Nutritional status, pain and fatigue in patients with rheumatic diseases

Authors

  • Mandica Vidović Zavod za pedijatrijsku pulmologiju, alergologiju, kliničku imunologiju i reumatologiju, Klinika za dječje bolesti Zagreb, Klaićeva ulica 16, Zagreb

DOI:

https://doi.org/10.13112/pc.1074

Keywords:

CHILD; RHEUMATIC DISEASES; NUTRITIONAL STATUS; PAIN; FATIGUE

Abstract

Rheumatic diseases in children are one of the most common chronic diseases and are characterized by exacerbations and remissions with or without treatment. The underlying cause is an autoimmune disorder that involves the activation of innate and/or acquired immune responses resulting in chronic inflammation with the involvement of various tissues and organs. Focus on pathophysiological mechanisms, genetic basis, and treatment with the introduction of "biological" drugs that ensured fast remission led to the neglect of some aspects of health that can significantly affect daily functioning, education, schooling, and quality of life. Nutritional status, pain, and fatigue should be taken into account and routinely assessed at each visit. In this article, the main characteristics of nutritional status, pain, and fatigue in children with rheumatic disease and possible interventions are described.

References

1. Song HM. Keeping up with the progress in the diagnosis and management of pediatric rheumatic diseases. World J Pediatr. 2020 Feb;16(1):1-4.

2. Schiettecatte E, Jans L, Jaremko JL, Chen M, Vande Walle C, Herregods N. MR Imaging of Rheumatic Diseases Affecting the Pediatric Population. Semin Musculoskelet Radiol. 2021 Feb;25(1):82-93.

3. Ogbu EA, Brunner HI. Treatment Guidelines in Pediatric Rheumatic Diseases. Rheum Dis Clin North Am. 2022 Aug;48(3):725-746.

4. van Royen-Kerkhof A, Vastert BS, Swart JF, Wulffraat NM. Biologic treatment of pediatric rheumatic diseases: are we spoilt for choice? Immunotherapy. 2014;6(1):1-3.

5. Lewandowski LB. Tackling global challenges in pediatric rheumatology. Curr Opin Rheumatol. 2020 Sep;32(5):414-420.

6. Fernández-Lázaro D, Seco-Calvo J. Nutrition, Nutritional Status and Functionality. Nutrients. 2023 Apr 18;15(8):1944.

7. Więch P, Sałacińska I, Bazaliński D, Dąbrowski M. Body composition and phase angle as an indicator of nutritional status in children with juvenile idiopathic arthritis. Pediatr Rheumatol Online J. 2018 Dec 27;16(1):82.

8. Little EM, Grevich S, Huber JL, et al. Parental Perception of Dietary Intervention in Juvenile Idiopathic Arthritis. J Altern Complement Med. 2019 Jun;25(6):643-647.

9. Więch P, Ćwirlej-Sozańska A, Wiśniowska-Szurlej A et al. The Relationship Between Body Composition and Muscle Tone in Children with Cerebral Palsy: A Case-Control Study. Nutrients. 2020 Mar 24;12(3):864.

10. Więch P, Bazaliński D, Sałacińska I, et al. Decreased Bioelectrical Impedance Phase Angle in Hospitalized Children and Adolescents with Newly Diagnosed Type 1 Diabetes: A Case-Control Study. J Clin Med. 2018 Dec 4;7(12):516.

11. Serón-Arbeloa C, Labarta-Monzón L, Puzo-Foncillas J, et al. Malnutrition screening and assessment. Nutrients. 2022;14(12):2392.

12. Bolayir B, Arik G, Yeşil Y, et al. Validation of nutritional risk screening-2002 in a hospitalized adult population. Nutr Clin Pract. 2019;34(2):297-303.

13. Fructuoso I, Romão B, Han H, et al. An overview on nutritional aspects of plant-based beverages used as substitutes for cow's milk. Nutrients. 2021 Jul 30;13(8):2650.

14. Simon D, Fernando C, Czernichow P, Prieur AM. Linear growth and final height in patients with systemic juvenile idiopathic arthritis treated with longterm glucocorticoids. J Rheumatol. 2002 Jun;29(6):1296-300.

15. Guzman J, Kerr T, Ward LM, et al. Growth and weight gain in children with juvenile idiopathic arthritis: results from the ReACCh-Out cohort. Pediatr Rheumatol Online J. 2017 Aug 22;15(1):68.

16. McErlane F, Carrasco R, Kearsley-Fleet L, et al. Growth patterns in early juvenile idiopathic arthritis: results from the Childhood Arthritis Prospective Study (CAPS). Semin Arthritis Rheum. 2018 Aug;48(1):53-60.

17. Consolaro A, Giancane G, Alongi A, et al. Paediatric Rheumatology International Trials Organisation. Phenotypic variability and disparities in treatment and outcomes of childhood arthritis throughout the world: an observational cohort study. Lancet Child Adolesc Health. 2019 Apr;3(4):255-263.

18. Bechtold S, Simon D. Growth abnormalities in children and adolescents with juvenile idiopathic arthritis. Rheumatol Int. 2014 Nov;34(11):1483-8.

19. Knops N, Wulffraat N, Lodder S, Houwen R, de Meer K. Resting energy expenditure and nutritional status in children with juvenile rheumatoid arthritis. J Rheumatol. 1999 Sep;26(9):2039-43.

20. Caetano MC, Ortiz TT, Terreri MT, et al. Inadequate dietary intake of children and adolescents with juvenile idiopathic arthritis and systemic lupus erythematosus. J Pediatr (Rio J). 2009 Nov-Dec;85(6):509-15.

21. Grönlund MM, Kaartoaho M, Putto-Laurila A, Laitinen K. Juvenile idiopathic arthritis patients with low inflammatory activity have increased adiposity. Scand J Rheumatol. 2014;43(6):488-92.

22. Little EM, Grevich S, Huber JL, et al. Parental Perception of Dietary Intervention in Juvenile Idiopathic Arthritis. J Altern Complement Med. 2019 Jun;25(6):643-647.

23. Bacon MC, White PH, Raiten DJ, et al. Nutritional status and growth in juvenile rheumatoid arthritis. Semin Arthritis Rheum. 1990 Oct;20(2):97-106.

24. Gorczyca D, Postępski J, Czajkowska A, et al. The profile of polyunsaturated fatty acids in juvenile idiopathic arthritis and association with disease activity. Clin Rheumatol. 2017 Jun;36(6):1269-1279.

25. Zhong Y, Wang Y, Guo J, Chu H, Gao Y, Pang L. Blueberry Improves the Therapeutic Effect of Etanercept on Patients with Juvenile Idiopathic Arthritis: Phase III Study. Tohoku J Exp Med. 2015 Nov;237(3):183-91.

26. Martino S, Pappagallo G, Ravelli A, Taddio A, Zulian F, Cimaz R; Rheumatology Italian Study Group. Methotrexate in juvenile idiopathic arthritis: advice and recommendations from the MARAJIA expert consensus meeting. Pediatr Rheumatol Online J. 2018 Jul 11;16(1):46.

27. Onel KB, Horton DB, Lovell DJ, et al. 2021 American College of Rheumatology Guideline for the Treatment of Juvenile Idiopathic Arthritis: Therapeutic Approaches for Oligoarthritis, Temporomandibular Joint Arthritis, and Systemic Juvenile Idiopathic Arthritis. Arthritis Care Res (Hoboken). 2022 Apr;74(4):521-537.

28. Yasser SA, Hashaad NI, Shouzan AM, el Nouty HA. Measurement of Serum Trace Elements Levels in Patients with Juvenile Idiopathic Arthritis. Egypt Rheumatol Rehabil. 2016;43:59–66.

29. Lin Z, Li W. The Roles of Vitamin D and Its Analogs in Inflammatory Diseases. Curr Top Med Chem. 2016;16(11):1242-61.

30. Rusu TE, Murgu A, Moraru E, et al. Osteopenia la copiii cu artrită juvenilă idiopatică [Osteopenia in children with juvenile idiopathic arthritis]. Rev Med Chir Soc Med Nat Iasi. 2008 Jan-Mar;112(1):88-93.

31. Chevalley T, Brandi ML, Cashman KD, et al. Role of vitamin D supplementation in the management of musculoskeletal diseases: update from an European Society of Clinical and Economical Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) working group. Aging Clin Exp Res. 2022 Nov;34(11):2603-2623.

32. Lovell DJ, Glass D, Ranz J, et al. A randomized controlled trial of calcium supplementation to increase bone mineral density in children with juvenile rheumatoid arthritis. Arthritis Rheum. 2006 Jul;54(7):2235-42.

33. Dağdeviren-Çakır A, Arvas A, Barut K, Gür E, Kasapçopur Ö. Serum vitamin D levels during activation and remission periods of patients with juvenile idiopathic arthritis and familial Mediterranean fever. Turk J Pediatr. 2016;58(2):125-131.

34. Çomak E, Doğan ÇS, Uslu-Gökçeoğlu A, et al. Association between vitamin D deficiency and disease activity in juvenile idiopathic arthritis. Turk J Pediatr. 2014 Nov-Dec;56(6):626-31.

35. Stawicki MK, Abramowicz P, Sokolowska G, Wołejszo S, Grant WB, Konstantynowicz J. Can vitamin D be an adjuvant therapy for juvenile rheumatic diseases? Rheumatol Int. 2023 Nov;43(11):1993-2009.

36. Wilson A, Yu HT, Goodnough LT, Nissenson AR. Prevalence and outcomes of anemia in rheumatoid arthritis: a systematic review of the literature. Am J Med. 2004 Apr 5;116 Suppl 7A:50S-57S.

37. Martini A, Ravelli A, Di Fuccia G, Rosti V, Cazzola M, Barosi G. Intravenous iron therapy for severe anaemia in systemic-onset juvenile chronic arthritis. Lancet. 1994 Oct 15;344(8929):1052-4.

38. Weiss G, Goodnough LT. Anemia of chronic disease. N Engl J Med. 2005 Mar 10;352(10):1011-23.

39. Armitage AE, Eddowes LA, Gileadi U, et al. Hepcidin regulation by innate immune and infectious stimuli. Blood. 2011 Oct 13;118(15):4129-39.

40. Weiss G, Schett G. Anaemia in inflammatory rheumatic diseases. Nat Rev Rheumatol. 2013 Apr;9(4):205-15.

41. Ganz T, Nemeth E. Hepcidin and iron homeostasis. Biochim Biophys Acta. 2012 Sep;1823(9):1434-43.

42. Cazzola M, Ponchio L, de Benedetti F, et al. Defective iron supply for erythropoiesis and adequate endogenous erythropoietin production in the anemia associated with systemic-onset juvenile chronic arthritis. Blood. 1996 Jun 1;87(11):4824-30.

43. Zare N, Mansoubi M, Coe S, et al. An investigation into the relationship between nutritional status, dietary intake, symptoms and health-related quality of life in children and young people with juvenile idiopathic arthritis: a systematic review and meta-analysis. BMC Pediatr. 2023 Jan 2;23(1):3.

44. Pascali M, Matera E, Craig F, et al. Cognitive, emotional, and behavioral profile in children and adolescents with chronic pain associated with rheumatic diseases: A case-control study. Clin Child Psychol Psychiatry. 2019 Jul;24(3):433-445.

45. Sonagra M, Jones J, McGill M, Gmuca S. Exploring the intersection of adverse childhood experiences, pediatric chronic pain, and rheumatic disease. Pediatr Rheumatol Online J. 2022 Feb 14;20(1):14.

46. Birket-Smith M. Somatization and chronic pain. Acta Anaesthesiol Scand. 2001 Oct;45(9):1114-20.

47. Minhas D. Pain mechanisms for the practicing rheumatologist. Best Pract Res Clin Rheumatol. 2024 Mar;38(1):101942.

48. Munro J, Singh-Grewal D. Juvenile idiopathic arthritis and pain -- more than simple nociception. J Rheumatol. 2013 Jul;40(7):1037-9.

49. Balague F, Dutoit G, Waldburger M. Low back pain in school-children. Scand J Rehabil Med. 1988;20:175–9.

50. Anthony KK, Schanberg LE. Pediatric pain syndromes and management of pain in children and adolescents with rheumatic disease. Pediatr Clin North Am. 2005 Apr;52(2):611-39.

51. McGrath T, Guzman J, Tucker L, et al. Research in Arthritis in Canadian Children Emphasizing Outcomes (ReACCh-Out) Investigators. Predictors of persisting pain in children with Juvenile Idiopathic Arthritis: a case control study nested in the ReACCh-Out cohort. Pediatr Rheumatol Online J. 2023 Sep 16;21(1):102.

52. Varni JW, Thompson KL, Hanson V. The Varni/Thompson Pediatric Pain Questionnaire. I. Chronic musculoskeletal pain in juvenile rheumatoid arthritis. Pain. 1987;28:27–38.

53. Schanberg LE, Sandstrom MJ. Causes of pain in children with arthritis. Rheum Dis Clin North Am. 1999;25:31–53.

54. Beyer JE, Denyes MJ, Villarruel AM. The creation, validation, and continuing development of the Oucher: a measure of pain intensity in children. J Pediatr Nurs. 1992;7:335–46.

55. Beyer JE, Villaruel AM, Denyes MJ. The Oucher. The new user’s manual and technical report. Denver: University of Colorado Health Science Center; 1993.

56. Dahlquist LM, Gil KM, Armstrong FD, et al. Preparing children for medical examinations: the importance of previous medical experience. Health Psychol. 1986;5:249–59.

57. Perquin CW, Hazebroek-Kampschreur AAJM, Hunfeld JAM, et al. Pain in children and adolescents: a common experience. Pain. 2000;87:51–8.

58. McGrath PA. An assessment of children's pain: a review of behavioral, physiological and direct scaling techniques. Pain. 1987 Nov;31(2):147-176.

59. Stanton-Hicks M. Complex regional pain syndrome. Anesthesiol Clin North Am. 2003 Dec;21(4):733-44.

60. van de Vusse AC, Stomp-van den Berg SG, Kessels AH, Weber WE. Randomised controlled trial of gabapentin in Complex Regional Pain Syndrome type 1 [ISRCTN84121379]. BMC Neurol. 2004 Sep 29;4:13.

61. Crofford LJ. Pain management in fibromyalgia. Curr Opin Rheumatol. 2008 May;20(3):246-50.

62. Mailis A, Furlan A. Sympathectomy for neuropathic pain. Cochrane Database Syst Rev. 2003;(2):CD002918.

63. Gordon N. Reflex sympathetic dystrophy. Brain Dev. 1996 Jul-Aug;18(4):257-62.

64. Eid MA, Aly SM, El-Shamy SM. Effect of electromyographic biofeedback training on pain, quadriceps muscle strength, and functional ability in juvenile rheumatoid arthritis. Am J Phys Med Rehabil. 2016 Dec;95(12):921-930.

65. Stinson JN, McGrath PJ, Hodnett ED, et al. An internet-based self-management program with telephone support for adolescents with arthritis: a pilot randomized controlled trial. J Rheumatol. 2010 Sep;37(9):1944-52.

66. Burckhardt CS, Goldenberg DL, Crofford L, et al. Guidelines for the management of fibromyalgia syndrome pain in adults and children. APS Clinical Practice Guidelines Series. Glenview, IL: American Pain Society; 2005.

67. Lomholt JJ, Thastum M, Christensen AE, et al. Cognitive behavioral group intervention for pain and well-being in children with juvenile idiopathic arthritis: a study of feasibility and preliminary efficacy. Pediatr Rheumatol Online J. 2015 Aug 21;13:35.

68. Brown RT, Shaftman SR, Tilley BC, et al. The health education for lupus study: a randomized controlled cognitive-behavioral intervention targeting psychosocial adjustment and quality of life in adolescent females with systemic lupus erythematosus. Am J Med Sci. 2012 Oct;344(4):274-82.

69. Field T, Hernandez-Reif M, Seligman S, et al. Juvenile rheumatoid arthritis: benefits from massage therapy. J Pediatr Psychol. 1997 Oct;22(5):607-17.

70. Tarakci E, Yeldan I, Baydogan SN, Olgar S, Kasapcopur O. Efficacy of a land-based home exercise programme for patients with juvenile idiopathic arthritis: a randomized, controlled, single-blind study. J Rehabil Med. 2012 Nov;44(11):962-7.

71. Baydogan SN, Tarakci E, Kasapcopur O. Effect of strengthening versus balance-proprioceptive exercises on lower extremity function in patients with juvenile idiopathic arthritis: a randomized, single-blind clinical trial. Am J Phys Med Rehabil. 2015 Jun;94(6):417-24.

72. lnaggar RK, Elshafey MA. Effects of combined resistive underwater exercises and interferential current therapy in patients with juvenile idiopathic arthritis: A randomized controlled trial. Am J Phys Med Rehabil. 2016 Feb;95(2):96-102.

73. Klepper SE. Effects of an eight-week physical conditioning program on disease signs and symptoms in children with chronic arthritis. Arthritis Care Res. 1999 Feb;12(1):52-60.

74. Nijhof LN, Nap-van der Vlist MM, van de Putte EM, van Royen-Kerkhof A, Nijhof SL. Non-pharmacological options for managing chronic musculoskeletal pain in children with pediatric rheumatic disease: a systematic review. Rheumatol Int. 2018 Nov;38(11):2015-2025.

75. Vroegindeweij A, Wulffraat NM, Van De Putte EM, et al. Targeting persistent fatigue with tailored versus generic self-management strategies in adolescents and young adults with a fatigue syndrome or rheumatic condition: A randomized crossover trial. Br J Health Psychol. 2024 Sep;29(3):516-532.

76. Menting J, Tack CJ, Bleijenberg G, et al. Is fatigue a disease-specific or generic symptom in chronic medical conditions? Health Psychol. 2018 Jun;37(6):530-543.

77. Nijhof LN, van de Putte EM, Wulffraat NM, Nijhof SL. Prevalence of severe fatigue among adolescents with pediatric rheumatic diseases. Arthritis Care Res (Hoboken). 2016 Jan;68(1):108-14.

78. Armbrust W, Siers NE, Lelieveld OT, Mouton LJ, Tuinstra J, Sauer P. Fatigue in patients with juvenile idiopathic arthritis: A systematic review of the literature. Semin Arthritis Rheum. 2016 Apr;45(5):587-95.

79. Butbul Aviel Y, Stremler R, Benseler SM, et al. Sleep and fatigue and the relationship to pain, disease activity and quality of life in juvenile idiopathic arthritis and juvenile dermatomyositis. Rheumatology (Oxford). 2011 Nov;50(11):2051-60.

80. Tarakçı E, Arman N, Barut K, et al. Fatigue and sleep in children and adolescents with juvenile idiopathic arthritis: A cross-sectional study. Turk J Med Sci. 2019 Feb 11;49(1):58-65.

81. Tucker LB. Making the diagnosis of systemic lupus erythematosus in children and adolescents. Lupus. 2007;16:546-9.

82. Wi D, Palermo TM, Stevens A, Ward TM. Sleep deficiency and symptoms of pain, fatigue, and depressed mood in youth with and without childhood systemic lupus erythematosus. J Clin Sleep Med. 2024 Oct 1;20(10):1607-1614.

83. Schanberg LE, Anthony KK, Gil KM, Maurin EC. Daily pain and symptoms in children with polyarticular arthritis. Arthritis Rheum. 2003 May;48(5):1390-7.

84. Ringold S, Ward TM, Wallace CA. Disease activity and fatigue in juvenile idiopathic arthritis. Arthritis Care Res (Hoboken). 2013 Mar;65(3):391-7.

85. Nap-van der Vlist MM, Dalmeijer GW, Grootenhuis MA, et al. Fatigue among children with a chronic disease: A cross-sectional study. BMJ Paediatr Open. 2021 Feb 17;5(1):e000958.

86. Ridao-Manonellas S, Fábregas-Bofill A, Núñez-Rueda G, et al. Health-related quality of life and multidimensional fatigue scale in children with primary immunodeficiencies. J Clin Immunol. 2020 May;40(4):602-609.

87. Lima GL, Paupitz J, Aikawa NE, Takayama L, Bonfa E, Pereira RM. Vitamin D supplementation in adolescents and young adults with juvenile systemic lupus erythematosus for improvement in disease activity and fatigue scores: A randomized, double-blind, placebo-controlled trial. Arthritis Care Res (Hoboken). 2016 Jan;68(1):91-8.

88. Hilderson D, Moons P, Van der Elst K, Luyckx K, Wouters C, Westhovens R. The clinical impact of a brief transition programme for young people with juvenile idiopathic arthritis: results of the DON'T RETARD project. Rheumatology (Oxford). 2016 Jan;55(1):133-42.

89. Fuchs CE, Van Geelen SM, Hermans HJ, et al. Psychological intervention for adolescents with juvenile idiopathic arthritis: for whom and when? J Rheumatol. 2013 Apr;40(4):528-34.

90. Cunningham NR, Fussner LM, Moorman E, Avar Aydin PO, Brunner HI, Kashikar-Zuck S. Development and pilot testing of the treatment and education approach for childhood-onset lupus (TEACH): a cognitive behavioral treatment. Pediatr Rheumatol Online J. 2019 Feb 18;17(1):9.

91. Kvien TK, Høyeraal HM, Sandstad B. Assessment methods of disease activity in juvenile rheumatoid arthritis--evaluated in a prednisolone/placebo double-blind study. J Rheumatol. 1982 Sep-Oct;9(5):696-702.

92. Dures E, Farisoğulları B, Santos EJF, et al. 2023 EULAR recommendations for the management of fatigue in people with inflammatory rheumatic and musculoskeletal diseases. Ann Rheum Dis. 2024 Sep 30;83(10):1260-1267.

93. Kant-Smits K, Van Brussel M, Nijhof S, Van der Net J. Reducing fatigue in pediatric rheumatic conditions: A systematic review. Pediatr Rheumatol Online J. 2021 Jul 8;19(1):111.

94. Habers GE, Bos GJ, van Royen-Kerkhof A, et al. Muscles in motion: A randomized controlled trial on the feasibility, safety and efficacy of an exercise training programme in children and adolescents with juvenile dermatomyositis. Rheumatology (Oxford). 2016 Jul;55(7):1251-62.

95. Houghton KM, Macdonald HM, McKay HA, Guzman J, Duffy C, Tucker L; LEAP Study Investigators. Feasibility and safety of a 6-month exercise program to increase bone and muscle strength in children with juvenile idiopathic arthritis. Pediatr Rheumatol Online J. 2018 Oct 22;16(1):67.

96. Sule SD, Fontaine KR. Slow speed resistance exercise training in children with polyarticular juvenile idiopathic arthritis. Open Access Rheumatol. 2019 May 21;11:121-126.

97. Samhan A, Mohamed N, Elnaggar R, Mahmoud W. Assessment of the clinical effects of aquatic-based exercises in the treatment of children with juvenile dermatomyositis: A 2x2 controlled-crossover trial. Arch Rheumatol. 2019 Oct 17;35(1):97-106.

98. Dover S, Stephens S, Schneiderman JE, et al. The effect of creatine supplementation on muscle function in childhood myositis: A randomized, double-blind, placebo-controlled feasibility study. J Rheumatol. 2021 Mar;48(3):434-441.

Published

2025-04-02

How to Cite

Vidović, M. (2025). Nutritional status, pain and fatigue in patients with rheumatic diseases. Paediatria Croatica, 69(Suppl 2), 203-213. https://doi.org/10.13112/pc.1074

Similar Articles

1-10 of 304

You may also start an advanced similarity search for this article.