Background Juvenile Idiopathic Arthritis (JIA) is one of the most common rheumatic diseases in childhood, affecting at least 1 in 1000 children. Children with JIA, experience joint inflammation and swelling, pain and tenderness, morning stiffness, limited mobility. Also, children with JIA and their parents complain fatigue easily and sleep disturbances such as falling asleep, fragmented sleep with more nightly awakenings, and daytime sleepiness (1,2).
Objectives The aim of this study to determine the prevalence of fatigue, disturbed sleep and pain in patients with JIA, at the same time to identify relationship between fatigue, pain, sleep quality and activity limitation and participation restriction.
Methods 84 patients (51 female, 33 male) with JIA and their parents were enrolled in the study. The subjects were recruited in a pediatric rheumatology clinic. They were diagnosed with JIA by a pediatric rheumatologist based on the ILAR diagnostic criteria. Patients with recent diagnoses of JIA and those with mental deficits were excluded. PedsQL Multidimensional Fatigue Scale was used to evaluate fatigue.Pittsburg sleep quality index (PSQI) was used to evaluate quality of sleep, daytime sleepiness. Pain was evaluated with 10 cm Visual Analog Scale (VAS). Childhood Health Assessment Questionnaire (CHAQ) was used to evaluate activity limitation and participation restriction.
Results Respectively, the mean age, disease duration and number of affected joint were 12.90±3.50 years, 5.70±3.76 years and 1.99±1.94. The mean of scores of PedsQL-fatigue was 66.21±23.27, the mean of PSQI-daytime sleepiness was 0.76±0.81, the mean of PSQI-sleep quality was 0.89±0.74, the mean of PSQI-Total was 4.34±2.34 the mean of scores of VAS was 2.35±2.50 and the mean of scores of CHAQ was 1.20±1.69, The relationships of scores of VAS, PedsQL-fatigue, PSQI and CHAQ were demonstrated Table 1.
Conclusions This study confirmed that patients with JIA suffer from pain, fatigue and sleep disturbances. In addition to, sleep disturbance and fatigue are strongly associated with increased pain. Due to this relationship, activity limitation and participation restriction may be observed in patients with JIA. Strategies aimed at improving sleep quality and reducing fatigue and pain should be studied as possible ways of improving participation in activities in children with JIA.
Butbul Aviel Y, Stremler R, Benseler SM, Cameron B, Laxer RM, Ota S, Schneider R, Spiegel L, Stinson JN, Tse SM, Feldman BM. Sleep and fatigue and the relationship to pain, disease activity and quality of life in juvenile idiopathic arthritis and juvenile dermatomyositis. Rheumatology (Oxford). 2011 Nov;50(11):2051-60.
Stinson JN, Hayden JA, Ahola Kohut S, Soobiah C, Cartwright J, Weiss SK, Witmans MB Sleep problems and associated factors in children with juvenile idiopathic arthritis: a systematic review. Pediatr Rheumatol Online J. 2014 Jun 2;12:19.
Disclosure of Interest None declared