Perception of health status in young adult patients with Juvenile idiopatic arthritis

Background: Outcome of juvenile idiopatic arthritis (JIA) is generally regarded as “good”, even if many patients have marked functional disability and active disease at 10 years of follow-up. Introduction of anti-TNF modified the course of JIA. To evaluate quality of life (QOL) in young adults with JIA, using validated measures of functional disability and generic health status. Methods: 17 JIA patients (>18 years old) switched from a pediatric to an adult rheumatologic setting were evaluated. Functional disability and generic health status/QOL were assessed by the Health Assessment Questionnaire (HAQ) and the Short Form 36-item health profile (SF-36), respectively. SF-36 physical summation score (PSS) and mental summation score (MSS) were considered to reduce the number of comparisons in clinical studies from 8 scales to 2 summary measures. Results: The 17 JIA patients had a mean age of 18.5±2.3 years, a mean disease duration of 10.7±4.9 years, an HAQ of 0.33±0.31, a DAS of 0.6±0.2. 82.4% were female, 7/17 (41.2%) had active joint disease, 10/17 (51.8%) were under treatment with DMARDs and/or anti-TNF agents. No differences were observed in health status (PSS and MSS) and in functional disability (HAQ) with respect to disease activity and current therapy. Disease duration correlated directly with PSS (r=0.80, p=0.02) and inversely with MSS (r=-0.74, p=0.03). Conclusions: Despite good functional indexes and irrespective of disease activity young JIA patients with longer disease duration had worse MSS, suggesting that QOL from a patient’s perspective is dependent on a variety of factors, not just physical impairment and functional disability.