الفهرس 
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Abstract
Children and youth with chronic physical conditions have increased risk for developing chronic mental health conditions and higher prevalence of mental illness. Psychological comorbidity in pediatric rheumatology has been studied most for juvenile idiopathic arthritis (JIA), systemic lupus erythematosus (SLE), and fibromyalgia. Children with pediatric rheumatic diseases seem to consistently have a lower health related quality of life (HRQOL) score compared with healthy children. The total, physical and psychosocial scores (aggregate of social, emotional and school domains) were lower in children with rheumatic diseases.
Studies indicate that individuals with childhood-onset rheumatologic disease may be at higher risk for mental health disorders than individuals with adult-onset disease.
In children with SLE, depression and anxiety have been associated with higher disease activity and increased medical services use across ambulatory and acute care settings. In children with JIA, depression has been associated with higher disease activity, worse pain, worse general health, greater functional disability, and overall lower health related quality of life (HRQOL) scores. About 20% of juvenile idiopathic arthritis patients have behavioral problems, communication impairment, depressive mood, and agitation.
While the scope of the problem of mental illness in youth with rheumatologic diseases has yet to be fully investigated, studies of other
pediatric chronic diseases indicate that mental illness can lead to poor outcomes during childhood and can affect development and risk of mental illness in adulthood.
The purpose of this study was to evaluate the psychological affection, cognitive function, HRQOL and treatment plan and its relation to disease severity, treatment plan and autoantibodies in a sample of Egyptian children with Systemic Lupus Erythematosus and Juvenile Idiopathic Arthritis and to compare them with normal children.
This study was a comparative cross-sectional study conducted at Immunology Unit- Pediatric Department - Faculty of medicine, Ain Shams University, Cairo, Egypt. The present study was conducted on 90 children that were divided into 3 groups: Study group 1: 30 patients with Systemic Lupus Erythematosus. Study group 2: 30 patients with Juvenile Idiopathic Arthritis. Study group 3:30 age and sex matched children as control group.
The results of our present study can be summarized as follows:
The current study shows that SLE patients with active disease and/or damage had worse LQoL scores.
An important finding in the present study is the strong association between ESR, ANA, ds- DNA and gender with the LQoL. Moreover socio-demographic such as age at entry of the study, disease duration and level of education did not affect directly or indirectly to HRQoL in SLE patients.
Our findings demonstrated that QoL in SLE patients with mucocutaneous manifestation is poor. Furthermore, CLE had bad effects on all domains of LQoL particularly emotional health, body image and fatigue.
In the present study the neuropsychiatric manifestations are not uncommon in SLE patients and were associated with a worse prognosis and poor HRQoL. All domains of the LQoL were lowered significantly as patients reported especially emotional health, planning and intimate relationship.
In the present study musculoskeletal manifestation worsen markedly the 8 domains of LQoL particularly, pain fatigue and burden to others.
Our results revealed that LN patients have poor QoL and the most specific domains adversely affected were; physical health, pain, fatigue, burden to others and emotional health.
In this study medium and weak relationships between impaired executive function and HRQoL and social role participation were found.
Further, when examining social role participation, a major life role was identified: academic performance for children with SLE.
The findings in this study suggest a moderate strength relationship between CI and academics.
In this study, the well-being of children with Systemic Lupus Erythematosus and Juvenile Idiopathic Arthritis tends to be similar to that of their peers without chronic disease.
But, like suboptimal HRQoL, this improvement was not correlated with disease activity. In this study, improvement was correlated with family adversity. This demonstrates that HRQoL and well-being are subjective measures that reflect not only the patient’s feelings about his or her health and functional status, but more importantly, how he or she feels about participating in society.
Finally, we revealed an improvement in well-being over time.
The analysis of mental health symptoms by JIA subtype. It is possible that polyarticular JIA patients are at an increased risk for depression compared to other subtypes because they commonly suffer from higher active joint counts and higher disease activity which may impair overall function and lead to lower quality of life.
In this study we found a positive correlation between higher disease activity and depression/anxiety symptoms.
We did not find any significant relationship between pain and depression or anxiety symptoms, we did find that pain was significantly correlated with symptoms.
In this study, physical disability appears to be correlated to mental health symptoms, as well.
In our study, the overall quality of life was worse or impaired in JIA patients with higher depressive scores.