Paint Me a Picture: Illustrating the Psychosocial Impact of Different Juvenile Idiopathic Arthritis Categories. Results from the CAPRI Registry

Objectives Our study aims to build on the emerging knowledge of the psychosocial challenges of living with juvenile idiopathic arthritis (JIA), by examining differences across the 7 JIA categories and identifying associated factors.

Methods We included 1072 patients (0-18 years old) enrolled within 3 months of diagnosis in the Canadian Alliance of Pediatric Rheumatology Investigators (CAPRI) Registry. The treating rheumatologist assigned JIA categories using ILAR classification criteria. Descriptive statistics summarized patient characteristics at baseline and at 1 year. Psychosocial impact was measured utilizing the psychosocial domain (22 items) within the Juvenile Arthritis Quality of Life Questionnaire (JAQQ). Boxplots visualized changes in JAQQ-psychosocial median scores over time, and Wilcoxon ranked-sum tests highlighted significant differences for JIA categories. Hierarchical clustering of patients using the standardized scores (Z-scores) of 22 JAQQ-psychosocial items produced heatmaps for JIA categories (baseline and 1 year), as well as a heatmap for JIA patients at enrollment (Figure 1). Spearman correlations investigated factors associated with psychosocial impact, and univariate and multivariate regressions quantified the relationship between factors and psychosocial impact. Analyses were conducted using STATA 15 and Python 3.13.

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Figure 1.

Heatmap at enrollment of the 22-JAQQ psychosocial items (y-axis) graphed against patients (x-axis).

Results Descriptive statistics showed oligoarthritis was the most frequent category (45.4% of patients) and polyarthritis RF-positive was the less frequent (3.8%). Significant improvements in JAQQ-psychosocial scores from enrollment to 1 year were observed for polyarthritis RF-negative, polyarthritis RF-positive, psoriatic, and systemic arthritis (p<0.05). Hierarchical clustering of JIA patients at enrollment (n=1072) revealed 4 patient clusters by psychosocial impact: minimal (51.0%), mild (30.6%), moderate (9.3%), and severe (9.0%). JAQQ-psychosocial items clustered into externalizing behaviors, internalizing behaviors, and school-related problems (Figure 1). Heatmaps at enrollment across JIA categories (excluding undifferentiated) showed polyarthritis RF-positive with the highest percentage of patients with severe psychosocial impact (12.5%, mean Z-score 2.24). Oligoarthritis patients exhibited a continuum of psychosocial impact, while psoriatic arthritis patients clustered at minimal or severe extremes. Spearman correlations showed moderate associations between psychosocial impact and functional disability, fatigue, pain, and other JAQQ domains at baseline and at 1 year (correlations=0.4-0.6). CHAQ disability index, fatigue, and pain interference were significant predictors of psychosocial impact in multivariate regression.

Conclusion Our findings suggest that patients diagnosed with certain JIA categories are at higher risk for greater psychosocial impact, especially polyarthritis RF-positive. Exploring the category-specific psychosocial burdens is vital for targeted, tailored psychosocial interventions to complement medical treatment for JIA.