A new study suggests that, in adolescents with juvenile idiopathic arthritis (JIA), anxiety and depression are associated with measures of pain and disability, but not with markers of inflammation.
The study, “Anxiety associates with pain and disability but not increased measures of inflammation for adolescent patients with juvenile idiopathic arthritis,” was published in the journal Arthritis Care & Research.
Many mental health problems manifest in adolescence, and having to deal with a chronic illness on top of puberty probably wouldn’t be expected to make things easier — indeed, as many as one in three adolescents living with a chronic disease has mental health issues.
In adolescents with JIA, the relationship between features of disease, such as pain and inflammation, and the likelihood of having anxiety or depression hasn’t been thoroughly assessed. It’s not even clear whether people with JIA experience anxiety or depression at different rates than their peers.
To shed light on these questions, researchers recruited 136 patients with JIA ages 13–18 who had not recently been treated with steroids. For comparison, they also recruited 88 controls of similar age with no history of autoimmune disease.
The participants were given questionnaires to assess their psychological well-being.
For JIA patients, pain was quantified using a visual analogue scale (VAS, which quantifies traits that are fairly subjective, exist on a spectrum, and as such are not easily translated into an objective number via direct measurement). Disability was assessed with another self-reported questionnaire, the Childhood Health Assessment Questionnaire (CHAQ).
The patients’ physicians also gave a VAS score of disease severity.
Researchers also collected blood samples from 100 of the JIA patients and 55 of the controls; the samples were used to measure levels of inflammatory molecules such as interleukin 6 (IL-6).
Based on the results of the psychological surveys, JIA patients and controls had similar levels of anxiety and depression symptoms.
Among JIA patients, anxiety and depression were associated with pain, disability, and the results of the physician VAS. However, the number of active (inflamed) joints was not associated with measurements of anxiety and depression in JIA, nor were any of the tested measurements of inflammation.
The researchers did note that, in the control subjects, anxiety (but not depression) was weakly linked with IL-6 levels. But given the very small size of this cohort, it’s hard to say whether this result is particularly meaningful.
“These results suggest that in this cohort, associations between anxiety, mood, pain, and disability are less likely to be mediated by inflammation and are more likely to be associated with other cognitive and behavioral mechanisms,” the researchers stated. Further research will be needed to fully understand what those other mechanisms might be.