In children with arthritis, stress and mood are important predictors of disease symptoms, research shows, suggesting that non-drug interventions, such as stress management and cognitive behavioral therapy, may be useful in ameliorating symptoms.

Childhood arthritis is characterized by unpredictable flares of disease symptoms such as pain, morning stiffness, fatigue, and sleep troubles. And while researchers have long suspected a link between psychosocial stress, mood, pain, and disease flares in childhood arthritis, these relationships have not been studied adequately.

Therefore, Dr. Laura E. Schanberg of Duke University Medical Center, Durham, North Carolina, and colleagues looked for patterns of stress, mood, disease symptoms and reduced activity in 51 children with arthritis.

For 2 months, the children kept a daily log of their symptoms as well as their mood and doctors rated the children's functional status and disease activity at baseline and during follow up.

The children reported pain, stiffness, and fatigue on more than 70 percent of days, despite use of pain medication, the researchers report. Moreover, the researchers observed significant same-day relationships between stress, mood, and disease symptoms.

For example, daily fluctuations in both stress and mood predicted increased pain, stiffness, and fatigue. There was a significant association between increases in daily stress, mood and disease symptoms and decreased participation in social activities on a day-to-day basis. Only mood and stiffness predicted a cutback in school attendance.

"Our data underscore the importance of day-to-day symptoms reported by children with arthritis," the investigators write. Aggressive treatment of pain, stiffness, and fatigue, such as cognitive-behavioral therapy, relaxation, and stress management, should be considered, they add.

SOURCE: Arthritis and Rheumatism April 2005.