Session Information
Date: Sunday, November 8, 2015
Title: Pediatric Rheumatology – Clinical and Therapeutic Aspects Poster I: Lupus, Scleroderma, JDMS
Session Type: ACR Poster Session A
Session Time: 9:00AM-11:00AM
Background/Purpose:
The Patient Reported Outcomes Measurement Information System
(PROMIS¨), developed by the National Institutes of Health, seeks to
create standardized instruments to measure patient reported health-related
quality of life (HRQoL) across diverse domains, both
within and between disease processes.
Our objective was to use PROMIS pediatric short form responses to conduct a comparison
of HRQoL between childhood-onset systemic lupus erythematosus (cSLE), juvenile
idiopathic arthritis (JIA), and widespread chronic musculoskeletal pain (CMP)
Methods:
We compared cross-sectional data from a cohort of 100 children
diagnosed with cSLE to a cohort of 121 patients diagnosed
with JIA, and 66 patients diagnosed with widespread chronic musculoskeletal
pain (CMP). Specifically we compared mean PROMIS pediatric short form T scores
across conditions using ANOVA and post-hoc Tukey
honest significant difference testing. We also compared mean pediatric quality
of life inventory (Peds QL) general core (GC) total
scores for cSLE and JIA via T-test.
Results:
Compared both to patients with cSLE
and JIA, CMP had significantly worse PROMIS T-scores in every category aside
from Peer Relationships (see table 2). cSLE
and JIA patients’ PROMIS T-scores did not differ significantly, except for
lower mobility reported by patients with JIA (p = 0.026). Comparison of cSLE and JIA via mean Peds QL GC total
scores showed cSLE fared significantly worse. The
level of difference in PROMIS scores observed between CMP patients and cSLE/JIA was marked, with large F scores (17 or greater, in
context of a critical difference of 2).
Conclusion:
We showed significantly poorer HRQoL
in children with widespread chronic musculoskeletal pain compared to JIA and
SLE patients (who did not differ significantly from each other). This result
emphasizes the importance of HRQoL to children with rheumatologic
and pain conditions, in addition to more objectively demonstrable physical
pathology. Assessment of patient reported outcomes helps to identify areas for
intervention to improve HRQoL. Further, given the
significant difference between cSLE and JIA seen on the
PEDS QL GC measures (but not PROMIS) additional validation of the PROMIS short forms
is required to ensure that they address all quality of life domains relevant for
SLE
Table 1.
Demographics and Mean Scores
|
Values are mean (SD) unless stated otherwise |
cSLE |
JIA |
CMP |
|
|
Total N |
100 |
121 |
66 |
|
|
Female N (%) |
80 (80%) |
86 (71.1%) |
*121 (83.5%)* |
|
|
Age (yrs) |
15.8 (2.2) |
13 (2.7) |
15.35 (2.2) |
p-value: |
|
Peds QL GC Summary Score |
70.63 (17.8) |
75.7 (15.3) |
**0.025** |
|
|
PROMIS Short Forms |
||||
|
Anxiety
|
48.02 (11) |
45 (9.6) |
56.49 (9.39) |
|
|
Depressive
|
47.84 (11.9) |
47.2 (9.3) |
58.38 (8.7) |
|
|
Fatigue
|
50.73 (14.1) |
48.1 (11.4) |
66.32 (8.69) |
|
|
Mobility
|
46.85 (10.1) |
44.8 (9.6) |
32.51 (6.42) |
|
|
Upper Extremity
|
46.4 (7.9) |
46.4 (9.9) |
38.05 (9.62) |
|
|
Pain
|
50.25 (11.7) |
51.3 (8.8) |
63.34 (5.62) |
|
|
Peer Relations
|
49.67 (13) |
51.4 (8.8) |
47.88 (11.47) |
*Data for larger studied group of patients with chronic
musculoskeletal pain, data for subgroup with widespread chronic musculoskeletal
pain not available.
**Compares cSLE to JIA only,
similar data not available for widespread chronic musculoskeletal pain.
Table 2: Comparison of cSLE with
JIA and Generalized Pain
|
p-value (Diff) 95% Confidence interval
|
SLE vs JIA (A)
|
SLE vs CMP (B)
|
JIA vs CMP (C)
|
p-value (A- C)
|
F-value
|
|
PROMIS Short Forms
|
|
|
|
|
|
|
Anxiety
|
0.20 (-2.3) -5.54 – 0.90 |
<0.0001 (8.47) 4.69-12.25 |
<0.0001 (10.79) 7.15- 14.43 |
<0.0001 |
25.05 |
|
Depressive Symptoms
|
0.8563 (0.74) -4.03 – 2.55 |
<0.0001 (10.54) 6.69- 14.39 |
<0.0001 (11.28) 7.56- 15.0 |
<0.0001 |
28.74 |
|
Fatigue
|
0.3775 (-2.13) -5.89-1.63 |
<0.0001 (15.59) 11.18-20.0 |
<0.0001 (17.7) 13.46-21.98 |
<0.0001 |
52.002 |
|
Mobility
|
0.026 (-3.25) -6.20–0.31 |
<0.0001 (-14.34) -17.8- -10.88 |
<0.0001 (-11.09) -14.42-7.76 |
<0.0001 |
50.229 |
|
Upper Extremity
|
0.6193 (-1.2) -4.23- 1.83 |
<0.0001 (-8.35) -11.9- -4.80 |
<0.0001 (-7.15) -10.58-3.73 |
<0.0001 |
17.07 |
|
Pain Interference
|
0.3941 (1.65) -1.33- 4.63 |
<0.0001 (13.09) 9.59- 16.59 |
<0.0001 (11.44) 8.07- 14.82 |
<0.0001 |
43.897 |
|
Peer Relationships
|
0.485 (1.73) -1.82- 5.23 |
0.5693 (-1.79) -5.95-2.37 |
0.099 (-3.52) -7.54-0.50 |
0.1134 |
2.193 |
To cite this abstract in AMA style:
Holland MJ, Jones J, Morgan DeWitt EM, Kashikar-Zuck S, Sherry DD, Carle AC, Huang B, Mara C, Brunner HI. A Comparison of the Illness Experience Reported Via the Patient Reported Outcomes Measurement Information System Between Patients with Childhood-Onset Systemic Lupus Erythematosus, Juvenile Idiopathic Arthritis, and Widespread Chronic Musculoskeletal Pain [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/a-comparison-of-the-illness-experience-reported-via-the-patient-reported-outcomes-measurement-information-system-between-patients-with-childhood-onset-systemic-lupus-erythematosus-juvenile-idiopathic/. Accessed .« Back to 2015 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/a-comparison-of-the-illness-experience-reported-via-the-patient-reported-outcomes-measurement-information-system-between-patients-with-childhood-onset-systemic-lupus-erythematosus-juvenile-idiopathic/