Unlike other chronic illnesses like diabetes, rheumatic diseases may vary considerably with respect to symptoms, course of the disease, prognosis, and therapy, all of which contribute to the psychosocial impact. Table 5 gives a list of important disease-related symptoms and factors. Drug-induced symptoms as well as severe functional impairment are associated with a more severe course of the disease. This occurs more often in patients with systemic or polyarticular onset juvenile idiopathic arthritis (JIA) (22,23) as well as in SLE patients (24). Functional impairment not only has implications for daily activities with peers, but may cause problems at school (absenteeism, transportation), too (25,26). Siegel and Baum (27), in an excellent paper on JIA and sexuality, also describe the impact of functional
Table 4 How to Identify Good Adaptation in the Chronically Ill
■ Age-appropriate dependence on family
■ Minimal need for secondary gains from the illness
■ Acceptance of the limits and responsibilities imposed by the disease
■ Development of compensatory sources of satisfaction
Source: Adapted from Ref. 20; cited from Ref. 16.
Table 5 Disease-Related Symptoms and Factors That May Impair Functioning and Psychosocial Maturation and Health
Localized growth anomalies (e.g., a short digit, micrognathia) Joint deformities (including leg-length discrepancies) Drug-induced altered distribution of fat stores
Change in skin appearance and body shape (either pathognomonic: rash, Raynaud's syndrome; or drug-induced: acne, hirsutism, striae, cushingoid appearance) Scars from previous surgery Self-esteem and social maturation Inability to perform household tasks Physical dependence from parents Limited mobility
Functional limitations (due to stiffness, joint deformity, pain, or impaired vision) Reduced fitness Mental health
Impaired body image, self-esteem, and social maturation Pain
Loss of control/sense of helplessness
Parental overprotection ("vulnerable child syndrome")
Lack of sympathetic peers and significant others aSource: Adapted from Ref. (53).
impairment on sexual activities. As regards the sense of helplessness and/or low sense of self-efficacy, patients with rheumatic disease may be more vulnerable than other chronic patients given the fact that—unlike for diabetes and other well-controllable diseases—there is only limited promise that adherence with therapy will prevent future symptoms and flares. Furthermore, there is also a greater risk of unsympathetic reactions from peers and significant others (including teachers): being a young person and suffering from a "disease of elderly people" may provoke insulting reactions from peers. Furthermore, rheumatic symptoms may vary extremely during the course of one day, which may falsely undermine credibility (regarding sick role).
On the other hand, among adolescents with rheumatic diseases, there are also some with minimal or no limitations at all, or whose disease is in remission. This occurs more often in JIA patients with an oligoarticular onset (22,23).
Age at disease manifestation may further act as an important modulating factor (28). Pelkonen (29), for instance, mentioned that disease onset in adolescence may eventually end up as a "disaster" [similarly (30)]. Late disease manifestation characteristically occurs in patients with rheumatoid factor positive JIA, enthesitis related JIA, and SLE.
In other words, there is a tremendous diversity both within and among the JIA groups, as well as among the broader spectrum of rheumatic diseases. This should be kept in mind if studies report on results of "rheumatic" patients.
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All you need is a proper diet of fresh fruits and vegetables and get plenty of exercise and you'll be fine. Ever heard those words from your doctor? If that's all heshe recommends then you're missing out an important ingredient for health that he's not telling you. Fact is that you can adhere to the strictest diet, watch everything you eat and get the exercise of amarathon runner and still come down with diabetic complications. Diet, exercise and standard drug treatments simply aren't enough to help keep your diabetes under control.