Epidemiologic Considerations in Unexplained Pediatric Arthralgia: The Role of Season, School, and Stress

• Published in: Journal of rheumatology Vol. 36; no. 2; pp. 427 - 433
• Main Authors: MCNALLY, J. Dayre, MATHESON, Loren A, ROSENBERG, Alan M
• Format: Journal Article
• Language: English
• Published: Toronto, ON The Journal of Rheumatology 01-02-2009; Journal of Rheumatology Publishing
• Subjects: Absenteeism; Adolescent; Age Factors; Arthralgia - blood; Arthralgia - epidemiology; Arthralgia - psychology; Biological and medical sciences; Child; Climate; Cold Temperature - adverse effects; Comorbidity; Diseases of striated muscles. Neuromuscular diseases; Diseases of the osteoarticular system; Female; Humans; Male; Medical sciences; Miscellaneous. Osteoarticular involvement in other diseases; Neurology; Prospective Studies; Psychology; Psychosocial Deprivation; Retrospective Studies; Saskatchewan - epidemiology; Schools - statistics & numerical data; Seasons; Stress, Psychological - epidemiology; Vitamin D - analysis; Vitamin D - blood; Vitamin D Deficiency - epidemiology; Saskatchewan; Human; Pediatrics; Constraint; Arthralgia; Diseases of the osteoarticular system; Rheumatology; Myalgia; Epidemiology; Stress; RHEUMATIC DISEASES; Striated muscle disease; Pain; Vitamin D; PEDIATRIC; Rheumatism; Season; Child
• ISSN: 0315-162X; 1499-2752
• DOI: 10.3899/jrheum.080358

Objective. To determine demographic and epidemiologic characteristics in children with unexplained joint pain.
Methods. The study population included 730 children (< 18 yrs of age) referred between 1981 and 2007 to the Saskatchewan Pediatric
Rheumatology Program, University of Saskatchewan, because of arthralgia. Parents and patients completed a questionnaire at
the time of initial presentation, and a diagnosis of unexplained arthralgia was assigned based on clinical assessment. Serum
vitamin D levels were measured in 73 patients diagnosed with arthralgia.
Results. Subjects with arthralgia were more likely to report psychosocial stresses including family discord and illness in the family,
and to be cared for by a single parent as a consequence of parental separation or death. Significantly more patients reported
fall and winter (30%) as the season of symptom onset compared to spring or summer (20%; p = 0.01). Significantly more survey
respondents in the arthralgia group reported missing school compared to the control group (62% vs 31%; p = 0.001). Referrals
from northern Saskatchewan were significantly more numerous than from southern Saskatchewan (107 vs 45 per 100,000; p < 0.001).
Serum vitamin D concentrations measured in a subgroup of patients (n = 73) showed that 62 (82%) were abnormally low, 42% between
50 and 75 nmol/l (insufficient), and 40% < 50 nmol/l (deficient).
Conclusion. Our results suggest an association between psychosocial stress, school absenteeism, vitamin D insufficiency, and unexplained
arthralgia in children.