TOPLINE:

Among patients with juvenile idiopathic arthritis (JIA) followed up for over 7 years, 10% and more than 10% exhibited moderate-to-severe anxiety and depressive symptoms, respectively — approximately twice the rates observed in healthy counterparts. Patients who later developed mental health problems already demonstrated reduced emotional functioning at the time of diagnosis.

METHODOLOGY:

• Researchers conducted a prospective observational study at 11 paediatric rheumatology centres in Germany (2010-2021), enrolling children and adolescents diagnosed with JIA within the previous 12 months.
• They included 344 patients (mean age, 18.7 years; 42% with polyarthritis) and 224 healthy control participants (mean age, 18.2 years); follow-up examinations were conducted every 3 months in the first year and every 6 months thereafter.
• Participants aged 13 years or older completed the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder Scale-7 (GAD-7) to assess depressive and anxiety symptoms, respectively, during follow-up visits at 7 and 9 years after inclusion in the inception cohort of newly diagnosed patients with JIA (ICON).
• Researchers documented demographic parameters; clinical parameters (including JIA category, active joint count, and physician's global assessment of disease activity); and patient-reported outcomes such as pain, fatigue, and health-related quality of life (assessed using the Pediatric Quality of Life Inventory [PedsQL]).

TAKEAWAY:

• Moderate-to-severe symptoms of depression (a PHQ-9 score ≥ 10) were present in 13.4% of patients with JIA compared with 6.7% of control participants, and moderate-to-severe anxiety symptoms (a GAD-7 score ≥ 10) were observed in 10.2% of patients vs 2.2% of control participants.
• Female participants and those aged 18 years or older reported moderate-to-severe depressive symptoms more frequently than male participants and younger individuals in both patient and control groups.
• Patients with JIA demonstrated lower health-related quality of life at enrolment than control participants (mean PedsQL score, 77.1 vs 91.4; P < .001), including reduced physical and emotional functioning (P < .001 for both).
• Patients who later developed moderate-to-severe depressive symptoms already showed lower emotional functioning at inclusion than those with PHQ-9 scores below 10 (66.1 vs 77.5; P ≤ .001); control participants with future mental health problems also showed reduced baseline emotional functioning (P = .035). Patients with PHQ-9 scores below 10 showed improvement in their physical functioning, whereas those with notable mental health issues showed less improvement at the 1-year follow-up.

IN PRACTICE:

"[T]his study suggests that impaired emotional functioning may be an early indicator of emerging mental health problems, independent of the severity of somatic illness as assessed by a physician," the authors wrote. "Incorporating HRQoL [health-related quality of life] evaluations into standard JIA management, particularly at disease onset and at the 1-year follow-up, can facilitate early identification of at-risk patients and support timely psychological interventions, potentially improving long-term outcomes," they added.

SOURCE:

This study was led by Prasad T. Oommen, MD, Heinrich Heine University Düsseldorf, Düsseldorf, Germany. It was published online on April 09, 2026, in RMD Open.

LIMITATIONS:

Not all patients in the ICON cohort were evaluated for symptoms of depression or anxiety due to age restrictions. The health-related quality of life was measured using the PedsQL only for those up to 17 years, which restricted longitudinal insights for older individuals. Psychological stress might be underreported because many people find it challenging to acknowledge.

DISCLOSURES:

The ICON study received funding from the Federal Ministry of Education and Research. One author disclosed receiving a grant or research support and speaker fees, another author reported serving on advisory boards, and a third author disclosed receiving honoraria for lectures or consulting from various sources including AbbVie, Pfizer, and Novartis.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.