Psychosomatic aspects of juvenile rheumatoid arthritis

The purpose of this study was to investigate the incidence of psychopathological symptoms and distorted family relationships in patients with juvenile rheumatoid arthritis (JRA). The study also evaluated the significance of life stress factors in the etiology of the illness. The series consisted of 54 children with JRA, 16 males and 38 females, who were investigated with regard to psychiatric, psychological and rheumatological variables. The mean age of the patients was 9.9 years, and the average length of the investigation period per patient was 49.7 days. In addition, 43 mothers, 20 fathers and 14 siblings of the patients were studied. Twenty one patients (39%) had suffered from an emotional disturbance prior to the investigation which in most cases (81%) was a depressive reaction. In only 12 children (22%) did the previous medical history reveal evidence of hyperactivity. During the investigation manifest psychopathology was observed in 17 patients (31%) of whom only eight patients (15%) showed evident depressive symptoms, whereas nine patients (16%) exhibited neurotic or psychomotor disturbances. In addition to the above mentioned overt psychopathology, 31 children (58%) revealed a personality profile marked by shyness, unresponsiveness, passivity, submissiveness, aloofness, feelings of inferiority and inability to express emotions or to establish contact with fellow patients. The majority of the patients with previous psychiatric history as well as most of the patients with overt psychopathology during the investigation exhibited the personality profile described above. Specific conflicts in the sphere of aggression dynamics were not detected. Though several kinds of skewed family relationships were observed, no uniform patterns of distortion could be demonstrated. The father child relationship appeared problematic in almost half (48%) of the families, whereas abnormal elements in the mother child relationship were found in a third (33%) of the cases only. Evident problems with siblings appeared in 13% of the patients. In 20 (37%) patients (the major conflict group, the MCG) a correlation between an emotionally important conflict and the onset of the illness was observed. In 34 (63%) patients (the non conflict group, the NCG) no such correlation could be detected. The incidence of rheumatoid relatives in the NCG was significantly greater than in the MCG justifying classification of the patients with JRA into two categories: patients with hereditary predisposition to illness in whom the disease is less influenced by environmental changes and patients with less hereditary predisposition in whom the onset of the disease is associated with psychodynamic conflict situations.