J. Vandernet et al., CORRELATES OF DISABLEMENT IN POLYARTICULAR JUVENILE CHRONIC ARTHRITIS- A CROSS-SECTIONAL STUDY, British journal of rheumatology, 35(1), 1996, pp. 91-100
To assess the impact of disease on the functional outcome of patients
with polyarticular juvenile chronic arthritis (JCA), the relationship
between impairments and functional limitations was studied. Therefore,
variables from the impairment domain were correlated with variables o
f the functional limitation domain and outcome variables were analysed
for differences as a result of inflammatory disease, rheumatoid facto
r (RF), disease duration and age at onset. Twenty-three patients with
polyarticular JCA were subjected to auxologic evaluation, a laboratory
check, radiographic evaluation, joint count on tenderness and swellin
g, joint mobility/deformity examination, functional assessment of skil
ls, health assessment and psychosocial evaluation. Inflammatory diseas
e parameters, like CRP, ESR, thrombocytosis and leucocytosis, were inc
reased in 6/23 patients. The parameters of the impairment domain, like
joint tenderness and swelling, showed mild outcome, while parameters
of the functional limitation domain showed more severe outcome. Genera
lly, perceived competence was found to be normal. A clinically relevan
t number of patients (10/13) showed low scores on the activity factor
of the Child Behaviour Check List (CBCL). A significant relationship w
as found between inflammatory disease variables and functional limitat
ion outcome. RF seropositivity was not a good outcome predictor. Disea
se duration and age of onset showed no significant difference in the o
utcome of the domains. Significant correlation was found between the p
arental report of the Childhood Health Assessment Questionnaire (CHAQ)
and all impairment parameters. Joint swelling showed a significant re
lationship with CHAQ and Juvenile Arthritis Functional Assessment Repo
rt (JAFAR). Disability outcome did not correlate with functional limit
ation. In general, children with polyarticular JCA function rather wel
l when using a multidomain evaluation approach. Compensatory and adapt
ational mechanisms might contribute to the poor correlation between im
pairment and functional limitation parameters. Laboratory evaluation o
f inflammatory disease, a joint count of swollen joints and parent's r
eport of the child's health status related best in our study.