing appreciation in pediatrics of the relationship between psychosocial stress in childhood and development of disease,” said Tamar Rubinstein, MD, MS, Assistant Professor, Pediatric Rheumatology, at Children’s Hospital at Montefiore, and the study’s co-author. “In addition, there is some evidence that psychosocial stress may be associated with worse outcomes in rheumatologic diseases specifically, perhaps even in the development of autoimmune and inflammatory diseases. This led us to question whether adverse childhood experiences, as a measure of psychosocial stress, might be associated with arthritis and among children with arthritis, with worse outcomes.”
The researchers examined data from the 2016 National Survey of Children’s Health (NSCH) to look at the distribution of adverse childhood experiences among children with arthritis. They compared the experiences among these patients with children who have other chronic, acquired physical conditions, and all other children. The NSCH included sampled households with children under 18 years old.
The study included 123 children with current arthritis. They found that 65 percent of these children had at least one adverse childhood experience, as compared to 40 percent of children without arthritis and 53 percent of children with other chronic conditions. Children who had four or more adverse experiences were more likely to have arthritis compared to those without adverse exposure. High exposure to adverse experiences was also associated with a higher likelihood of arthritis as opposed to the other examined chronic conditions.
The study showed that among children with arthritis, physical impairment and co-morbid depression/anxiety were associated with the degree of exposure to adverse childhood experiences. Ninety-five percent of arthritis children with a high exposure to adverse childhood experiences had physical impairment and 68 percent had depression/anxiety.
“We look forward to examining this relationship in children with well-defined rheumatologic phenotypes to see whether this pattern holds true, specifically in children with known JIA, SLE and other rheumatic diseases,” said Dr. Rubinstein. “At this point, we do not know which contributes to which, whether having higher ACEs contributes to arthritis, or whether having a child with arthritis contributes to family stress and leads to ACEs, or finally, whether there is a third, not-yet-identified factor that ties these two together. Either way, because ACEs increase the risk of chronic disease in adulthood, it is important to understand why these children in particular are so affected, and what we can do in the future to help mitigate those effects.”
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