Characterizing Mental Health Burden of Patients with Juvenile Spondyloarthritis

Objectives To describe the frequency of mental health issues in Juvenile Spondyloarthritis (JSpA) patients attending the SickKids rheumatology clinic and to explore potential relationships between mental health symptoms and disease activity. Methods A cross-sectional retrospective study was conducted among children aged 12-18 years diagnosed with JSpA/Enthesitis Related Arthritis (ERA) using the 2019 PRINTO criteria. Patients attending the SickKids JSpA Clinic (Oct 2024-Sept 2025) were screened for mental health symptoms using the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and PROMIS 37 v1.1 tools, as part of a hospital-wide measurement-based care initiative. Additional data included demographics, disease characteristics (age of onset, duration, joint/entheseal involvement), disease activity scores (cJADAS, BASDAI), and Physician Global Assessment (MDPGA). Descriptive statistics were calculated, and Spearman correlations determined relationships between PROMIS measures and disease variables. Ethics approval was obtained from the SickKids REB. Results Thirty-one patients were included (Table 1). 84% were male, mean ± SD age at onset was 15.7 ± 1.7 years, and mean disease duration was 47 ± 36.4 months. Joint involvement at diagnosis was peripheral (32%), axial (26%), or mixed (39%). Over 90% were on biologics; only 23% had active joints at the screening visit. The PHQ-9 and GAD-7 were completed by n=20, and PROMIS-37 by n=26. Elevated depressive symptoms on the PHQ-9 were reported by 65% (n=13) - 40% mild, 5% moderate and 20% severe. Elevated anxiety symptoms on GAD-7 were reported by 60% (n=12)- 30% mild, 15% moderate, and 15% severe. On average, PROMIS scores indicated good physical functioning and peer relationships. Correlation analysis showed significant positive associations between self-reported disease activity (BASDAI) and depression (ρ = 0.690, p = 0.001), fatigue (ρ = 0.807, p < 0.001), pain interference (ρ = 0.672, p = 0.001) and pain intensity (ρ = 0.744, p = 0.001). cJADAS scores were significantly correlated with pain intensity (ρ = 0.734, p = 0.001) and pain interference (ρ = 0.721, p = 0.001). Anxiety and depression scores were highly correlated with each other (ρ = 0.880, p < 0.001) and both correlated with fatigue and pain interference (p < 0.001). Table 1 Baseline Characteristics of JSpA/ERA Patients in the Study Conclusion Mental health symptoms were highly prevalent in this male predominant cohort of JSpA, even in the context of well-controlled disease. Furthermore, mental health symptoms correlated with self-reported disease-related measures. These findings support routine mental health screening to identify at-risk JSpA patients and provide timely interventions, potentially improving overall outcomes.