POS1313 PSYCHIATRIC DISORDERS IN JUVENILE IDIOPATHIC ARTHRITIS - A POPULATION-BASED COHORT STUDY
Authors: B. Delcoigne, A. Horne, S. Omarsdottir, J. Reutfors, J. Askling
Journal: Annals of the Rheumatic Diseases (2021)

Background: Juvenile idiopathic arthritis (JIA) may have substantial consequences for quality of life, for instance due to chronic pain, restriction of activities, concern about physical appearance, and treatment protocols that may limit interactions with peers. However, it remains unclear whether children and adolescents with JIA sow a higher incidence of psychiatric disorders compared with the general population. Objectives: To examine the incidence of psychiatric disorders during childhood in JIA patients in Sweden relative to general population controls. Methods: We performed a register- and population-based cohort study including new-onset JIA patients aged 0 to 17 years 1 st January 2012 through 31st December 2017. Incident JIA patients were followed-up from the date of their 2 nd JIA diagnosis. At this date, five sex-age-region matched individuals were sampled from the general population. Nine psychiatric disorders were defined with ICD-10 codes and associated drugs (ATC codes): psychotic disorders (ICD-10: F20-29; ATC: N05A), mood and anxiety disorders (F30-F43; N05B, N06A, R06AD01, R06AD02, N03AX16), sleeping disorders (F51; N05C, N03AE01), eating and personality disorders (F50, F60-61, F69), neuropsychiatric disorders (F70-F79, F84, F90; N06BA, C02AC02), substance misuse (F10-F19; N07B), suicide attempts (X60-X84, Y10-34) and death by suicide or substance abuse, and all these combined. The follow-up stopped at date of first outcome, migration, death, 18 th birthday or end of the study period, whichever occurred first. Incidence rates were calculated and compared by Cox regression analyses, adjusted for age, sex, calendar year, patient’s and family’s history of psychiatric disorder, country of birth, parents’ education level, and comorbidities (IBD, obesity and celiac disease). In sensitivity analyses, we (1.) excluded children with a history of a psychiatric diagnosis at start of follow-up, and (2.) defined the psychiatric disorders based on ICD-10 codes only. Results: We identified 2224 JIA patients (64% girls, mean age: 9.8 years) and 10,264 matched controls. In the JIA cohort, 309 patients developed a psychiatric disorder (all outcomes combined) during 4998 person-years (pyrs), which corresponded to a crude incidence rate (IR) of 6.2 per 100 pyrs (95% confidence interval (CI): 5.5-6.9). The corresponding crude IR for the general population matched controls was 3.6 (3.4-3.9). Comparing these incidence rates resulted in a sex-age adjusted hazard ratio (HR) of 1.66 (95% CI: 1.46-1.89) and a fully adjusted HR of 1.68 (1.47-1.91). Considering specific outcomes, the IRs per 100 pyrs in the JIA population ranged from 0.1 (suicide attempt) to 3.7 (mood and anxiety disorders) (Table 1). No death from suicide was recorded. There was an overlap across the seven outcomes: among all individuals diagnosed with at least one of the psychiatric outcomes during follow-up, 58% were diagnosed with one outcome only, 25% with two and 19% with three or more outcome conditions. The Cox analyses of the 7 outcome groups demonstrated four statistically significant increased risks for psychotic, mood and anxiety, sleeping and neuropsychiatric disorders (Figure 1). The three latter outcomes were correlated to each other (with Cramer’s V coefficient between 0.3 and 0.5). The sensitivity analyses did not substantially modify these findings. Conclusion: The burden of psychiatric illness in individuals with JIA is increased compared to the general population. Table 1. Risk of psychiatric disorders in JIA patients and general population controls. Disorders N events JIA N events controls IR JIA (95% CI) IR controls (95% CI) All combined 309 918 6.2 (5.5-6.9) 3.6 (3.4-3.9) Psychotic 25 44 0.5 (0.3-0.7) 0.2 (0.1-0.2) Mood 194 534 3.7 (3.2-4.3) 2.0 (1.9-2.2) Sleeping 148 348 2.8 (2.4-3.3) 1.3 (1.2-1.5) Neuropsychiatric 126 442 2.4 (2.0-2.8) 1.7 (1.5-1.9) Eating 13 55 0.2 (0.1-0.4) 0.2 (0.2-0.3) Substance misuse 14 49 0.3 (0.2-0.4) 0.2 (0.1-0.2) Suicide attempt 7 55 0.1 (0.1-0.3) 0.2 (0.2-0.3) IR: crude incidence rate per 100 person-years; CI: confidence interval 1 adjustment: see text. Figure 1. Disclosure of Interests: Bénédicte Delcoigne: None declared, AnnaCarin Horne Consultant of: SOBI and Novartis, Soley Omarsdottir: None declared, Johan Reutfors: None declared, Johan Askling Consultant of: Abbvie, Astra-Zeneca, BMS, Eli Lilly, MSD, Pfizer, Roche, Samsung Bioepis, Sanofi, and UCB. These entities have entered into agreements with Karolinska Institutet with JA as principal investigator, mainly in the context of safety monitoring of biologics via the ARTIS national safety monitoring system