title: Prevalence of Severe Fatigue Among Adolescents With Pediatric Rheumatic Diseases.
abstract: OBJECTIVE
  To determine the prevalence of severe fatigue and fatigue-related limitations among adolescents with juvenile idiopathic arthritis (JIA) and other pediatric rheumatic diseases (PRDs). In addition, we assessed the effect of disease activity and pain on the severity of fatigue.
  
  
  METHODS
  This cross-sectional study included 175 patients (ages 10-18 years) who visited the pediatric rheumatology and immunology outpatient clinic at Wilhelmina Children's Hospital from April through July 2013. Patients completed validated questionnaires regarding fatigue, physical functioning, and school attendance. Disease activity in JIA patients was measured using the Juvenile Arthritis Disease Activity Score including 27 joints. The results were compared against a healthy control group.
  
  
  RESULTS
  The prevalence of severe fatigue among patients with PRDs was 25.1%, which was significantly higher than among the healthy control group (P < 0.001). Fatigued patients had significantly lower levels of physical functioning compared to nonfatigued patients (62.1% versus 89.0%, respectively; P < 0.001) and a significantly higher percentage of school absences (21.2% versus 11.6%, respectively; P = 0.005). Among JIA patients, the level of pain was significantly correlated with fatigue. Finally, disease activity was not a predictor for fatigue.
  
  
  CONCLUSIONS
  Fatigue is a common problem among teenagers with PRDs, with a higher prevalence among these patients than in the general population. Severe fatigue leads to significant impairments, including increased school absences and decreased physical functioning. Interestingly, fatigue was associated with pain, but not with the disease activity. Therefore, in this patient population, fatigue may be a promising therapeutic target for improving functioning, school attendance, and possibly pain as well.
authors: Wilhelmina Children's Hospital, University Medical Center, Utrecht, The Netherlands.
authors: Linde N
authors: LN
authors: Nijhof
authors: Wilhelmina Children's Hospital, University Medical Center, Utrecht, The Netherlands.
authors: Elise M
authors: EM
authors: van de Putte
authors: Wilhelmina Children's Hospital, University Medical Center, Utrecht, The Netherlands.
authors: Nico M
authors: NM
authors: Wulffraat
authors: Wilhelmina Children's Hospital, University Medical Center, Utrecht, The Netherlands.
authors: Sanne L
authors: SL
authors: Nijhof
mesh_terms: D000041:Absenteeism; D000293:Adolescent; D000294:Adolescent Behavior; D000367:Age Factors; D016022:Case-Control Studies; D002648:Child; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D005221:Fatigue / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D010147:Pain Measurement; D015995:Prevalence; D012216:Rheumatic Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology / Q000523:psychology; D012574:Schools; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires