Physical Functioning, Pain, and Health-Related Quality of Life in Adults With Juvenile Idiopathic Arthritis: A Longitudinal 30-Year Followup Study

There is a need for a short form questionnaire with known psychometric characteristics that may be used as an indicator of level of global mental distress. A weighted sum of 5 questions from the Symptom Check List (SCL) anxiety and depression subscales (SCL-25) correlates at r = 0.92 with the global SCL-25 score. The alpha reliability for the (5-item) short form questionnaire was 0.85%. Age differences seemed to be trivial, and sex differences were moderate. Descriptive statistics for short form scores in a large, representative sample are given.

The Health Assessment Questionnaire (HAQ) disability index (DI) has been commonly used in rheumatology to quantify functional disability in patient groups, but current general population values of this index are not available. This study was undertaken to establish normative values for the HAQ DI in a general population and to analyze its correlates. The HAQ DI (range of scores 0-3) was measured in a random sample of 1,530 adults in the Central Finland District. Prevalence rates of disability by strata of age, sex, education level, body mass index (BMI), and health behaviors (including smoking and exercise habits) were calculated. Pearson's product-moment correlation coefficient and ordinary least squares regression were used to analyze the data. The estimated population mean HAQ DI was 0.25 (95% confidence interval 0.22-0.28), and 32% of respondents had at least some disability. Both for men and for women, functional disability increased exponentially with age. The HAQ DI was correlated with pain (r = 0.58) and global self assessment (r = 0.61). The prevalence of disability decreased with increasing number of years of education, lower BMI, and increasing frequency of physical exercise. Almost one-third of the general population has some functional disability. Functional disability is associated in part with lifestyle choices and increases with age in a nonlinear manner. The normative values of the HAQ DI that we have presented could be used as a reference benchmark for clinical and epidemiologic studies using this measure of disability.

To describe the long-term outcome of juvenile idiopathic arthritis (JIA). All patients with JIA referred to a pediatric rheumatology center between 1978 and 1988 were identified and invited to undergo an assessment. Patients with JIA from a population-based cohort from East Berlin were included. The outcome assessment considered changes in body function and structure (e.g., mortality, joint abnormalities, disease activity), activities at the individual level (Health Assessment Questionnaire), and participation in society (e.g., mobility, educational and vocational background). Of 260 eligible patients, 215 (83%) were evaluated. Subtypes of JIA at disease onset included oligoarthritis (40%), polyarthritis (14%), systemic arthritis (14%), psoriatic arthritis (1%), enthesitis-related arthritis (15%), and other arthritis (16%). Followup was conducted after a median of 16.5 years. No deaths occurred in this cohort. At followup, approximately half of the patients had active disease and/or changes in body structures to a variable extent. Approximately one-third of patients rated themselves as being functionally limited. Patients demonstrated good social integration: few mobility problems were reported, and the educational achievements of patients were higher and their rate of unemployment was lower compared with the age-matched population. No significant differences in outcome were found between the population-based and the referral-based cohorts. Even though approximately half of the JIA patients had more or less distinctive changes in body function and/or structure after a disease duration of >15 years, fewer than 10% were severely disabled or handicapped. Because JIA often persists into adulthood, long-term followup and care are necessary.