"Why did you choose that score?" - Associations between patient global assessment scores and mental health symptoms in patients with juvenile idiopathic arthritis and systemic lupus erythematosus.

BACKGROUND

Rheumatic disease significantly alters a child's quality of life. Rheumatologists often apply a patient global assessment score (PGA) in real time to gauge quality of life, effectiveness of treatment, and disease activity for clinical and research purposes. Previous studies showed a discrepancy between the PGA and objective disease activity measures. This study explores patients' self-reported reasons behind their PGA score, especially the role of anxiety and depression.

METHODS

This is a single-center, cross-sectional, survey-based study. Seventy-one patients 12-18 years old with JIA, SLE or JDM completed a survey including the PGA, Patient Health Questionnaire-9 (PHQ9) and Screen for Childhood Anxiety Related Disorders (SCARED). The associations of high (≥ 3) and low (< 3) PGA scores with mental health scores and reasons for selecting a PGA were analyzed using appropriate nonparametric tests.

RESULTS

Twenty-seven participants (38.0%) had clinically significant anxiety symptoms and sixteen (22.5%) had moderate or worse depressive symptoms. Patients with high PGA scores were more likely to have clinically significant depressive (32.4% vs. 11.8%, p = 0.05) or anxiety symptoms (48.6% vs. 26.5%, p = 0.05) compared to patients with low PGA scores. Patients with either high depressive symptoms or anxiety symptoms were more likely to report trouble sleeping, feeling stressed about their disease, feeling anxious or sad/depressed, having to take too many medications, and an inability to participate in sports/activities as reasons for their PGA score compared to patients without high depressive or anxiety symptoms. In contrast, the degree of objective disease activity was only associated with the reason "inability to participate in sports".

CONCLUSION

Mental health likely influences how adolescents with rheumatic disease view the impact of their disease on their quality of life and functioning. This is important to consider when applying PGA scores in research studies and clinical care. The rheumatology community must develop efficient ways to better evaluate and treat potential factors mediating their patients' overall health and functioning.