Background Juvenile idiopathic arthritis (JIA) is the most common chronic rheumatic disease in children and is one of the major causes of morbidity and physical disability.Due to frequent absences,children with chronic health impairments are also often confronted with educational difficulties.
Objectives The aims of this study were to assess the impact of JIA on children's schooling and to determine the factors that influence their school level.
Methods This is a cross-sectional study including patients with JIA (ILAR criteria).A detailed questionnaire was completed for each participant by interviewing them or their parents as well as by information obtained from their medical records.Collected data included age,sex,subtype of JIA,disease duration,level of disability according to the Childhood Heath Assessment Questionnaire (CHAQ),visual analog scale for patient's overall assessment of disease activity,duration of morning stiffness, joint counts,erythrocyte sedimentation rate,C-Reactive Protein,Disease Activity Score (DAS28).Medications used for JIA treatment were also documented.
Data on the school performance of patients and their siblings were obtained using telephone interviews (educational level, absenteeism, school delay by repetition, drop-out).
The comparison of quantitative variables was performed with the Mann-Whitney test and the comparison of qualitative ones was performed with the Chi square test. The significance level was set at 0.05.
Results A total of 38 patients with JIA were included, 23 female and 15 male, with a mean age of 26 years [12–51] and a mean disease duration of 237 months [5–496].The average age of the onset of the disease was 7.4 years [1.5–16].
The most common subtype was rheumatoid factor-positive polyarthritis (n=16) followed by systematic (n=7), oligoarticular (n=6), rheumatoid factor-negative polyarthritis (n=5) and Enthesitis-related arthritis (n=4). The mean DAS28 was 2.63 [0.76 - 5.55] and the median CHAQ was 0.528 [0–3].Twenty-seven of the children were receiving corticosteroid. Disease-modifying anti-rheumatic drugs were used by 34 of the 38 patients: methotrexate (n=23), sulfasalazine (n=8),leflunomide (n=7),biotherapies (n=14). Twenty patients had complications:Hip arthritis (n=15), growth stunting (n=12), uveitis (n=4). Joint replacement was required in 9 cases.
Four patients were illiterate,12 had dropped out of school,21 reported repeated absences due to illness.A year of schooling was repeated by 61.7% of patients.Ten out of 32 patients over the age of 20 had an university level.Almost 80% of patients were exempted of physical education.
There were no significant associations between the school-related problems,the socio-demographic characteristics and the various parameters of clinical and biological activity studied.School failure was similar among patients and their siblings (p=0.05).
Conclusions Our study suggested that JIA negatively affects schooling of children.More studies with a larger sample are needed to identify the variables associated with school failure in order to ensure the proper management of these patients and to increase their academic performance.
Bouaddi et al. Impact of juvenile idiopathic arthritis on schooling. BMC Pediatrics 2013,13:2.
Kamrul Laila et al. Impact of Juvenile Idiopathic Arthritis on School Attendance and Performance. American Journal of Clinical and Experimental Medicine 2016;4(6):185–190.
Disclosure of Interest None declared