E20 Factors associated with school and work impairment in patients with Juvenile idiopathic arthritis
Authors: Fazaa Alia , Rachdi Mariem , Miladi Saoussen , Makhlouf Yassmine , Boussaa Hiba , Ouenniche Kamar , Souabni Leila , Kassab Salma , Chekili Salma , Abdelghani Kawther Ben , Laatar Ahmed 
Published: August 2023

Abstract

Background
Juvenile idiopathic arthritis (JIA) is the most common arthropathy of childhood. It is frequently associated with chronic pain and physical disability. Moreover, it can persist over many years and can lead to disability and dysfunction in adulthood.

Objectives
The aim of this study was to investigate the factors associated with school or work absenteeism and poor school functioning in patients with JIA.

Methods
We conducted a cross-sectional study including patients with JIA according to the International League of Associations for Rheumatology (ILAR). Sociodemographic data as well as disease characteristics were collected from patient’s medical records. A detailed questionnaire was completed for each participant by interviewing them about their school level and their educational and work performance. The rate of absenteeism due to health complications was noted. The data were analyzed using SPSS version 11.5. A P-value cut-off of 0,05 to determine significance was fixed.

Results
We studied 31 JIA patients. There were 11 males (35.5%) and 20 females (64.5%). The mean age of participants was 28.6 years [9–45]. The mean age at onset was 6.65 years [2–13]. The mean disease duration was 256.5 months [36–444]. The distribution of the different subtypes in patients was as follows: RF-positive polyarthritis (n = 10), oligoarthritis (n = 7), RF-negative polyarthritis (n = 6), Enthesitis-related arthritis (n = 4) and systemic arthritis (n = 4). Nineteen patients were receiving corticosteroids. Disease-modifying anti-rheumatic drugs were used by 18 patients: methotrexate (n = 11), sulfasalazine (n = 3), leflunomide (n = 4) and biologics (n = 13). Twelve patients developed complications: coxitis (n = 11), growth retardation (n = 9) and uveitis (n = 4). Joint replacement was required in 7cases.
The mean DAS28 ESR was 2.71 [0.76–5.23] and the mean CHAQ was 0.85 [0–2.30]. The mean number of tender and swollen joints was 0.45[0–8] and 0.29 [0–5] respectively. The mean amount of CRP and ESR was respectively 12.71 mg/l [0–91] and 21.23 mm/h[0–84].
Seven patients were illiterate (26.9%), 11 had dropped out of school (42.3%). Twenty-two patients (70.9%) reported repeated absences due to illness. A year of schooling was repeated by 43.6% of patients. Fourteen out of 26 patients over the age of 20 attended university.
Almost 77% of patients were exempted of physical education. Among the adult patients, 10 had an intellectual job (38.4%), 12 had a manual job (46.1%) and 4 were unemployed (15.3%).
A total of 37% of the schooled patients and 18.4% of adult patients missed 2 weeks or more of school or work during the past year. A total of 26.3% of the patients had poor school functioning.
A significant association was found between absenteeism and tender joints (P = 0.044).
However, there were no significant association between the school-related problems, the socio-demographic characteristics and the other parameters of clinical and biological activity studied.

Conclusion
Our study suggested that JIA negatively affected patients schooling and adults work performances. Therefore, proper management of these patients is important to increase their academic and professional performance.