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Abstract Number: 1162

Patients with Juvenile Idiopathic Arthritis From a Low Socio-Economic Background Perceive Their Disease Activity and Physical Limitations Higher Than Patients from a High Socio-Economic Background

Suzanne Verstappen1, Joanna Cobb2, H. E. Foster3, Eileen Baildam4, Lucy R. Wedderburn5, Janet Gardner-Medwin6, Alice Chieng7, Joyce Davidson6, Wendy Thomson8 and Kimme L. Hyrich9, 1Arthritis Research UK Epidemiology Unit,, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, United Kingdom, 2Manchester Academic Health Science Centre, Arthritis Research UK Epidemiology Unit, University of Manchester, Manchester, United Kingdom, 3Paediatric Rheumatology, Newcastle Hospitals NHS Foundation Trust and Great North Children's Hospital, Newcastle Upon Tyne, United Kingdom, 4Paediatric Rheumatology, Alder Hey Children's Foundation NHS Trust, Liverpool, United Kingdom, 5Rheumatology Unit , Institute of Child Health, University College London (UCL), London, United Kingdom, 6Royal Hospital for Sick Children, Glasgow, United Kingdom, 7Manchester Children's Hospital, Manchester, United Kingdom, 8Manchester Academic Health Science Centre, Arthritis Research UK Epidemiology Unit, Manchester, United Kingdom, 9Centre for Musculoskeletal Research, University of Manchester, Manchester, United Kingdom

Meeting: 2012 ACR/ARHP Annual Meeting

Keywords: juvenile idiopathic arthritis (JIA)

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Session Information

Title: Pediatric Rheumatology - Clinical and Therapeutic Aspects: Juvenile Idiopathic Arthritis

Session Type: Abstract Submissions (ACR)

Background/Purpose:   It has been suggested that socio-economic status (SES) may be associated with delayed to access to rheumatology care and with worse disease severity in patients with juvenile idiopathic arthritis (JIA).  The objectives of this study were to examine the association between SES and delay to rheumatology clinic and disease severity in patients with JIA in England.

Methods:   Consecutive children from the Childhood Arthritis Prospective Study (CAPS), a large prospective longitudinal inception cohort study, were included.  At baseline, a clinical examination was performed including the physician’s global assessment (PGA), number of active and limited joints and JADAS71. The CHAQ, pain score, the parental general evaluation (PGE) and the CHQ, including several physical and psychosocial concepts (higher scores indicate better functioning and well-being), were completed by the child or parent.  Using postcode data, SES was determined by calculating the Index of Multiple Deprivation score (IMD).  Based on the ranking of the IMD score, patients were included in the low SES group (lowest quartile), middle SES group (two middle quartiles) and high SES (highest quartile).  Differences in demographic and disease characteristics between these three groups were statistically tested applying the Kruskal-Wallis test or Chi-square test for gender.

Results:   934 JIA patients with a median age of 6.8 [IQR 2.9 – 10.9] yrs at baseline were included in this study.  At baseline the percentage of patients according to the ILAR subtypes for the low, middle and high SES classes were, respectively:  systemic (3.6%, 6.8%, 8.0%), oligoarthritis (54%, 51%, 48%), extended oligoarthritis (1.6%, 2.4%, 2.5%), polyarthritis RF- (13.6%, 18.4%, 19.0%), polyarthritis RF+ (4.2%, 2.9%, 2.5%), enthesitis related arthritis (4.2%, 5.8%, 5.5%), psoriatic arthritis (6.1%, 4.2%, 5.5%), undifferentiated  (7.2%, 5.8%, 4.9%), other (5.5%, 3.2%, 4.3%).  There was no difference in delay to first rheumatology consultation between the three SES groups.  Although no significant differences in diseases activity scores assessed by the rheumatologist were observed between the three SES groups, children and/or parents of children with JIA in the low SES group recorded higher pain scores, disease activity scores and lower physical function scores than those in the high SES group.  SES did not seem to impact on psycho-social outcomes as measured in the CHQ.

Conclusion:   Patients from lower SES background score their disease activity and functional disability higher than patients from higher SES background, whereas no differences were found in disease activity scores obtained in clinic between the different SES groups.  This study suggests that it is important to take SES background into account when patients with JIA present to the clinic for the first time.

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Disclosure:

S. Verstappen,
None;

J. Cobb,
None;

H. E. Foster,
None;

E. Baildam,
None;

L. R. Wedderburn,
None;

J. Gardner-Medwin,
None;

A. Chieng,
None;

J. Davidson,
None;

W. Thomson,
None;

K. L. Hyrich,
None.

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