FRI0638-HPR IMPACT OF PARENTAL MIGRATION IN THE CONTEXT OF THE MULTIFACTORIAL ETIOLOGY OF CHRONIC ARTHRITIS IN CHILDHOOD
Authors: L. Ailioaie, C. Ailioaie
Journal: Annals of the Rheumatic Diseases (2020)

Background: Migration of Romanians to work abroad began after 1990 with the aim to provide a better income and life for their family. Current studies show that the migration of one parent or both, even when it is temporary, produces negative long-term effects on the health and psychosocial evolution of the children affected. Children and adolescents exposed to chronic stress due to migration, misunderstandings between the parents, alcoholism, violence, divorce of the parents etc., present an increased risk of illness. More and more data from the literature suggest that prolonged stress and depression induces inadequate cortisol along with norepinephrine secretion, increased synthesis of proinflammatory cytokines, which are the basis for autoimmune pathologies, such as chronic arthritis. Objectives: Given the extended phenomenon of migration from Romania and the increase in the cases with autoimmune pathology in children and adolescents, we aimed to evaluate the association between the disorders related to the permanent stress induced by the parental migration abroad and the risk of developing arthritis during childhood. Methods: The study included 201 children and adolescents aged 13.4 ± 3.7 years, who were in evidence of an outpatient health unit, from 2016-2019. These cases were included in a chronic disease registry with the diagnosis of Juvenile Idiopathic Arthritis (JIA), established by a pediatric rheumatologist. For the initial evaluation, we used a questionnaire that included the socio-demographic data. In comparison, we studied 40 healthy children (control group). The family drawing test was used for patients between 5 and 16 years of age to identify possible conflicts with certain family members, to assess the emotional and psychological maturity of the child or adolescent, and to find out if are there any problems at home. Results: At the end of the study, only 181 (90%) of the eligible patients completed the questionnaire and the family drawing test. Demographic data showed that patients from rural areas predominated (71.8%), compared to 28.2% from urban areas. In terms of sex, 52.5% were male, compared to 47.5% female. Family history (mother, father, sister, brother, grandfather, aunt, uncle) of autoimmune disease was encountered in 28.1% of patients, as follows: spondylarthritis in 9.4% cases, rheumatoid arthritis in 8.8% cases, JIA in 3.9% cases and other autoimmune diseases (Systemic Lupus Erythematosus, Scleroderma, Diabetes, Asthma) in 6% cases. Patients from low-income families were in 82.3% of cases. 72.5% of the cases had a prolonged state of stress by migrant parents for working abroad [38.7% only one parent (30% mother) and both parents in 17.7% of cases], divorce in the family in 11.6% of cases, unmarried mother in 2.8% of cases, and a close relative recently deceased in 1.7% of patients. Subcategories of JIA included: polyarticular JIA negative Rheumatoid Factor (RF) in 39.77% of cases, enthesitis-related arthritis in 27.07% of cases, polyarticular JIA positive RF in 14.36% of cases, oligoarticular JIA in 14.9% of cases, systemic JIA in 3.31% of cases and psoriatic JIA in 0.59% of patients. Conclusion: Both the data from the questionnaires, but especially the family drawing tests, suggest that the prolonged state of stress with anxiety, sadness, pain and depression, in combination with starvation, lack of parental love and the genetic predisposition, have contributed to the emergence of chronic arthritis, pathology that is growing more and more in recent years in Romania. References: [1] Dube SR, Fairweather D, Pearson WS, Felitti VJ, Anda RF, Croft JB. Cumulative childhood stress and autoimmune disease in adults. Psychosom Med. 2009; 71:243–250. [2] Song H, Fang F, Tomasson G, et al. Association of stress-related disorders with subsequent autoimmune disease. JAMA, 2018; 319:2388–2400. [3] Vallerand IA, Patten SB, Barnabe C. Depression and the risk of rheumatoid arthritis. Curr Opin Rheumatol. 2019; 31(3):279-284. Disclosure of Interests: None declared