Children With JIA Have Higher Rate of Adverse Childhood Experiences
CHICAGO — Children with juvenile idiopathic arthritis demonstrate a higher prevalence of adverse childhood experiences, including abuse and domestic household dysfunction, according to Tamar Rubinstein, MD, MS, of the Albert Einstein College of Medicine Children’s Hospital at Montefiore.
In addition, these same children also experience higher rates of depression and anxiety.
“It is well-established that exposure to adverse childhood experiences has a detrimental effect on physical and mental health, and prior studies have shown associations between these experiences and diseases such as heart disease, lung disease and depression,” Rubinstein said, addressing attendees at the ACR/ARHP 2018 Annual Meeting. “How it happens is currently being investigated, and researchers are currently looking into mechanisms that include behavioral, hormonal, immunologic, and even epigenetic responses to stress and trauma.”
To analyze the relationship between adverse childhood experiences and JIA, and how such experiences may be linked to health-related outcomes among these patients, Rubinstein and colleagues examined data from the 2016 National Survey of Children’s Health. Focusing on 123 children with current JIA, the researchers studied the distribution of adverse childhood experiences, and compared such experiences among the patients with juveniles with other chronic, acquired conditions, as well as all other children.
The researchers defined adverse childhood experiences as abuse, neglect and household dysfunction that occured prior to age 18 years. Specifically, the researchers examined food and housing security, the death of a parent, parental divorce or separation, parental incarceration, witnessing physical abuse in the home or neighborhood violence, domestic drug or alcohol abuse, racial or ethnic discrimination and mental illness in the home.
According to Rubinstein, 65% of children with JIA included in the study had at least one reported adverse experience, compared with 40% among juveniles without arthritis and 53% of children with other chronic conditions. In addition, those with four or more adverse childhood experiences were more likely to demonstrate JIA compared with children who were never exposed to adverse experiences. High exposure to adverse experiences was also linked to a greater likelihood of JIA compared with other chronic conditions. The researchers also found that 95% of children with JIA who experienced higher rates of adverse experiences demonstrated physical impairment, with 68% having comorbid depression or anxiety.
“What does this mean for people like me who are taking care of kids with arthritis?” Rubinstein said. “For one, perhaps we should be taking note of childhood adverse experiences clinically, a practice that has gained traction in primary pediatric practices across the country but is not yet common practice among pediatric rheumatologists. Building resilience and providing families and patients with psychosocial support, mental services and resources for coping with stress — these efforts may prevent adverse childhood events, or at least prevent some of the toxic impact of these events, and perhaps they have an important role in the care of children with arthritis.” – by Jason Laday
Rubinstein T. Abstract 914. Presented at ACR/ARHP Annual Meeting, Oct. 20-24, 2018; Chicago.
Disclosure: Rubinstein reports no relevant financial disclosures.