TY - JOUR
T1 - Causal pathways to health-related quality of life in children with juvenile idiopathic arthritis
T2 - Results from the ReACCh-Out cohort
AU - ReACCh-Out investigators
AU - Oen, Kiem
AU - Tian, Jiahao
AU - Loughin, Thomas M.
AU - Shiff, Natalie J.
AU - Tucker, Lori B.
AU - Huber, Adam M.
AU - Berard, Roberta A.
AU - Levy, Deborah M.
AU - Rumsey, Dax G.
AU - Tse, Shirley M.
AU - Chan, Mercedes
AU - Feldman, Brian M.
AU - Duffy, Ciaran M.
AU - Guzman, Jaime
AU - Bolaria, Roxana
AU - Cabral, David
AU - Gross, Katherine
AU - Houghton, Kristin
AU - Morishita, Kimberly
AU - Petty, Ross
AU - Turvey, Stuart E.
AU - Ellsworth, Janet
AU - Benseler, Susanne
AU - Johnson, Nicole
AU - Miettunen, Paivi
AU - Schmeling, Heinrike
AU - Larche, Maggié
AU - Cameron, Bonnie
AU - Laxer, Ronald M.
AU - Spiegel, Lynn
AU - Schneider, Rayfel
AU - Silverman, Earl
AU - Yeung, Rae S.M.
AU - Gibbon, Michele
AU - Roth, Johannes
AU - Duffy, Karen Watanabe
AU - Chetaille, Anne Laure
AU - Dorval, Jean
AU - Boire, Gilles
AU - Bruns, Alessandra
AU - Campillo, Sarah
AU - Chedeville, Gaelle
AU - LeBlanc, Claire
AU - Scuccimarri, Rosie
AU - Haddad, Elie
AU - St. Cyr, Claire
AU - Feldman, Debbie
AU - Lang, Bianca
AU - Ramsey, Suzanne E.
AU - Stringer, Elizabeth
N1 - Publisher Copyright:
© 2021 The Author(s) 2021.
PY - 2021/10/1
Y1 - 2021/10/1
N2 - Objective: Structural equation modelling was applied to data from the Research in Arthritis in Canadian Children emphasizing Outcomes (ReACCh-Out) cohort to help elucidate causal pathways to decreased health-related quality of life (HRQoL) in children with JIA. Methods: Based on published literature and clinical plausibility, a priori models were constructed with explicit root causes (disease activity, treatment intensity) and mediators (pain, disease symptoms, functional impairments) leading to HRQoL [measured by the Quality of my Life (QoML) scale and the Juvenile Arthritis Quality of Life Questionnaire (JAQQ)] at five disease stages: (i) diagnosis, (ii) 3-9 months after diagnosis, (iii) flare, (iv) remission on medications, (v) remission off medications. Following structural equation modelling, a posteriori models were selected based on data fit and clinical plausibility. Results: We included 561, 887, 137, 186 and 182 patients at each stage, respectively. In a posteriori models for active disease stages, paths from disease activity led through pain, functional impairments, and disease symptoms, directly or through restrictions in participation, to decreased QoML scores. Treatment intensity had detrimental effects through psychosocial domains; while treatment side effects had a lesser role. Pathways were similar for QoML and JAQQ, but JAQQ models provided greater specificity. Models for remission stages were not supported by the data. Conclusion: Our findings support disease activity and treatment intensity as being root causes of decreased HRQoL in children with JIA, with pain, functional impairments, and participation restrictions being mediators for disease activity; they support psychosocial effects and side effects as being mediators for treatment intensity.
AB - Objective: Structural equation modelling was applied to data from the Research in Arthritis in Canadian Children emphasizing Outcomes (ReACCh-Out) cohort to help elucidate causal pathways to decreased health-related quality of life (HRQoL) in children with JIA. Methods: Based on published literature and clinical plausibility, a priori models were constructed with explicit root causes (disease activity, treatment intensity) and mediators (pain, disease symptoms, functional impairments) leading to HRQoL [measured by the Quality of my Life (QoML) scale and the Juvenile Arthritis Quality of Life Questionnaire (JAQQ)] at five disease stages: (i) diagnosis, (ii) 3-9 months after diagnosis, (iii) flare, (iv) remission on medications, (v) remission off medications. Following structural equation modelling, a posteriori models were selected based on data fit and clinical plausibility. Results: We included 561, 887, 137, 186 and 182 patients at each stage, respectively. In a posteriori models for active disease stages, paths from disease activity led through pain, functional impairments, and disease symptoms, directly or through restrictions in participation, to decreased QoML scores. Treatment intensity had detrimental effects through psychosocial domains; while treatment side effects had a lesser role. Pathways were similar for QoML and JAQQ, but JAQQ models provided greater specificity. Models for remission stages were not supported by the data. Conclusion: Our findings support disease activity and treatment intensity as being root causes of decreased HRQoL in children with JIA, with pain, functional impairments, and participation restrictions being mediators for disease activity; they support psychosocial effects and side effects as being mediators for treatment intensity.
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U2 - 10.1093/rheumatology/keab079
DO - 10.1093/rheumatology/keab079
M3 - Article
C2 - 33506861
AN - SCOPUS:85117169707
SN - 1462-0324
VL - 60
SP - 4691
EP - 4702
JO - Rheumatology
JF - Rheumatology
IS - 10
ER -