Substance use and sexual function in juvenile idiopathic arthritis

174 adolescents with pediatric rheumatic diseases were selected. A cross-sectional study with 54 JIA patients and 35 controls included demographic/anthropometric data and puberty markers assessments, physician-conducted CRAFFT (car/relax/alone/forget/friends/trouble) screen tool for substance abuse/dependence high risk and a questionnaire that evaluated sexual function, bullying and alcohol/tobacco/illicit drug use. Clinical/laboratorial data and treatment were also assessed in JIA.

Results:

The median current age was similar between JIA patients and controls [15(10–19) vs. 15(12–18) years, p = 0.506]. Frequencies of alcohol/tobacco/illicit drug use were high and similar in both JIA and controls (43% vs. 46%, p = 0.829). However, age at alcohol onset was significantly higher in those with JIA [15(11–18) vs. 14(7–18) years, p = 0.032], particularly in polyarticular onset (p = 0.040). High risk for substance abuse/dependence (CRAFFT score ≥ 2) was found in both groups (13% vs. 15%, p = 1.000), likewise bullying (p = 0.088). Further analysis of JIA patients regarding alcohol/tobacco/illicit drug use showed that the median current age [17(14–19) vs. 13(10–19)years, p < 0.001] and education years [11(6–13) vs. 7(3–12)years, p < 0.001] were significant higher in those that used substances. Sexual activity was significantly higher in the former group (48% vs. 7%, p < 0.001). A positive correlation was evidenced between CRAFFT score and current age in JIA patients (p = 0.032, r = +0.296).

Conclusion:

A high risk for substance abuse/dependence was observed in both JIA and controls. JIA substance users were more likely to have sexual intercourse. Therefore, routine screening is suggested in all visits of JIA adolescents.

Keywords:
Alcohol; Tobacco; Illicit drug; Bullying; Juvenile idiopathic arthritis

Variables	JIA (n = 54)	Healthy controls (n = 35)	p
Demographic data
Current age, yrs	15 (10–19)	15 (12–18)	0.506
Female gender	38 (70)	26 (74)	0.688
BMI, kg/m ²	20.79 (13.2–35.6)	19.53 (16.4–25.9)	0.205
Social economic class B and C	51 (94)	34 (97)	1.000
Education, yrs	9 (3–13)	10 (6–12)	0.826

Puberty markers
Tanner 3	7 (13)	4 (11)	1.000
Tanner 4	10 (19)	12 (34)	0.102
Tanner 5	30 (57)	19 (54)	0.830
Menarche	32/38 (84)	26/26 (100)	0.073
Menarche age, yrs	12 (9–15)	11.5 (9–15)	0.528
Spermarche	10/16 (63)	7/9 (78)	0.661
Spermarche age, yrs	13 (10–15)	13 (12–14)	0.959

Sexual function
Sexual activity	13 (24)	9 (26)	0.861
First sexual activity age, yrs	15 (13–17)	15 (12–17)	0.606
Sexual intercourse in last month	8/13 (62)	4/9 (44)	0.666
Condom at the first sexual activity	13/13 (100)	8/9 (89)	0.409
Oral contraception use in females	5/11 (46)	3/10^a a One healthy control used oral contraception before sexual activity. (30)	0.659
Emergency contraceptive use	4/11 (36)	4/9 (44)	1.000
Knowledge of sexual activity by parents	9/13 (69)	6/8 (75)	1.000
Total number of sexual partner, number	2.5 (1–5)	1 (1–2)	0.071

Alcohol, tobacco and/or illicit drug use	23 (43)	16 (46)	0.829
Alcohol use	23 (43)	16 (46)	0.829
Age at onset alcohol, yrs	15 (11–18)	14 (7–18)	0.032
Polyarticular onset JIA, n = 17	15 (13–17)	14 (7–18)	0.040
Systemic onset JIA, n = 19	15 (11–17)	14 (7–18)	0.188
Drinking alcohol in past 30 days, number	0 (0–7)	0 (0–5)	0.505
Tobacco use	4 (7)	5 (14)	0.308
Age at onset smoking, yrs	16 (13–18)	15 (7–15)	0.250
Smoking in past 30 days, number	0	0 (0–30)	0.180
Illicit drug use	1 (2)	2 (6)	0.559
Age at onset illicit drug, yrs	14	14	1.000
Illicit drug use in past 30 days, number	0 (0–0)	1.5 (0–3)	0.480
CRAFFT score (0–6)	0 (0–3)	0 (0–5)	0.836
CRAFFT score ≥ 2	7 (13)	5 (15)	1.000

CRAFFT item
Car	14/54 (26)	5/34 (15)	0.213
Relax	4/16 (25)	2/11 (18)	1.000
Alone	1/16 (6)	1/11 (9)	1.000
Forget	2/16 (13)	5/11 (46)	0.084
Friends	5/16 (31)	5/11 (46)	0.687
Trouble	1/16 (6)	0 (0)	1.000

Bullying	11/43 (26)	15/34 (44)	0.088

Variables	Use alcohol, tobacco and/or illicit drug (n = 23)	Non use alcohol, tobacco and/or illicit drug (n = 31)	p
Demographic data
Current age, yrs	17 (14–19)	13 (10–19)	<0.001
Disease duration, yrs	6 (1–17)	4 (0.25–15)	0.063
Female gender	16 (70)	22 (71)	0.911
BMI, kg/m ²	21.15 (18–27)	20.09 (13–30)	0.132
Social economic class B and C	22 (96)	28 (90)	0.628
Education, yrs	11 (6–13)	7 (3–12)	<0.001

Puberty markers
Tanner 3	1 (4)	6 (20)	0.123
Tanner 4	3 (13)	7 (23)	0.484
Tanner 5	19 (83)	11 (37)	0.001
Menarche	16 (100)	16 (73)	0.030
Menarche age, yrs	12 (9–15)	12 (9–14)	0.861
Spermarche	7 (100)	3 (33)	0.011
Spermarche age, yrs	13 (12–15)	11 (10–13)	0.082

Sexual function
Sexual activity	11 (48)	2 (7)	<0.001
First sexual activity age, yrs	16 (13–17)	14 (14)	0.227
Sexual intercourse in last month	7/11 (64)	1/2 (50)	1.000
Condom at the first sexual activity	11/11 (100)	2/2 (100)	1.000
Oral contraception use in females	4/9 (44)	1/2 (50)	1.000
Emergency contraceptive use	4/9 (44)	0	0.491
Knowledge of sexual activity by parents	7/11 (64)	2/2 (100)	1.000
Total number of sexual partner, number	3 (1–5)	1 (1)	0.074

Bullying	5/18 (28)	6/25 (24)	1.000

JIA parameters
Morning stiffness	7 (30)	2/29 (7)	0.061
Morning stiffness, min	30 (10–120)	20 (10–30)	0.492
Active joints	7 (30)	10 (32)	0.887
Number of active joints	1 (1–8)	1 (1–9)	0.956
Limited joints	16 (70)	20 (65)	0.697
Number of limited joints	2 (1–11)	3.5 (1–61)	0.165
ESR, mm/1st h	14.5 (2–60)	20 (2–47)	0.809
ESR, >20 mm/1st h	10/22 (46)	11/27 (41)	0.740
CRP, mg/L	2.23 (0–76)	1.23 (0–155)	0.847
CRP, >5 mg/L	6/22 (27)	7/26 (27)	0.978
Patient's VAS, cm	1 (0–9)	1 (0–5)	0.748
Physician's VAS, cm	0 (0–4)	1 (0–4)	0.307
CHAQ	0.56 (0–2.6)	0.63 (0–1.5)	0.779

Current treatment	19 (83)	29 (94)	0.384
NSAID	7 (30)	16 (52)	0.120
Naproxen	2 (9)	6 (19)	0.443
Glucocorticoids	3 (13)	8 (26)	0.319
Dose, mg/day	11.3 (2.5–40)	5 (2.5–25)	0.214
Methotrexate	4 (17)	6 (19)	1.000
Dose, mg/week	25 (10–50)	25 (10–37.5)	0.731
Leflunomide	3 (13)	5 (16)	1.000
Dose, mg/day	20 (20)	20 (10–20)	0.094
Sulfasalazine	0	1 (3)	1.000
Cyclosporine	2 (9)	3 (10)	1.000
Dose, mg/day	190 (180–200)	150 (100–200)	0.584
Biological agents	12 (52)	10 (32)	0.141
Abatacept	1 (4)	2 (7)	1.000
Etanercept	5 (22)	3 (10)	0.217
Adalimumab	4 (17)	3 (10)	0.443
Tocilizumab	2 (9)	2 (7)	1.000

Sociedade Brasileira de Reumatologia Av Brigadeiro Luiz Antonio, 2466 - Cj 93., 01402-000 São Paulo - SP, Tel./Fax: 55 11 3289 7165 - São Paulo - SP - Brazil
E-mail: sbre@terra.com.br

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[1] *Corresponding author. E-mail: clovisaasilva@gmail.com (C.A. Silva).