Seattle Children's Hospital, Seattle, Washington 98015, USA.
Arthritis Care Res (Hoboken). 2013 Mar;65(3):391-7. doi: 10.1002/acr.21801.
To examine the association between parent/proxy- and child-reported fatigue and disease activity in children with polyarticular, extended oligoarticular, and persistent oligoarticular juvenile idiopathic arthritis (JIA).
We enrolled a cross-sectional cohort of 309 children recruited from the Seattle Children's Hospital rheumatology clinic from 2009-2011. Parents and children completed the PedsQL Multidimensional Fatigue Scales. The parent/proxy, child, and/or physician provided additional disease activity data at each clinic visit, including active joint count, pain, and the Childhood Health Assessment Questionnaire (C-HAQ). Disease activity was dichotomized as active or inactive using the American College of Rheumatology provisional criteria for clinically inactive disease. The Juvenile Arthritis Disease Activity Score (JADAS) was also calculated. Linear regression was used to examine the associations between fatigue and disease activity.
Associations among fatigue, clinically inactive disease, and the JADAS were not statistically significant after controlling for pain. In the multivariable models of fatigue, the C-HAQ and parent/child-reported disease activity were significantly associated with fatigue; however, only the C-HAQ remained significantly associated after adjustment for pain. The C-HAQ and parent/child-reported disease activity explained 17% and 30% of the variance in fatigue for the parent/proxy- and child-reported multivariable models, respectively.
In this cohort, functional ability, as measured by the C-HAQ, was significantly associated with fatigue. Child- and parent/proxy-reported pain were important confounders of the relationship between fatigue and disease activity. Routinely incorporating pain and fatigue into interventional and observational trials of JIA will enable better delineation of the relationships between these variables.
研究多发性关节炎、广泛型少关节炎和持续性少关节炎幼年特发性关节炎（JIA）患儿的父母/代理人报告的疲劳与疾病活动度和儿童报告的疲劳与疾病活动度之间的关系。
我们纳入了 2009 年至 2011 年从西雅图儿童医院风湿病诊所招募的 309 名患儿的横断面队列。父母和儿童完成了 PedsQL 多维疲劳量表。每次就诊时，父母/代理人、儿童和/或医生提供了额外的疾病活动数据，包括活跃关节计数、疼痛和儿童健康评估问卷（C-HAQ）。使用美国风湿病学会（ACR）暂定的临床无活动疾病标准，将疾病活动度分为活跃或不活跃。还计算了幼年特发性关节炎疾病活动度评分（JADAS）。线性回归用于检查疲劳与疾病活动度之间的关联。
在控制疼痛后，疲劳与临床无活动疾病和 JADAS 之间的关联无统计学意义。在疲劳的多变量模型中，C-HAQ 和父母/儿童报告的疾病活动与疲劳显著相关；然而，在调整疼痛后，只有 C-HAQ 仍然与疲劳显著相关。C-HAQ 和父母/儿童报告的疾病活动分别解释了父母/代理人和儿童报告的多变量模型中疲劳的 17%和 30%的方差。
在本队列中，C-HAQ 测量的功能能力与疲劳显著相关。儿童和父母/代理人报告的疼痛是疲劳与疾病活动之间关系的重要混杂因素。在 JIA 的干预和观察性试验中，常规纳入疼痛和疲劳将能够更好地区分这些变量之间的关系。
