Thursday, May 26, 2005

The Impact of Stress, Mood, and Loneliness on Juvenile Arthritis
By Brandon Hines

Psychological factors, such as mood, stress, and isolation, may have powerful effects on the development and intensity of childhood arthritis. This fact has been assumed for a long time, but no one has clinically explored the possibility, until now.

Laura Schanberg, MD

No one knows for sure what triggers arthritis in children, but the researchers believe it to be a combination of psychological stress, trauma, infection, and genetic predisposition.

In other words, having a genetic tendency for juvenile arthritis makes the impact of stress much more pronounced. The physical and emotional stress accumulated by a child increases the chances of getting arthritis. In fact, it has been increasingly known that daily stress influences the expression of many diseases for both children and adults.

In addition, the research suggests that a depressive mood increases the daily intensity of pain and other arthritic symptoms. Not surprisingly, mood is influenced by daily levels of pain.

Children with arthritis tend to limit their social interaction with peers because of their physical disability, uncertainty about the future, increased dependence on family members, and medical worries. Oddly enough, the very symptoms of juvenile arthritis are believed to also be the causes of the illness: "pain, stiffness, and fatigue [could] lead to increased stress and lower mood, as well as the reverse," say the authors.

Arthritis’ emotional effect on children is harmful for their social well-being. For example, "mood and stiffness," the researchers point out, "were crucial predictor variables for a cutback in school attendance." The authors elaborate: "A reduction in social activities may contribute to feelings of social isolation and worsen the quality of life for children.”"

Therefore, long absences from school and decreased social interaction may lead to depression and anxiety. Reducing stress and improving mood in arthritic children may help with their well-being and with reducing arthritic symptoms, thereby preventing further development of psychological problems.

The results of this study impact the clinical management of juvenile arthritis. In light of the psychological influences on arthritis, pain medication is no longer seen as sufficient care for patients. Rather, a counseling program is needed to help families cope with daily stress for their children.

The researchers suggest a change in treatment from traditional “immunosuppressive therapy, [to] more effective treatment with cognitive-behavioral therapy, relaxation, and stress management.”

Other members of this study team include Kelly K. Anthony, Ph.D, and the DCRI’s Eric Yow, M.S., and James Rochon, Ph.D.

This report was supported by an Arthritis Foundation Clinical Science Grant and Doctoral Dissertation Award, by a grant from the Office of Research on Women’s Health in conjunction with the National Institute of Arthritis and Musculoskeletal and Skin Diseases (AR-45238), and by the Fetzer Institute.