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Abstract Number: 53

A Prospective Study to Assess for Changes in Mood with Initiation of Anti-TNF therapy: A Pilot Study

Kader Cetin Gedik1, Helen Papaioannou2, Monica Marcus3, Clifford Deutschman4 and Beth Gottlieb5, 1Pediatric Rheumatology, Cohen Children's Medical Center fo New York, New Hyde Park, NY, 2Developmental and Behavioral Pediatrics, Cohen Children's Medical Center of New York, New Hyde Park, NY, 3Pediatric Immunology, Allergy and Rheumatology, Texas Children's Hospital, Houston, TX, 4Center for Pediatric Research, Cohen Chilredn's Medical Center of New York, New Hyde Park, NY, 5Pediatric Rheumatology, Cohen Children's Medical Center of New York, New Hyde Park, NY

Meeting: Pediatric Rheumatology Symposium 2017

Keywords:

Session Information

Date: Thursday, May 18, 2017

Title: Clinical and Therapeutic Poster Session

Session Type: Abstract Submissions

Session Time: 5:30PM-7:00PM

Background/Purpose:  Anti- tumor necrosis factor (anti-TNF) agents have been widely studied in the treatment of juvenile idiopathic arthritis (JIA) and inflammatory bowel disease (IBD). Although there are anecdotal reports of mood changes with anti-TNF therapy, these effects are not well described. Our aim is to prospectively evaluate mood changes in patients with JIA and IBD receiving anti-TNF therapy.

Methods:  A single center, prospective, pilot study recruited patients with JIA, rheumatoid arthritis (RA), and IBD (8-17 years) who had never been treated with an anti-TNF agent. Each patient served as his/her own control. Formal rating scales were used to assess mood, pain and overall well-being (Table 1). Statistical analysis was performed using the paired t-test.

Results: We report a total of 10 patients (Table 2) who received anti-TNF therapy for the entire study period. Rating scales were completed before and during treatment with anti-TNF therapy. All 10 patients were evaluated between 1-4.5 months while 6/10 patients had a second evaluation between 4.5 and 9 months. Two had pre-existing psychologically – related diagnoses [1: depression/anxiety, 1: attention deficit hyperactivity disorder (ADHD)/oppositional defiant disorder (ODD)]. Baseline testing was abnormal in 5 patients including the 2 with known diagnoses [3: multiple abnormal results 1: ADHD/ODD, 1: school avoidance] and at risk for mood disorders in 2 patients [2: separation/panic]. At 1st follow up (n=10), the scores for pain, performance/fears, separation/panic and school avoidance significantly decreased (p= 0.014, p: 0.008, p= 0.012, p= 0.041 respectively); no change was detected in the rest of the scores. At 2ndfollow up (n=6), a significant change was detected only in pain scores (p=0.038); no significant change relative to baseline was detected.

Conclusion: Mood disorders may be underestimated in patients with chronic conditions such as JIA and IBD and healthcare providers should consider screening their patients. Our results revealed a decrease in fears and in separation/panic, and an increase in school attendance in association with therapy. To our knowledge, this is the first study to evaluate mood changes prospectively in arthritis and IBD patients treated with anti-TNF therapy. Additional investigation in larger cohorts is required.

Table 1: Study Surveys

Rating Scales

Subcategories

Children’s Depression Inventory (CDI)

Emotional Problems

Negative Mood/ Physical Symptoms

Negative Self-Esteem

Functional Problems

Ineffectiveness

Interpersonal Problems

Multidimensional Anxiety Scale for Children (MASC)

Anxiety Disorder

Physical Symptoms

Harm Avoidance

Social Anxiety

Separation/ Panic

Screen for Child Anxiety Related Disorders (SCARED)

Panic Disorder/ Somatic Symptoms

Generalized Anxiety disorder

Separation Anxiety Disorder

Social Anxiety Disorder

Significant School Avoidance

Anxiety Disorder

Childhood Symptom Inventory Parent Rating Scale (CSI)

Attention Deficit Hyperactivity Disorder

Oppositional Defiant Disorder

Conduct Disorder

Generalized Anxiety Disorder

Separation Anxiety Disorder

Depression

Autism

Phobia/Tics

Obsessions/Compulsions

Schizophrenia

Dysthymic Disorder

Visual Analog Scale (VAS)

Pain

Overall Well-being

Childhood Health Assessment Questionnaire (CHAQ)

Table 2: Sample Characteristics

Number (n)

Percent (%)

Male

Female

8

2

80

20

Age at Diagnosis

Age at Enrollment

Mean = 14.5 years (SD = 2.46)

Mean = 15 years (SD = 2.31)

White

Black

Asian

7

1

2

70

10

20

Hispanic

Not Hispanic

1

9

10

90

Juvenile Idiopathic Arthritis

ERA

Other

Rheumatoid Arthritis

IBD

IBD Associated Arthritis

6

6

0

1

2

1

60

60

0

10

20

10

Known Mood Disorders

Known ADHD

1

1

10

10

Adalimumab

Infliximab

Etanercept

6

3

1

60

30

10

Baseline

1st Follow-up

2nd Follow-up

10

10

6

100

100

60

SD: standard deviation, ERA: enthesitis related arthritis, IBD: inflammatory bowel disease, ADHD: attention deficit hyperactivity disorder

Disclosure: K. Cetin Gedik, None; H. Papaioannou, None; M. Marcus, None; C. Deutschman, None; B. Gottlieb, 5.

To cite this abstract in AMA style:

Cetin Gedik K, Papaioannou H, Marcus M, Deutschman C, Gottlieb B. A Prospective Study to Assess for Changes in Mood with Initiation of Anti-TNF therapy: A Pilot Study [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 4). https://acrabstracts.org/abstract/a-prospective-study-to-assess-for-changes-in-mood-with-initiation-of-anti-tnf-therapy-a-pilot-study/. Accessed .

ACR Meeting Abstracts - https://acrabstracts.org/abstract/a-prospective-study-to-assess-for-changes-in-mood-with-initiation-of-anti-tnf-therapy-a-pilot-study/