Quality of Life of Children with Crohn’s Disease as a Potential Criterion for Monitoring Disease Activity

Abstract

Study Objective: To analyse the activity dynamics of Crohn’s disease (CD) and the quality of life (QoL) of children aged 8–17 years. Study Design: Open prospective non-randomized comparative study. Materials and Methods. The quality of life was assessed in 37 healthy children and 28 children with Crohn's disease (17 boys and 11 girls). Disease activity (Paediatric Crohn’s Disease Activity Index, PCDAI) was determined using PedsQL 4.0 Generic Core Scales questionnaire which comprises assessment of health and activity, child’s attitude, problems with interpersonal relations, and progress at school. Observation spanned over 18 months; tests parameters were assessed at the beginning (first visit), after 6, 12 and 18 months. QoL was assessed by both children and their parents, the indicators were assessed over time and compared with the levels of activity, the duration of the disease, and the presence of extraintestinal manifestations of the disease. Study Results. Children with CD aged 8–17 years demonstrated a decrease in the majority of PedsQL 4.0 parameters. The shifts are observed both when QoL is assessed by children and their parents. The therapy in these patients is accompanied by positive QoL dynamics; these changes occur in parallel with a decrease in the values of the CD activity index, suggesting the possibility of using the QoL parameters to predict the course of the disease and the effectiveness of the treatment in this population. PCDAI values in subjects demonstrated moderate statistically significant negative correlations with “Physical activity” (r = –0.412), “Attitude” (r = –0.364), “Psychosocial functioning” (r = –0.306) and “School life” (r = –0.344) and the overall PedsQL 4.0 values (r = –0.406). The duration of the disease has statistically significant negative correlation with “Physical activity” (r = –0.386), “Attitude” (r = –0.423), “Psychosocial functioning” (r = –0.345), and the integral PedsQL 4.0 value (r = –0.397); the presence of extraintestinal manifestations demonstrated moderate negative correlation with “Physical activity” (r = –0.342), “School life” (r = –0.431) and overall value (r = –0.372). Conclusion. Monitoring of the health-related quality of life should become a mandatory component of the examination and management of children with inflammatory bowel diseases, since this category of patients is characterized by a significant decrease relative to the corresponding indicators in healthy peers. Keywords: inflammatory bowel disorder, Crohn’s disease, quality of life, disease activity, extraintestinal manifestations.