For a young person with a chronic rheumatic disease like juvenile idiopathic arthritis (JIA), maintaining friendships outside the family may pose additional challenges. This may be a direct consequence of the disease, such as pain, stiffness, and fatigue or secondary consequences such as limited knowledge and/or inaccurate beliefs about their condition and the benefits of social and sporting activities. Fear of hurting themselves or making worse their condition may lead to self-imposed limitations. These behaviors may be inadvertently reinforced by family, friends, school personnel as well as health care professionals. Fatigue may also limit opportunities to join friends in a number of social arenas including shopping and sports. However fatigue is not necessarily related to disease activity, and it may be necessary to consider other factors. Young people with chronic rheumatic disease may be less physically active compared to their healthy peers, resulting in de-conditioning, decreased exercise tolerance, lower aerobic capacity, and muscle weakness (3,4). In addition Miller et al. (5) reported that children and young people with JIA report functional difficulties even in the absence of active signs of the disease. Careful assessment of the young persons function including social activities should therefore be documented by health professionals regardless of disease activity.
The relationship between friendship and social activity is not always straightforward however. A Canadian study (6) reported that young people with physical disabilities between the ages of 11 and 16 were less socially active and involved in fewer intimate relationships despite reporting good self-esteem, strong family relationships, and many close friends compared to national statistics. Other factors may therefore be relevant. Adolescents with JIA have reported increased social support from parents and teachers, which could perhaps be interpreted as having a potentially negative impact on the development of social activities. Overprotectiveness by parents, teachers, and health professionals often results in a delay in the development of self-advocacy, separation from family, as well as the challenging of authority, all of which are necessary to achieve independence from parents.
Disease experience has been shown to correlate with levels of self-competence, including physical attractiveness and global self worth, even after controlling for disease severity (7) suggesting psychosocial factors such as friendships can play an important role in disease outcome. Peer support may therefore be particularly important for this group and act as a buffer against the stresses of the disease.
Various authors have studied the significance of peer relationships in the context of chronic illness during adolescence. Friends of adolescents with chronic illnesses are often younger and nondisabled (8). Wolman et al. (9) reported that 32% of the variance in the emotional well-being of adolescents with chronic condition was explained by concern about peer relationships along with body image and family connectedness. When data of young people with visible versus invisible conditions were compared, there was no difference (9).
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