Depression and anxiety are prevalent in children with rheumatologic diseases, including juvenile idiopathic arthritis (JIA). However, prevalence rates and the relationship with disease outcomes, including quality of life are conflicting in the early literature. To review the current literature, determine gaps in our knowledge, and identify areas in need of further investigation, we conducted a systematic review of studies examining depression and anxiety symptoms among children with JIA and the impact these symptoms may have on disease outcomes and quality of life. Six electronic databases were searched up until January 2019. Of 799 potential articles, 60 articles were included with the main focus on 28 articles from 2009 to 2019, to concentrate on the most current evidence. We found that JIA patients experience symptoms of depression and anxiety similar to other childhood chronic diseases and at higher rates than in healthy children. Patients who experience these symptoms have worse quality of life, with some evidence pointing to depression and anxiety symptoms having a greater impact on quality of life than other disease features, such as active joint count. Family members of JIA patients experience high rates of anxiety and depression symptoms which may impact their child’s mental health and pain symptoms related to JIA. Conflicting reports of associations between depression/anxiety symptoms and disease features/disease outcomes and a paucity of longitudinal studies investigating the impact of treatment on mental health symptoms indicate areas in need of further research to effectively identify patients at greatest risk of depression and anxiety and to better understand how to treat and prevent these symptoms in youth with JIA. Family mental health should also be considered in investigations concerning mental health and disease outcomes of children with JIA.

Objective: Describe anxiety and depressive symptoms in children with juvenile idiopathic arthritis (JIA) using Patient Reported Outcomes Measurement Information System (PROMIS) measures and evaluate potential correlations with disease manifestations.Methods: We performed a cross-sectional study of children with JIA and a parent proxy who completed PROMIS measures on depression, anxiety, stress, and pain. The Childhood Health Assessment Questionnaire (CHAQ) measured mobility, and the clinical Juvenile Arthritis Disease Activity Score in 10 joints (cJADAS10) measured disease activity.Results: Eighty-four patients completed the study. Demographic median values included age (14 yrs), disease duration (4.73 yrs), CHAQ score (0), total active joint count (0), and cJADAS10 (2). Using cJADAS10, 57 patients (70%) had inactive or low disease activity. Mean PROMISt-scores for depressive and anxiety symptoms were lower in children with JIA compared to the reference population (P< 0.0001). Nineteen patients (23%) had moderate to severe symptoms of anxiety and/or depression. Age and CHAQ score (mobility) correlated with depressive symptoms (r= 0.36,P=0.0008 andr= 0.32,P =0.0029, respectively) but not anxiety. Depressive and anxiety symptoms correlated with pain (r= 0.64 andr= 0.47, respectively,P <0.0001) and stress (r= 0.79 andr= 0.75, respectively,P <0.0001) but not with sex, JIA subtype, disease duration, or disease activity.Conclusion: Approximately one-quarter of children with JIA reported moderate to severe symptoms of anxiety and depression. These symptoms are associated with pain and stress, but they are not associated with other disease manifestations. Understanding how mental health symptoms and JIA affect each other is necessary in order to improve patient outcomes and provide well-rounded care.

Objective: To describe the selection, development, and implementation of quality measures (QMs) for juvenile idiopathic arthritis (JIA) by the Pediatric Rheumatology Care and Outcomes Improvement Network (PR‐COIN), a multihospital learning health network using quality improvement methods and leveraging QMs to drive improved outcomes across a JIA population since 2011.Methods: An American College of Rheumatology–endorsed multistakeholder process previously selected initial process QMs. Clinicians in PR‐COIN and parents of children with JIA collaboratively selected outcome QMs. A committee of rheumatologists and data analysts developed operational definitions. QMs were programmed and validated using patient data. Measures are populated by registry data, and performance is displayed on automated statistical process control charts. PR‐COIN centers use rapid‐cycle quality improvement approaches to improve performance metrics. The QMs are revised for usefulness, to reflect best practices, and to support network initiatives.Results: The initial QM set included 13 process measures concerning standardized measurement of disease activity, collection of patient‐reported outcome assessments, and clinical performance measures. Initial outcome measures were clinical inactive disease, low pain score, and optimal physical functioning. The revised QM set has 20 measures and includes additional measures of disease activity, data quality, and a balancing measure.Conclusion: PR‐COIN has developed and tested JIA QMs to assess clinical performance and patient outcomes. The implementation of robust QMs is important to improve quality of care. PR‐COIN's set of JIA QMs is the first comprehensive set of QMs used at the point‐of‐care for a large cohort of JIA patients in a variety of pediatric rheumatology practice settings.

Objective: Juvenile idiopathic arthritis (JIA) is complicated by morbidity, with suboptimal rates of prolonged remission, decreased health-related quality of life, and functional limitations. The Pediatric Rheumatology Care and Outcomes Improvement Network (PR-COIN), a North American learning health network, has a centralized registry of patients with JIA to track quality measures. We assessed for health disparities in our collaborative JIA population by evaluating our performance on disease activity outcomes, overall well-being, and pain by race and ethnicity, age, sex, and JIA subtype. Methods: A cross-sectional analysis of patients in the PR-COIN registry was conducted to estimate the association between race and ethnicity groups and outcomes including physician global assessment of disease activity (PGA), patient/parent global assessment of overall well-being (PtGA), active joint count, 10-joint clinical Juvenile Arthritis Disease Activity Score (cJADAS10), arthritis-related pain intensity score, and morning stiffness duration. Results: Data from 9601 patients were analyzed. Current age was positively and significantly associated with higher scores of pain intensity, PGA, PtGA, and cJADAS10. Non-Hispanic Black patients had statistically higher cJADAS10 scores compared to non-Hispanic White patients, in addition to statistically higher pain intensity scores, and PGA and PtGA scores. Female patients had statistically higher scores compared to male patients for all outcome variables assessed. Conclusion: We found disparities in outcomes of patients with JIA related to race and ethnicity, sex, and age. This information is imperative to drive further improvement efforts and understand possible causes of these differences to close disparity gaps and improve outcomes for all patients with JIA.

Mental health, which encompasses psychological and emotional well-being, is increasingly being recognized as an important aspect of overall health in youth with chronic disease. Particularly in this time of the mental health crisis in children due in large part to the coronavirus disease 2019 (COVID-19) pandemic,¹ with evidence of adverse effects on managing rheumatologic disease,² addressing mental health issues has become critical.