Background/Purpose: To assess the adiposity/BMI of children diagnosed with JPsA in a North American registry, examining differences between overweight and non-overweight patients with regard to demographic data, family history, clinical characteristics, radiological manifestations, and scores on Physician Global Assessment, Health-Related Quality of Life, parent/subject overall well-being (PSOWBS), parent/subject pain scale & the Childhood Health Assessment Questionnaire (CHAQ). 

Methods: The study population included all JPsA patients in the Childhood Arthritis and Rheumatology Research Alliance (CARRA) registry for whom age, height and weight were recorded at baseline visit. We assessed adiposity according to CDC 2010 recommendations—in children < 2 years, the ratio of weight to length was plotted on WHO curves, and in children ≥ 2 years, BMI was calculated according to height, weight and age using the CDC/NCHS growth references. Children were divided into two groups: non-overweight including underweight (<2.3rd percentile for children < 2 years and calculated BMI < 5th percentile in children ≥ 2 years old) and normal weight (2.3rd – 97.7th percentile for children < 2 years and calculated BMI ≥ 5-85th percentile in children ≥ 2 years old) children and an overweight group including overweight (>97.7th percentile for children < 2 years and calculated BMI > 85th percentile in children ≥2 years old) and obese (BMI ≥ 95th percentile in children >2 years) children. Descriptive analysis of BMI subgroups was performed using prevalence and percent for the categorical characteristics and mean ±standard deviation or median for continuous parameters. Comparisons of categorical characteristics between two independent groups (non-overweight and overweight) were done by Chi square or Fisher’s exact test. Comparison of continuous parameters between BMI subgroups was performed by T-test or Mann Whitney test, as appropriate.

Results: 320 out of 361 (88.6%) children with JPsA were included in the study: 116 (36.3%) were overweight and 204 (63.8%) were non-overweight. The majority of patients were white (90.6%), non-Hispanic (91.3%) and female (64.7%). Between the two groups, children in the overweight category were significantly older at symptoms onset (9.26 ± 4.48 vs. 7.74 ±4.67 years, P=0.005). There were no significant differences between the two groups for other demographic parameters (race/ethnicity, gender, age at first rheumatology assessment), family history, number of joints involved, nail pitting, dactylitis, psoriasis, enthesitis, sacroiliitis, uveitis and radiological manifestations. In health assessment questionnaires, overweight patients scored worse on the PSOWBS (2.64 ± 2.32 vs 2.15 ± 2.15, p=0.04) and CHAQ (0.42 ± 0.52 vs 0.31 ± 0.47, p=0.05). 

Conclusion: More than 1/3 of patients with JPsA from this registry were overweight and around 19% were obese. Patients who were overweight developed symptoms later and had worse patient reported outcomes as shown by PSOWBS and CHAQ scores. Not only does this JPsA subgroup feel subjectively worse, but patients with increasing adiposity/BMI also may have poorer long-term outcomes with regards to growth and health.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/adiposity-in-children-with-juvenile-psoriatic-arthritis-jpsa/