Pain, stiffness, and fatigue in juvenile polyarticular arthritis - Contemporaneous stressful events and mood as predictors
Pain, stiffness, and fatigue in juvenile polyarticular arthritis - Contemporaneous stressful events and mood as predictors
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DOI：
10.1002/art.20952
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发表时间：
2005-04-01
影响因子：
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通讯作者：
Rochon, J
中科院分区：
文献类型：
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作者：
Schanberg, LE;Gil, KM;Rochon, J
Objective.采用前瞻性每日日记法分析多关节关节炎患儿的压力、情绪、疾病症状和活动减少的模式。在2个月的时间里，51名患有多关节关节炎的儿童（平均年龄12.4岁，65%为女性）完成了每日日记，包括疼痛，僵硬和疲劳症状的测量，以及压力，情绪和活动减少。在初始和随访评估时，使用儿童健康评估问卷、医生总体评估、关节计数和实验室检查评估功能状态和疾病活动。儿童在> 70%的天数报告疼痛、僵硬和疲劳，症状水平存在显著差异。结果显示，显着的同一天之间的关系，压力，情绪和疾病症状，控制协变量后。具体来说，压力和情绪的日常波动预示着疼痛、僵硬和疲劳的增加。日常压力、情绪和疾病症状的增加也与日常社会活动参与的减少显著相关。只有情绪和僵硬是减少上学的预测因子。压力和情绪是多关节炎儿童日常疾病症状的重要预测因子。此外，压力、情绪和疾病症状的日常波动可以预测日常功能的各个方面，包括参与学校和社会活动。因此，卫生保健提供者应征求每日症状报告时作出决定，临床管理。非药物干预，如认知行为治疗和压力管理可能是有用的辅助治疗时，治疗儿童多关节炎的疾病症状。
Objective. To analyze patterns of stress, mood, disease symptoms, and activity reduction in children with polyarticular arthritis, using a prospective daily diary method.Methods. For a 2-month period, 51 children with polyarticular arthritis (mean age 12.4 years, 65% female) completed daily diaries that included measures of symptoms of pain, stiffness, and fatigue, as well as stress, mood, and activity reduction. Functional status and disease activity were assessed at the initial and followup evaluations with use of the Childhood Health Assessment Questionnaire, physician global assessment, joint count, and laboratory testing.Results. Children reported having pain, stiffness, and fatigue on > 70% of days, with significant variability in symptom levels. Results revealed significant same-day relationships between stress, mood, and disease symptoms, after controlling for covariates. Specifically, daily fluctuations in both stress and mood were predictive of increased pain, stiffness, and fatigue. Increases in daily stress, mood, and disease symptoms were also significantly related to decreased participation in social activities on a day-to-day basis. Only mood and stiffness were predictors of a cutback in school attendance.Conclusion. Stress and mood are important predictors of daily disease symptoms in children with polyarticular arthritis. Moreover, daily fluctuations in stress, mood, and disease symptoms are predictive of aspects of daily function, including participation in school and social activities. Thus, health care providers should solicit daily symptom reports when making decisions regarding clinical management. Nonpharmacologic interventions such as cognitive-behavioral therapy and stress management may be useful adjuvant therapy when treating the disease symptoms of children with polyarticular arthritis.