Gender roles, sexuality & reproductive health—Young adulthood ushers increasing understanding about gender roles in society, emergence of a personal sexual orientation and experimentation with sexual behavior. A considerable proportion of adolescent rheumatology patients have reproductive concerns.5 The patient may be coping with the added complexity of the impact of arthritis on body image, including one’s feelings of attractiveness. A poor self-evaluation can cause a cascade of negativity on the desire for emotional closeness and openness to sensory experiences.
Transition clinic staff is well situated to discuss such themes as sexual identity and the physical and emotional changes that are impacting on body image. The clinician may initiate a conversation on family planning or explore patients’ decision making while under peer pressure for sex. Additionally, links to sexual health services in the community, where available, can be provided.
Vocational planning—The patient’s sense of competence to achieve in life may be undermined by arthritis symptoms. Pain and extreme fatigue are important determinants of increased school absences and lower physical functioning, independent of the extent of disease activity.6 Consequently, arthritis may exacerbate feelings of directionless at a crucial time when the young person is already struggling to establish a clear purpose to life, as defined by career aspirations.
For patients in the midst of contemplating the impact of symptomatology as a blocking force on a desired career path, the clinician must be available to console patients over truncated vocational plans. The young adult may require help in formulating realistic expectations for future employment—without summarily ruling out alternate ideas for a future occupation. A referral to vocational rehabilitation services, where available, will expedite an accurate assessment of the compatibility of interests and physical abilities with post-secondary education or training options.
Environmental Challenges
The global economy and the imposition of financial constraints—The seemingly capricious nature of the global economy is well documented, and its vagaries have had an enormous impact on young people. Within the timespan of a generation, it’s now taking up to a decade longer to meet previously accepted indicators of adulthood: finding a job or establishing a career, achieving financial independence, deciding on a life partner, having children and owning property. For contemporary 20-somethings, this stage in life may be a time of wondrous discovery or it may induce a crushing sense of personal failure.7
We are witnessing a growing abundance of poorly educated young workers who are mired in low-wage jobs as their only source of income. Nor is it uncommon for those who acquired an education to be entering adult life hamstrung by the requirement to service a massive student debt load. These financial constraints have the power to influence the selection of treatment options.
