Kids with Arthritis Have Higher Prevalence of Adverse Childhood Experiences


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KIDS WITH ARTHRITIS HAVE HIGHER PREVALENCE OF ADVERSE CHILDHOOD EXPERIENCES

Newswise — CHICAGO – Depression, anxiety, and physical impairment are more prevalent in children with arthritis who have high adverse childhood experiences, according to new research findings presented this week at the 2018 ACR/ARHP Annual Meeting (Abstract #914). Children with arthritis also have a higher prevalence of adverse childhood experiences according to the study’s nationwide survey data.

Juvenile arthritis, also known as juvenile idiopathic arthritis (JIA), is used to describe a child with chronic (long-term) arthritis. JIA may involve one or more joints and can also cause silent eye inflammation. Several types of arthritis fall under the JIA heading, and it’s estimated that around 300,000 children in the United States have been diagnosed with the condition.

Researchers at the Children’s Hospital at Montefiore in Bronx, NY, the University of Minnesota, Minneapolis, MN, and Northwestern University, Chicago, IL explored the relationship between adverse childhood experiences and arthritis, and how these experiences may be associated with health-related outcomes in these children. The study defined adverse childhood experiences as abuse, neglect, and household dysfunction that occur in childhood (before someone turns 18 years old). Specific experiences taken into consideration were food/housing security, death of parent, divorce/separation, incarceration of a parent, witnessing physical abuse in the home or violence in the neighborhood, alcohol/drug abuse at home, racial/ethnic discrimination, and mental illness in the home.

“There is growing literature and increasing appreciation in pediatrics of the relationship between psychosocial stress in childhood and development of disease,” said Tamar Rubinstein, MD, MS, Assistant Professor, Pediatric Rheumatology, at Children’s Hospital at Montefiore, and the study’s co-author. “In addition, there is some evidence that psychosocial stress may be associated with worse outcomes in rheumatologic diseases specifically, perhaps even in the development of autoimmune and inflammatory diseases. This led us to question whether adverse childhood experiences, as a measure of psychosocial stress, might be associated with arthritis and among children with arthritis, with worse outcomes.”

The researchers examined data from the 2016 National Survey of Children’s Health (NSCH) to look at the distribution of adverse childhood experiences among children with arthritis. They compared the experiences among these patients with children who have other chronic, acquired physical conditions, and all other children. The NSCH included sampled households with children under 18 years old.

The study included 123 children with current arthritis. They found that 65 percent of these children had at least one adverse childhood experience, as compared to 40 percent of children without arthritis and 53 percent of children with other chronic conditions. Children who had four or more adverse experiences were more likely to have arthritis compared to those without adverse exposure. High exposure to adverse experiences was also associated with a higher likelihood of arthritis as opposed to the other examined chronic conditions.

The study showed that among children with arthritis, physical impairment and co-morbid depression/anxiety were associated with the degree of exposure to adverse childhood experiences. Ninety-five percent of arthritis children with a high exposure to adverse childhood experiences had physical impairment and 68 percent had depression/anxiety.

“We look forward to examining this relationship in children with well-defined rheumatologic phenotypes to see whether this pattern holds true, specifically in children with known JIA, SLE and other rheumatic diseases,” said Dr. Rubinstein. “At this point, we do not know which contributes to which, whether having higher ACEs contributes to arthritis, or whether having a child with arthritis contributes to family stress and leads to ACEs, or finally, whether there is a third, not-yet-identified factor that ties these two together. Either way, because ACEs increase the risk of chronic disease in adulthood, it is important to understand why these children in particular are so affected, and what we can do in the future to help mitigate those effects.”

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About the American College of Rheumatology

The American College of Rheumatology is an international medical society representing over 9,400 rheumatologists and rheumatology health professionals with a mission to empower rheumatology professionals to excel in their specialty. In doing so, the ACR offers education, research, advocacy and practice management support to help its members continue their innovative work and provide quality patient care. Rheumatologists are experts in the diagnosis, management and treatment of more than 100 different types of arthritis and rheumatic diseases. For more information, visit www.rheumatology.org.

 

Abstract #: 914

Increased Adverse Childhood Experiences in Children with Arthritis: An Analysis of the National Survey of Children's Health

Tamar Rubinstein1, Danielle R. Bullock2, Kaveh Ardalan3, Wenzhu B. Mowrey4, Nicole Brown5 and Ruth E K Stein4, 1Albert Einstein College of Medicine, Children's Hospital at Montefiore, Bronx, NY, 2University of Minnesota, Minneapolis, MN, 3Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, 4Albert Einstein College of Medicine, Bronx, NY, 5Albert Einstein College of Medicine/ Children's Hospital at Montefiore, Bronx, NY

Background/Purpose: Adverse Childhood Experiences (ACEs) are associated with increased risk of chronic disease and poorer health in children and adults. Emerging data suggest an association between exposure to ACEs and autoimmune diseases in adults, but the relationship between ACEs and childhood-onset rheumatologic diseases has not been examined. Our objective was to investigate the relationship between ACEs and arthritis, the most common manifestation of childhood-onset rheumatologic disease, and to examine the relationship between ACEs and health-related outcomes in children with arthritis.

Methods: We examined data from the 2016 National Survey of Children’s Health (NSCH) to describe the distribution of ACEs among children with current arthritis compared to 1) children with other chronic acquired physical conditions (CAPC)* and 2) all other children. The NSCH is a survey of sampled households with children <18 years conducted by the US Census Bureau. We performed bivariate and multivariable logistic regression to determine associations between arthritis and cumulative ACE scores, measured as a categorical variable (0 ACEs, 1 ACE, 2-3 ACEs, ≥4 ACEs). Chi-square tests and non-parametric tests for linear trends were used to assess associations between cumulative ACE scores and health-related outcomes.

Results: Among 138 children with current arthritis, 123 had complete ACE data and were included in the analysis. Sixty-five percent of children with arthritis were reported to have at least one ACE, while 40% (p<0.001) of children without arthritis and 53% (p<0.001) of children with other CAPC were exposed to ACEs. Children with a high exposure (≥4 ACEs) were more likely to have arthritis compared to those without ACE exposure, odds ratio (OR=5.4, 95% confidence interval (CI) (3.2, 9.2) (p<0.001). High ACE exposure compared to none was associated with higher likelihood of having arthritis versus having other CAPC, OR=3.4, 95% CI (2, 5.8) (p<0.001). A graded relationship was observed between ACE scores and arthritis in logistic regression models for both children with CAPC and all children (Table 1). Among children with arthritis, children with high ACE exposure had the highest proportion of physical impairment (95%) and comorbid depression/anxiety (68%) with significant linear trends of increasing proportions of affected children for both outcomes across increasing ACE scores, (p=0.001, p<0.001)

Conclusion: A markedly high prevalence of ACEs is reported among youth with arthritis from a large national survey. Higher ACE scores were associated with increased odds of arthritis and among children with arthritis, increased proportions of mental illness and physical impairment. Future investigations should examine how adversity may play a role in arthritis development, disease severity, and physical and mental health outcomes.

Table 1: Odds Ratios (OR) for Arthritis by Adverse Childhood Experience (ACE) Exposure

Number of ACEs

Arthritis among all children**

(N = 46,599)

Arthritis among children with CAPC**

(N = 12,225)

 

OR

Confidence Interval

p value

OR

Confidence Interval

p value

0 ACEs

1

---

---

1

---

---

1

1.5

0.8 - 2.4

0.14

1.2

0.7 - 2

0.5

2-3

3.4

2.2 - 5.4

<0.001

2.4

1.5 - 3.8

<0.001

>=4

5.4

3.2 – 9.2

<0.001

3.4

2 - 5.8

<0.001

Adjusted models^

 

OR^

Confidence Interval

p value

OR^

Confidence Interval

p value

0 ACEs

1

---

---

1

----

----

1

1.2

0.7 – 2

0.43

1

0.7 - 1.8

0.7

2-3

2.4

1.5 - 3.9

<0.001

2

1.3 - 3.2

0.003

>=4

3.5

2 – 6

<0.001

2.5

1.5 - 4.5

0.001

* Children with a history of arthritis, but no current arthritis, were censored from this analysis.

** CAPC = Chronic acquired physical conditions: allergies, asthma, arthritis, diabetes, and epilepsy.

* Children with a history of arthritis, but no current arthritis, were censored from this analysis.

^ Adjusted for age, sex, minority race/ethnicity, and poverty status.

 Disclosures:

  1. Rubinstein, None D. R. Bullock, None K. Ardalan, None W. B. Mowrey, None N. Brown, None R. E. K. Stein, None

 

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