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Vasil E, M Nesbitt C, Toomey C, Kuntze G, Esau S, A Emery C, Gabel L. Bone health and physical activity in adolescents with juvenile idiopathic arthritis: a cross-sectional case-control study. Pediatr Rheumatol Online J 2024; 22:45. [PMID: 38641611 PMCID: PMC11031938 DOI: 10.1186/s12969-024-00982-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 04/04/2024] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND Adolescents with juvenile idiopathic arthritis (JIA) tend to engage in less physical activity than their typically developing peers. Physical activity is essential for bone development and reduced physical activity may detrimentally effect bone health. Thus, we examined differences in total body bone mineral content (BMC) and areal bone mineral density (aBMD) between adolescents with JIA and adolescent controls without JIA. We also examined associations between moderate-to-vigorous physical activity (MVPA), lean mass, and bone outcomes. METHODS Participants included 21 adolescents with JIA (14 females, 7 males) and 21 sex- and age-matched controls aged 10-20 years. Assessments included: height; weight; triple-single-leg-hop distance (TSLH); MVPA by accelerometry; and total body BMC, aBMD, and lean mass measured using dual X-ray absorptiometry. Height-adjusted z-scores were calculated for BMC and aBMD and used for all analyses. Multiple linear mixed effects models examined group differences in BMC and aBMD, adjusting for sex, maturity, MVPA, TSLH, and lean mass. Participants clusters, based on sex and age (within 18 months), were considered random effects. RESULTS Adolescents with JIA had lower total body aBMD z-scores [β (95% CI); -0.58 (-1.10 to -0.07), p = 0.03] and BMC z-scores [-0.47 (-0.91 to -0.03), p = 0.04] compared with controls. Mean daily MVPA was 22.0 min/day lower in adolescents with JIA than controls; however, MVPA was not associated with aBMD [-0.01 (-0.01 to 0.01), p = 0.32] or BMC [0.00 (-0.01 to 0.00), p = 0.39]. Lean mass was positively associated with aBMD [0.05 (0.01 to 0.09) g/cm2, p = 0.03] and BMC [0.06 (0.03 to 0.10) g, p < 0.001]. CONCLUSION Adolescents with JIA had lower total body aBMD and BMC compared with sex- and age-matched controls without JIA. Group differences in bone outcomes were not associated with the lower MVPA participation of adolescents with JIA. Despite this, physical activity should still be encouraged as it promotes physical well-being.
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Affiliation(s)
- Egi Vasil
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, 2500 University Dr NW, T2N 1N4, Calgary, AB, Canada
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Canada
| | - Colleen M Nesbitt
- Sport Injury Prevention Research Center, Faculty of Kinesiology, University of Calgary, Calgary, Canada
| | - Clodagh Toomey
- Sport Injury Prevention Research Center, Faculty of Kinesiology, University of Calgary, Calgary, Canada
- School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Gregor Kuntze
- Alberta Bone and Joint Health Institute, Calgary, AB, Canada
| | - Shane Esau
- Sport Injury Prevention Research Center, Faculty of Kinesiology, University of Calgary, Calgary, Canada
| | - Carolyn A Emery
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Canada
- Sport Injury Prevention Research Center, Faculty of Kinesiology, University of Calgary, Calgary, Canada
- Departments of Community Health Sciences and Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada
| | - Leigh Gabel
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, 2500 University Dr NW, T2N 1N4, Calgary, AB, Canada.
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Canada.
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada.
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Rongo R, Michelotti A, Pedersen TK, Resnick CM, Stoustrup P. Management of temporomandibular joint arthritis in children and adolescents: An introduction for orthodontists. Orthod Craniofac Res 2023; 26 Suppl 1:151-163. [PMID: 37226648 DOI: 10.1111/ocr.12676] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 05/02/2023] [Indexed: 05/26/2023]
Abstract
Juvenile idiopathic arthritis (JIA) is the most common inflammatory rheumatic disease of childhood. JIA can affect any joint and the temporomandibular joint (TMJ) is one of the joints most frequently involved. TMJ arthritis impacts mandibular growth and development and can result in skeletal deformity (convex profile and facial asymmetry), and malocclusion. Furthermore, when TMJs are affected, patients may present with pain at joint and masticatory muscles and dysfunction with crepitus and limited jaw movement. This review aims to describe the role of orthodontists in the management of patients with JIA and TMJ involvement. This article is an overview of evidence for the diagnosis and treatment of patients with JIA and TMJ involvement. Screening for the orofacial manifestation of JIA is important for orthodontists to identify TMJ involvement and related dentofacial deformity. The treatment protocol of JIA with TMJ involvement requires an interdisciplinary collaboration including orthopaedic/orthodontic treatment and surgical interventions for the management of growth disturbances. Orthodontists are also involved in the management of orofacial signs and symptoms; behavioural therapy, physiotherapy and occlusal splints are the suggested treatments. Patients with TMJ arthritis require specific expertise from an interdisciplinary team with members knowledgeable in JIA care. Since disorders of mandibular growth often appear during childhood, the orthodontist could be the first clinician to see the patient and can play a crucial role in the diagnosis and management of JIA patients with TMJ involvement.
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Affiliation(s)
- Roberto Rongo
- Department of Neurosciences, Reproductive sciences and Oral Sciences, School of Orthodontics, University of Naples "Federico II", Naples, Italy
| | - Ambrosina Michelotti
- Department of Neurosciences, Reproductive sciences and Oral Sciences, School of Orthodontics, University of Naples "Federico II", Naples, Italy
| | - Thomas Klit Pedersen
- Department of Dentistry and Oral Health, Section of Orthodontics, Aarhus University, Aarhus, Denmark
- Department of Maxillofacial Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Cory M Resnick
- Department of Oral and Maxillofacial Surgery, Harvard School of Dental Medicine and Harvard Medical School, Boston, MA, USA
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Peter Stoustrup
- Department of Dentistry and Oral Health, Section of Orthodontics, Aarhus University, Aarhus, Denmark
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Ribeiro SCCR, Sales LP, Fernandes AL, Perez MO, Takayama L, Caparbo VF, Assad APL, Aiwaka NE, Goldenstein-Schainberg C, Borba EF, Domiciano DS, Figueiredo CP, Pereira RM. Bone erosions associated with systemic bone loss on HR-pQCT in women with longstanding polyarticular juvenile idiopathic arthritis. Semin Arthritis Rheum 2023; 63:152247. [PMID: 37595510 DOI: 10.1016/j.semarthrit.2023.152247] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 07/06/2023] [Accepted: 07/24/2023] [Indexed: 08/20/2023]
Abstract
OBJECTIVES To analyze longstanding polyarticular juvenile idiopathic arthritis (pJIA) for possible associations between localized bone damage (erosions), and systemic bone loss. Besides, to compare the systemic bone mass of pJIA with healthy controls. METHODS Thirty-four pJIA women and 99 healthy controls (HC) were included. Radius and tibia of all subjects were scanned by HR-pQCT. Volumetric bone mineral density (vBMD), bone microarchitecture, and -finite element parameters were analyzed. Patients underwent HR-pQCT of 2nd and 3rd metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints of the dominant hand, for bone erosions quantification. RESULTS The mean age of patients was 31.5 ± 7.4yrs with a mean disease duration of 21.7 ± 9.2yrs. Bone erosions were detectable in 79% of patients. The number of bone erosions was positively correlated with cortical porosity (Ct.Po) at tibia (r = 0.575, p = 0.001), and radius (r = 0.423, p = 0.018); and negatively correlated with cortical vBMD at tibia (r=-0.420, p = 0.015). In a logistic regression analysis, adjusted for anti-CCP, the presence of bone erosions was independently associated with Ct.Po at radius (p = 0.018) and cortical vBMD at tibia (p = 0.020). Moreover, cortical and trabecular vBMD, trabecular number, and μ-finite element parameters were decreased in patients compared to HC (p < 0.05). CONCLUSION Bone erosions in longstanding pJIA women were associated with decreased cortical bone parameters, and these patients showed systemic bone impairment at peripheral sites compared with healthy controls.
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Affiliation(s)
- Surian Clarisse C R Ribeiro
- Bone Metabolism Laboratory, Rheumatology Division, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Lucas P Sales
- Bone Metabolism Laboratory, Rheumatology Division, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Alan L Fernandes
- Bone Metabolism Laboratory, Rheumatology Division, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Mariana O Perez
- Bone Metabolism Laboratory, Rheumatology Division, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil; Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Liliam Takayama
- Bone Metabolism Laboratory, Rheumatology Division, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Valeria F Caparbo
- Bone Metabolism Laboratory, Rheumatology Division, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Ana Paula L Assad
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Nadia E Aiwaka
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Cláudia Goldenstein-Schainberg
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Eduardo F Borba
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Diogo S Domiciano
- Bone Metabolism Laboratory, Rheumatology Division, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil; Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Camille P Figueiredo
- Bone Metabolism Laboratory, Rheumatology Division, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil.
| | - Rosa Mr Pereira
- Bone Metabolism Laboratory, Rheumatology Division, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil; Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
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Barik S, Jain A, Chanakya PV, Raj V, Goyal T. What has changed in total hip arthroplasty in patients of juvenile idiopathic arthritis since 2000? A systematic review and pooled data analysis. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:2737-2748. [PMID: 36947313 DOI: 10.1007/s00590-023-03525-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 03/13/2023] [Indexed: 03/23/2023]
Abstract
PURPOSE The prevalence of juvenile idiopathic arthritis (JIA) is estimated to be 16-150 per 100,000 children worldwide. The hip joint may be involved in over 50% of children leading to significant morbidity which may require surgical intervention in the form of arthroplasty. The literature lacks a concise overview of the outcomes, including complication and implant survival of total hip arthroplasty (THA) in juvenile idiopathic arthritis (JIA). The aim of this study is to systematically analyze the literature and report the outcomes of THA in JIA. METHODS Search was conducted in the online databases PubMed, Embase and Cochrane database. It included all original studies which evaluated clinical and/or radiological outcomes of THA in JIA with a minimum sample size of 5 patients and published in English. The level of evidence of the included studies was graded according to the Oxford Centre for Evidence Based Medicine. The Institute of Health Economics checklist was used to assess the quality of the studies included. RESULTS The nine studies included were retrospective in nature with all being Level IV according to Oxford Centre for Evidence Based Medicine. 475 hips in 304 patients with majority of them being females (241/304, 79.2%) were included in this review. All the studies reported the outcome objectively using various scores. The proportion of revision surgeries (92/378), either femoral or acetabular, noted was 22% (95% CI 10-33%). The proportion of acetabular revisions (72/378) was 16% (95% CI 8-25%) as compared to 4% (95% CI 1-6%) for femoral revisions (20/378). There was no difference in survivorship when cemented and uncemented implants were compared. CONCLUSION JIA patients with advanced hip disease represent a unique population with need for extra-long implant longevity. THA in patients of JIA leads to improved pain relief as well as mobility but the conversion of the same outcomes to functional activity is not proportionally improved. The current trend is the use of uncemented and ceramic-on-ceramic implants. Acetabular implants require earlier revision as compared to femoral implants. Age at surgery can be delayed by early institution of methotrexate which indirectly improves implant survival. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Sitanshu Barik
- Department of Orthopedics, All India Institute of Medical Sciences, Deoghar, India.
| | - Aakash Jain
- Department of Orthopedics, All India Institute of Medical Sciences, Rishikesh, India
| | - P V Chanakya
- Department of Orthopedics, All India Institute of Medical Sciences, Rishikesh, India
| | - Vikash Raj
- Department of Orthopedics, All India Institute of Medical Sciences, Deoghar, India
| | - Tarun Goyal
- Department of Orthopedics, All India Institute of Medical Sciences, Bhatinda, India
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Grammatikopoulou MG, Gkiouras K, Syrmou V, Vassilakou T, Simopoulou T, Katsiari CG, Goulis DG, Bogdanos DP. Nutritional Aspects of Juvenile Idiopathic Arthritis: An A to Z for Dietitians. CHILDREN (BASEL, SWITZERLAND) 2023; 10:203. [PMID: 36832332 PMCID: PMC9955348 DOI: 10.3390/children10020203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 01/15/2023] [Accepted: 01/18/2023] [Indexed: 01/25/2023]
Abstract
Juvenile idiopathic arthritis (JIA) represents a chronic, autoimmune, rheumatic musculoskeletal disease with a diagnosis before 16 years of age. Chronic arthritis is a common manifestation in all JIA subtypes. The nature of JIA, in combination to its therapy often results in the development of nutrition-, gastrointestinal (GI)- or metabolic-related issues. The most-common therapy-related nutritional issues involve methotrexate (MTX) and glucocorticosteroids (GCC) adverse events. MTX is a folic acid antagonist, thus supplementation with folic acid in required for improving GI side effects and correcting low serum levels. On the other hand, long-term GCC administration is often associated with hyperglycemia, insulin resistance and growth delay. This relationship is further aggravated when more joints are affected and greater doses of GCC are being administered. Apart from stature, body mass index z-scores are also suboptimal in JIA. Other signs of malnutrition include decreased phase angle and muscle mass, especially among patients with polyarthritis JIA. Evidence also points to the existence of an inverse relationship between disease activity and overweight/obesity. Specific dietary patterns, including the anti-inflammatory diet, might confer improvements in selected JIA outcomes, but the level of available research is yet insufficient to draw safe conclusions. The majority of patients exhibit suboptimal vitamin D status; hence, supplementation is recommended. Collectively, the evidence indicates that, due to the age of onset and the complexity of the disease, along with its pharmacotherapy, children with JIA are prone to the development of several nutritional problems, warranting expert monitoring. Vitamin deficiencies, oral and GI-problems limiting dietary intake, faltering growth, overweight and obesity, physical inactivity, or impaired bone health are among the many nutritional issues in JIA requiring dietitian support.
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Affiliation(s)
- Maria G. Grammatikopoulou
- Immunonutrition Unit, Department of Rheumatology and Clinical Immunology, University General Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, GR-41110 Larissa, Greece
| | - Konstantinos Gkiouras
- Immunonutrition Unit, Department of Rheumatology and Clinical Immunology, University General Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, GR-41110 Larissa, Greece
| | - Vasiliki Syrmou
- Immunonutrition Unit, Department of Rheumatology and Clinical Immunology, University General Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, GR-41110 Larissa, Greece
| | - Tonia Vassilakou
- Department of Public Health Policy, School of Public Health, University of West Attica, 196 Alexandras Avenue, GR-11521 Athens, Greece
| | - Theodora Simopoulou
- Immunonutrition Unit, Department of Rheumatology and Clinical Immunology, University General Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, GR-41110 Larissa, Greece
| | - Chistina G. Katsiari
- Immunonutrition Unit, Department of Rheumatology and Clinical Immunology, University General Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, GR-41110 Larissa, Greece
| | - Dimitrios G. Goulis
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Faculty of Health Sciences, Papageorgiou General Hospital, Aristotle University of Thessaloniki, 76 Agiou Pavlou Str., Pavlos Melas, GR-56429 Thessaloniki, Greece
| | - Dimitrios P. Bogdanos
- Immunonutrition Unit, Department of Rheumatology and Clinical Immunology, University General Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, GR-41110 Larissa, Greece
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Fernández-Pérez JJ, Mascaraque-Ruiz P, Martín-Gómez C, Martínez-Caballero I, Otón T, Carmona L, Lerma-Lara S. Musculoskeletal and Gait Characteristics in Patients with Stickler Syndrome: A Cross-Sectional Study. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9121895. [PMID: 36553338 PMCID: PMC9777477 DOI: 10.3390/children9121895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 11/24/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Stickler syndrome (SS) is a connective tissue disorder of fibrillary collagen with very variable clinical manifestations, including premature osteoarthritis and osteopenia. This musculoskeletal alteration may affect gait maturity or produce strength difficulties. OBJECTIVE Our aim was to describe the musculoskeletal characteristics, bone stiffness, gait kinematics, and kinetics of SS patients. METHODS This is a cross-sectional study of children and youngsters with SS recruited by telephone calls through the Spanish SS Association. All participants underwent an analysis of musculoskeletal characteristics, including a 3D gait analysis. RESULTS The sample included 26 SS patients, mainly boys (65.4%) with a median age of 11 (IQR 5-14). The manual muscle testing was normal in 88.5% of patients. The median distance covered in the 6-min walking test was 560.1 ± 113.4 m. Bone stiffness index scores were 70.9 ± 19.7 for children under 10 years and 88.3 ± 17.5 for children older than 10 years. The gait indicators GPS and GDI were: 7.4 ± 1.9 and 95.3 ± 9.7, respectively, for the left side and 6.8 ± 2.0 and 97.7 ± 9.5 for the right side, respectively. CONCLUSIONS In our series of patients with SS, we found muscle-articular involvement does not have a high impact on strength or gait problems. More work is needed to understand the effect of SS on the musculoskeletal system.
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Affiliation(s)
- Juan José Fernández-Pérez
- Toledo Physiotherapy Research Group (GIFTO), Faculty of Physiotherapy and Nursing, Castilla la Mancha University, 45004 Toledo, Spain
| | | | - Carlos Martín-Gómez
- Facultad de Ciencias de la Salud, CSEU La Salle, UAM, 28023 Madrid, Spain
- Fundación Hospital Universitario Niño Jesús, 28009 Madrid, Spain
| | | | - Teresa Otón
- Instituto de Salud Musculoesquelética, 28045 Madrid, Spain
| | - Loreto Carmona
- Instituto de Salud Musculoesquelética, 28045 Madrid, Spain
| | - Sergio Lerma-Lara
- Facultad de Ciencias de la Salud, CSEU La Salle, UAM, 28023 Madrid, Spain
- Correspondence:
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Kindler JM, Guo M, Baker J, McCormack S, Armenian SH, Zemel BS, Leonard MB, Mostoufi-Moab S. Persistent Musculoskeletal Deficits in Pediatric, Adolescent and Young Adult Survivors of Allogeneic Hematopoietic Stem-Cell Transplantation. J Bone Miner Res 2022; 37:794-803. [PMID: 35080067 DOI: 10.1002/jbmr.4513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 01/17/2022] [Accepted: 01/19/2022] [Indexed: 11/08/2022]
Abstract
Allogeneic hematopoietic stem cell transplantation (alloHSCT) is a common therapy for pediatric hematologic malignancies. With improved supportive care, addressing treatment-related late effects is at the forefront of survivor long-term health and quality of life. We previously demonstrated that alloHSCT survivors had increased adiposity, decreased lean mass, and lower bone density and strength, 7 years (median) from alloHSCT compared to their healthy peers. Yet it is unknown whether these deficits persist. Our longitudinal study characterized changes in muscle and bone over a period of 3.4 (range, 2.0 to 4.9) years in 47 childhood alloHSCT survivors, age 5-26 years at baseline (34% female). Tibia cortical bone geometry and volumetric density and lower leg muscle cross-sectional area (MCSA) were assessed via peripheral quantitative computed tomography (pQCT). Anthropometric and pQCT measurements were converted to age, sex, and ancestry-specific standard deviation scores, adjusted for leg length. Muscle-specific force was assessed as strength relative to MCSA adjusted for leg length (strength Z-score). Measurements were compared to a healthy reference cohort (n = 921), age 5-30 years (52% female). At baseline and follow-up, alloHSCT survivors demonstrated lower height Z-scores, weight Z-scores, and leg length Z-scores compared to the healthy reference cohort. Deficits in MCSA, trabecular volumetric bone density, and cortical bone size and estimated strength (section modulus) were evident in survivors (all p < 0.05). Between the two study time points, anthropometric, muscle, and bone Z-scores did not change significantly in alloHSCT survivors. Approximately 15% and 17% of alloHSCT survivors had MCSA and section modulus Z-score < -2.0, at baseline and follow-up, respectively. Furthermore, those with a history of total body irradiation compared to those without demonstrated lower MCSA at follow-up. The persistent muscle and bone deficits in pediatric alloHSCT survivors support the need for strategies to improve bone and muscle health in this at-risk population. © 2022 American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Joseph M Kindler
- Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Michelle Guo
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Joshua Baker
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA.,Division of Rheumatology, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Shana McCormack
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.,Division of Endocrinology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Saro H Armenian
- Department of Pediatrics, City of Hope, Duarte, CA, USA.,Department of Population Sciences, City of Hope, Duarte, CA, USA
| | - Babette S Zemel
- Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Mary B Leonard
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Sogol Mostoufi-Moab
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.,Division of Endocrinology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
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8
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Lee JD, Becker JI, Larkin LM, Almarza AJ, Kapila SD. Morphologic and histologic characterization of sheep and porcine TMJ as large animal models for tissue engineering applications. Clin Oral Investig 2022; 26:5019-5027. [PMID: 35359187 PMCID: PMC9276584 DOI: 10.1007/s00784-022-04472-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 03/21/2022] [Indexed: 11/26/2022]
Abstract
Objective The aim of this study was to compare and characterize the structural and ultrastructural organization of the temporomandibular joint (TMJ) between two large animal models for use in the development of tissue engineering strategies. Materials and methods Whole TMJs from sheep and pigs were evaluated with micro-computed tomography (μCT) for morphology and quantitative analyses of bone parameters. Histological examination was performed on the TMJ disc and its attachments to investigate regional distribution of collagen, elastin, and glycosaminoglycans (GAGs). Results μCT analyses demonstrate higher bone mineral density (BMD) in the temporal fossa compared to the mandibular condyle in both species, with this variable being significantly higher in sheep than pig. Quantitative morphometry of the trabecular condyle reveals no statistical differences between the species. Histology demonstrates similar structural organization of collagen and elastin between species. Elastin staining was nearly twofold greater in sheep than in the pig disc. Finally, Safranin-O staining for GAGs in the TMJ disc was localized to the intermediate zone in the sheep but was absent from the porcine disc. Conclusions Our findings show some important differences in the pig and sheep TMJ μCT variables and histology and composition of the disc and discal attachment. These disparities likely reflect differences in masticatory and TMJ functional loading patterns between the two species and provide insights into large animal models towards human applications. Clinical relevance As with the established pig model, the sheep is a suitable large animal model for TMJ research such as regenerative strategies, with specific considerations for design parameters appropriate for human-analog applications.
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Affiliation(s)
- Jonah D Lee
- Department of Molecular & Integrative Physiology, University of Michigan School of Medicine, Ann Arbor, MI, 48109, USA
- Animal Care and Use Office, Office of Research, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Josh I Becker
- Department of Molecular & Integrative Physiology, University of Michigan School of Medicine, Ann Arbor, MI, 48109, USA
| | - Lisa M Larkin
- Department of Molecular & Integrative Physiology, University of Michigan School of Medicine, Ann Arbor, MI, 48109, USA
| | - Alejandro J Almarza
- Department of Oral and Craniofacial Sciences, School of Dental Medicine, University of Pittsburgh, Pittsburgh, PA, 15261, USA
- Center of Craniofacial Regeneration, University of Pittsburgh, Pittsburgh, PA, 15261, USA
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, 15261, USA
| | - Sunil D Kapila
- Section of Orthodontics, School of Dentistry, University of California Los Angeles School of Dentistry, 10833 Le Conte Avenue, CHS 33-089, Box 951668, Los Angeles, CA, 90095, USA.
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Prevalence and characteristics of systemic conditions in patients undergoing orthognathic surgery: a retrospective study. Int J Oral Maxillofac Surg 2022; 51:1205-1210. [DOI: 10.1016/j.ijom.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 11/21/2021] [Accepted: 02/04/2022] [Indexed: 11/20/2022]
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Abstract
The foundation of bone health is established in utero. Bone accrual starts from the developing fetus and continues throughout childhood and adolescence. This process is crucial to achieve peak bone mass. Understanding factors that influence bone accrual before attainment of peak bone mass is thus critical to improve bone health and prevent osteoporosis, thereby reducing the burden of osteoporotic fractures in older women. In this review, we broadly outline factors influencing peak bone mass from pregnancy to infancy, childhood and adolescence with potential diseases and medications that may affect the optimum trajectory to maximizing bone health. It is estimated that a 10% increase in peak bone mass will delay the onset of osteoporosis by 13 years in a woman.
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Affiliation(s)
- R F Vasanwala
- KK Women's and Children's Hospital, Singapore, Singapore
| | - L Gani
- Changi General Hospital, Singapore, Singapore
| | - S B Ang
- KK Women's and Children's Hospital, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore.,Lee Kong Chian School of Medicine, Singapore, Singapore
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11
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Ward LM, Ma J, Robinson ME, Scharke M, Ho J, Houghton K, Huber A, Scuccimarri R, Barsalou J, Roth J, Shenouda N, Matzinger MA, Lentle B, Jaremko JL, Koujok K, Watanabe Duffy K, Stein R, Sbrocchi AM, Rodd C, Miettunen PM, LeBlanc CMA, Larche M, Jurencak R, Cummings EA, Couch R, Cabral DA, Atkinson S, Alos N, Sykes E, Konji VN, Rauch F, Siminoski K, Lang B. Osteoporotic Fractures and Vertebral Body Reshaping in Children With Glucocorticoid-treated Rheumatic Disorders. J Clin Endocrinol Metab 2021; 106:e5195-e5207. [PMID: 34232311 DOI: 10.1210/clinem/dgab494] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT Osteoporotic fractures are an important cause of morbidity in children with glucocorticoid-treated rheumatic disorders. OBJECTIVE This work aims to evaluate the incidence and predictors of osteoporotic fractures and potential for recovery over six years following glucocorticoid (GC) initiation in children with rheumatic disorders. METHODS Children with GC-treated rheumatic disorders were evaluated through a prospective inception cohort study led by the Canadian STeroid-induced Osteoporosis in the Pediatric Population (STOPP) Consortium. Clinical outcomes included lumbar spine bone mineral density (LS BMD), vertebral fractures (VF), non-VF, and vertebral body reshaping. RESULTS A total of 136 children with GC-treated rheumatic disorders were enrolled (mean age 9.9 years, SD 4.4). The 6-year cumulative fracture incidence was 16.3% for VF, and 10.1% for non-VF. GC exposure was highest in the first 6 months, and 24 of 38 VF (63%) occurred in the first 2 years. Following VF, 16 of 19 children (84%) had complete vertebral body reshaping. Increases in disease activity and body mass index z scores in the first year and declines in LS BMD z scores in the first 6 months predicted incident VF over the 6 years, while higher average daily GC doses predicted both incident VF and non-VF. LS BMD z scores were lowest at 6 months (mean -0.9, SD 1.2) and remained low by 6 years even when adjusted for height z scores (-0.6, SD 0.9). CONCLUSION VF occurred early and were more common than non-VF in children with GC-treated rheumatic disorders. Eighty-four percent of children with VF underwent complete vertebral body reshaping, whereas vertebral deformity persisted in the remainder of children. On average, LS BMD z scores remained low at 6 years, consistent with incomplete recovery.
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Affiliation(s)
- Leanne M Ward
- University of Ottawa, Ottawa, Ontario K1H 8L1, Canada
| | - Jinhui Ma
- McMaster University, Hamilton, Ontario L8S 4L8, Canada
| | | | - Maya Scharke
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario K1H 8L1, Canada
| | - Josephine Ho
- University of Calgary, Calgary T3B 6A8, Alberta, Canada
| | - Kristin Houghton
- University of British Columbia, Vancouver V6T 1Z4, British Columbia, Canada
| | - Adam Huber
- Dalhousie University, Halifax B3K 6R8, Nova Scotia, Canada
| | | | - Julie Barsalou
- Université de Montréal, Montréal H3T 1C5, Quebec, Canada
| | - Johannes Roth
- University of Ottawa, Ottawa, Ontario K1H 8L1, Canada
| | | | | | - Brian Lentle
- University of British Columbia, Vancouver V6T 1Z4, British Columbia, Canada
| | | | | | | | - Robert Stein
- University of Western Ontario, London N6A 5A5, Ontario, Canada
| | | | - Celia Rodd
- University of Manitoba, Winnipeg R3E 0Z3, Manitoba, Canada
| | | | | | - Maggie Larche
- McMaster University, Hamilton, Ontario L8S 4L8, Canada
| | | | | | - Robert Couch
- University of Alberta, Edmonton, Alberta T6G 2R3, Canada
| | - David A Cabral
- University of British Columbia, Vancouver V6T 1Z4, British Columbia, Canada
| | | | - Nathalie Alos
- Université de Montréal, Montréal H3T 1C5, Quebec, Canada
| | - Elizabeth Sykes
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario K1H 8L1, Canada
| | - Victor N Konji
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario K1H 8L1, Canada
| | - Frank Rauch
- McGill University, Montréal H4A 3J1, Quebec, Canada
| | | | - Bianca Lang
- Dalhousie University, Halifax B3K 6R8, Nova Scotia, Canada
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12
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Avitabile CM, Saavedra S, Sivakumar N, Goldmuntz E, Paridon SM, Zemel BS. Marked skeletal muscle deficits are associated with 6-minute walk distance in paediatric pulmonary hypertension. Cardiol Young 2021; 31:1426-1433. [PMID: 33568240 DOI: 10.1017/s1047951121000342] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Poor growth is common in children with pulmonary hypertension; however, skeletal muscle deficits have not been described and the association between muscle deficits and functional status is unknown. METHODS Patients aged 8-18 years with pulmonary hypertension (diagnostic Groups 1, 2, or 3) and World Health Organization functional class I or II underwent dual-energy absorptiometry to measure leg lean mass Z-score (a surrogate for skeletal muscle). Muscle strength was assessed using dynamometry. Physical activity questionnaires were administered. Clinical data, including 6-minute walk distance, were reviewed. Relationships between skeletal muscle, physical activity score, and 6-minute walk distance were assessed by correlations and linear regression. RESULTS Sixteen patients (12.1 ± 3.2 years, 50% female, 56% Group 1, 56% functional class II) were enrolled. Leg lean mass Z-score was significantly less than reference data (-1.40 ± 1.12 versus 0.0 ± 0.9, p < 0.001) and worse in those with functional class II versus I (-2.10 ± 0.83 versus -0.50 ± 0.73, p < 0.01). Leg lean mass Z-score was positively associated with right ventricular systolic function by tricuspid annular plane systolic Z-score (r = 0.54, p = 0.03) and negatively associated with indexed pulmonary vascular resistance (r = -0.78, p < 0.001). Leg lean mass Z-score and forearm strength were positively associated with physical activity score. When physical activity score was held constant, leg lean mass Z-score independently predicted 6-minute walk distance (R2 = 0.39, p = 0.03). CONCLUSIONS Youth with pulmonary hypertension demonstrate marked skeletal muscle deficits in association with exercise intolerance. Future studies should investigate whether low leg lean mass is a marker of disease severity or an independent target that can be improved.
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Affiliation(s)
- Catherine M Avitabile
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Sofia Saavedra
- Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Nithya Sivakumar
- Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Elizabeth Goldmuntz
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Stephen M Paridon
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Babette S Zemel
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Division of Gastroenterology, Hepatology, and Nutrition, Children's Hospital of Philadelphia, Philadelphia, PA, USA
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13
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Polizzi A, Quinzi V, Santonocito S, Palazzo G, Marzo G, Isola G. Analysis of Earlier Temporomandibular Joint Disorders in JIA Patients: A Clinical Report. Healthcare (Basel) 2021; 9:healthcare9091140. [PMID: 34574914 PMCID: PMC8466676 DOI: 10.3390/healthcare9091140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 08/28/2021] [Accepted: 08/30/2021] [Indexed: 02/07/2023] Open
Abstract
The aim of this study was to analyse the structural characteristics of the temporo-mandibular joint (TMJ) and the dysfunctional consequences induced by disease in subjects with juvenile idiopathic arthritis (JIA). The study was conducted in 25 patients with JIA (median age (IQR), 13.9 (10.9-15.3)) and 26 healthy controls (median age (IQR), 14.3 (11.6-17.2)) years. All enrolled patients were subjected to anamnestic evaluation, laboratory parameters, JIA subclass, and type of therapy for the disease. A clinical-gnathological evaluation, anamnestic and dysfunctional index (Ai and Di), and magnetic resonance imaging of TMJs were performed in all patients. The test group showed a significant reduction (p < 0.001) regarding the clinical findings such as maximal mouth opening, left and rightward laterotrusion and protrusion, and a significant difference in the reported symptoms (TMJ sounds, reduced mouth opening and pain), and Ai and Di (p < 0.001) compared to healthy patients. Correlation analysis showed a significant correlation between the median duration of disease and the maximum mouth opening and between visual analogue scale (VAS) score and maximum mouth opening, leftward laterotrusion, rightward laterotrusion, and protrusion. The results obtained in this study suggest that patients with JIA presented a cohort of symptoms in TMJs in comparison with healthy controls. Moreover, a careful TMJs evaluation and an early diagnosis of TMJs dysfunction and regular follow-ups are recommended in order to prevent and reduce functional and chewing problems in patients with JIA.
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Affiliation(s)
- Alessandro Polizzi
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, Via S. Sofia 78, 95124 Catania, Italy; (A.P.); (S.S.); (G.P.)
- Department of Life Health and Environmental Sciences, University of L’Aquila, 61700 L’Aquila, Italy; (V.Q.); (G.M.)
| | - Vincenzo Quinzi
- Department of Life Health and Environmental Sciences, University of L’Aquila, 61700 L’Aquila, Italy; (V.Q.); (G.M.)
| | - Simona Santonocito
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, Via S. Sofia 78, 95124 Catania, Italy; (A.P.); (S.S.); (G.P.)
| | - Giuseppe Palazzo
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, Via S. Sofia 78, 95124 Catania, Italy; (A.P.); (S.S.); (G.P.)
| | - Giuseppe Marzo
- Department of Life Health and Environmental Sciences, University of L’Aquila, 61700 L’Aquila, Italy; (V.Q.); (G.M.)
| | - Gaetano Isola
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, Via S. Sofia 78, 95124 Catania, Italy; (A.P.); (S.S.); (G.P.)
- Correspondence: ; Tel.: +39-095-7435-359
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14
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Sakka SD, Cheung MS. Management of primary and secondary osteoporosis in children. Ther Adv Musculoskelet Dis 2020; 12:1759720X20969262. [PMID: 33224280 PMCID: PMC7649886 DOI: 10.1177/1759720x20969262] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 10/05/2020] [Indexed: 12/13/2022] Open
Abstract
Osteoporosis in children differs from adults in terms of definition, diagnosis, monitoring and treatment options. Primary osteoporosis comprises primarily of osteogenesis imperfecta (OI), but there are significant other causes of bone fragility in children that require treatment. Secondary osteoporosis can be a result of muscle disuse, iatrogenic causes, such as steroids, chronic inflammation, delayed or arrested puberty and thalassaemia major. Investigations involve bone biochemistry, dual-energy X-ray absorptiometry scan for bone densitometry and vertebral fracture assessment, radiographic assessment of the spine and, in some cases, quantitative computed tomography (QCT) or peripheral QCT. It is important that bone mineral density (BMD) results are adjusted based on age, gender and height, in order to reflect size corrections in children. Genetics are being used increasingly for the diagnosis and classification of various cases of primary osteoporosis. Bone turnover markers are used less frequently in children, but can be helpful in monitoring treatment and transiliac bone biopsy can assist in the diagnosis of atypical cases of osteoporosis. The management of children with osteoporosis requires a multidisciplinary team of health professionals with expertise in paediatric bone disease. The prevention and treatment of fragility fractures and improvement of the quality of life of patients are important aims of a specialised service. The drugs used most commonly in children are bisphosphonates, that, with timely treatment, can give good results in improving BMD and reshaping vertebral fractures. The data regarding their effect on reducing long bone fractures are equivocal. Denosumab is being used increasingly for various conditions with mixed results. There are more drugs trialled in adults, but these are not yet licenced for children. Increasing awareness of risk factors for paediatric osteoporosis, screening and referral to a specialist team for appropriate management can lead to early detection and treatment of asymptomatic fractures and prevention of further bone damage.
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Affiliation(s)
- Sophia D Sakka
- Department of Endocrinology and Diabetes, Evelina London Children's Hospital, 3rd Floor, Becket House, Westminster Bridge Road, SE1 7EH, London, UK
| | - Moira S Cheung
- Department of Endocrinology and Diabetes, Evelina London Children's Hospital, London, UK
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15
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Valentino R, Rongo R, Alessio M, Alstergren P, Bucci R, Leone G, D’Antò V, Michelotti A. “Pressure pain threshold over masticatory muscles and temporomandibular joint in patients with juvenile idiopathic arthritis”. J Oral Rehabil 2020; 47:944-950. [DOI: 10.1111/joor.13024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 05/05/2020] [Accepted: 05/16/2020] [Indexed: 12/22/2022]
Affiliation(s)
- Roberta Valentino
- School of Orthodontics Department of Neurosciences, Reproductive Sciences and Oral Sciences University of Naples Federico II Naples Italy
| | - Roberto Rongo
- School of Orthodontics Department of Neurosciences, Reproductive Sciences and Oral Sciences University of Naples Federico II Naples Italy
| | - Maria Alessio
- Department of Translational Medicine University Naples Federico II Naples Italy
| | - Per Alstergren
- Orofacial Pain and Jaw Function Institute of Dental Medicine Karolinska Institutet Huddinge Sweden
- Orofacial Pain Unit Faculty of Odontology Malmö University Malmö Sweden
| | - Rosaria Bucci
- School of Orthodontics Department of Neurosciences, Reproductive Sciences and Oral Sciences University of Naples Federico II Naples Italy
| | - Giovanna Leone
- School of Orthodontics Department of Neurosciences, Reproductive Sciences and Oral Sciences University of Naples Federico II Naples Italy
| | - Vincenzo D’Antò
- School of Orthodontics Department of Neurosciences, Reproductive Sciences and Oral Sciences University of Naples Federico II Naples Italy
| | - Ambrosina Michelotti
- School of Orthodontics Department of Neurosciences, Reproductive Sciences and Oral Sciences University of Naples Federico II Naples Italy
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16
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Kuntze G, Nesbitt C, Nettel‐Aguirre A, Esau S, Scholz R, Brooks J, Twilt M, Toomey C, Mosher D, Ronsky JL, Benseler S, Emery CA. Gait Adaptations in Youth With Juvenile Idiopathic Arthritis. Arthritis Care Res (Hoboken) 2020; 72:917-924. [DOI: 10.1002/acr.23919] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 04/30/2019] [Indexed: 01/17/2023]
Affiliation(s)
| | | | | | - Shane Esau
- University of Calgary Calgary Alberta Canada
| | | | - Julia Brooks
- Alberta Children’s Hospital Calgary Alberta Canada
| | - Marinka Twilt
- University of Calgary and Alberta Children’s Hospital Calgary Alberta
| | | | | | | | - Susanne Benseler
- University of Calgary and Alberta Children’s Hospital Calgary Alberta
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17
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Kuntze G, Nettel-Aguirre A, Brooks J, Esau S, Nesbitt C, Mosher D, Twilt M, Benseler S, Ronsky JL, Emery CA. Consequences of Juvenile Idiopathic Arthritis on Single Leg Squat Performance in Youth. Arthritis Care Res (Hoboken) 2020; 73:1187-1193. [PMID: 32407563 DOI: 10.1002/acr.24254] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 05/05/2020] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Juvenile idiopathic arthritis (JIA) affects body structure and function outcomes that may increase the risk of acute joint injury. The purpose of this study was to examine single leg squat (SLS) biomechanics for youth with JIA and their healthy peers. The study design was a matched pair cohort study. METHODS Sixty-five youth (JIA n = 30; control n = 35) participated in this ethics-approved study. Participants performed 3 sets of 5 consecutive SLS tasks. Disease activity and functional status were assessed using the Juvenile Arthritis Disease Activity Score and Child Health Assessment Questionnaire. Indexed (most-affected leg [JIA]; dominant leg [control]) and contralateral extremity biomechanics were obtained using a 12-camera system. Outcomes included hip flexion/extension (FE), adduction/abduction (AA), and internal/external (IE) rotation range of motion (ROM). Data were analyzed using a multivariate random coefficient model in R (α⍺ = 0.05). RESULTS A total of 29 matched pairs were analyzed. Youth with JIA had low disease activity and performed the SLS with a more internally rotated hip (indexed leg P = 0.023, β = -1.9°). Female participants displayed greater hip FE (indexed leg P = 0.015, β = -4.3°; contralateral leg P = 0.005, β = -4.8°) and IE ROM (indexed leg P = 0.021, β = -2.1°) than male participants. Associations were observed for body mass index and hip IE ROM (contralateral leg P = 0.001, β = -0.4°), knee flexion angle, and hip FE ROM (indexed leg P = 0.001, β = 0.4°; contralateral leg P = 0.001, β = 0.5°) and AA (indexed leg P = 0.010, β = 0.1°; contralateral leg P = 0.002, β = 0.2°). CONCLUSION This study identified functional alterations for an SLS in youth with JIA. These findings support the use of physical therapy as part of a multidisciplinary management approach, to restore normal hip posture and movement.
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Affiliation(s)
| | | | - Julia Brooks
- Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Shane Esau
- University of Calgary, Calgary, Alberta, Canada
| | | | - Dianne Mosher
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Marinka Twilt
- Cumming School of Medicine, University of Calgary, and Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Susanne Benseler
- Cumming School of Medicine, University of Calgary, and Alberta Children's Hospital, Calgary, Alberta, Canada
| | | | - Carolyn A Emery
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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18
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Kuntze G, Nettel-Aguirre A, Brooks J, Esau S, Nesbitt C, Mosher D, Twilt M, Benseler S, Ronsky JL, Emery CA. Vertical Drop Jump Performance in Youth With Juvenile Idiopathic Arthritis. Arthritis Care Res (Hoboken) 2020; 73:955-963. [PMID: 32293101 DOI: 10.1002/acr.24219] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Accepted: 04/07/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Juvenile idiopathic arthritis (JIA) is associated with altered body structure and function outcomes that may expose youth with JIA to a greater risk of secondary joint injury. This study aimed to examine differences in vertical drop jump (VDJ) biomechanics for youth with JIA and healthy youth (control group). METHODS The present study was a matched pair cohort study. Youth with JIA (n = 30) and their age- and sex-matched control peers participated in this ethics-approved study. Lower-extremity biomechanics information was obtained using a motion analysis system (Motion Analysis) and 2 force plates (AMTI). Biomechanics outcomes included hip, knee, and ankle joint angles, ground reaction forces (GRF), and VDJ phase durations. Other outcomes included disease activity, physical disability, and sports participation. Matched pairs data (JIA-control) were analyzed using a multivariate random coefficient model (version 3.5.0, R Core Team; joint angles, potential confounders) and paired samples t-tests with Bonferroni correction (α = 0.0125; GRF, VDJ phase durations). RESULTS Youth with JIA had low disease activity, pain, and disability scores. Youth with JIA maintained a more erect posture at the hip (β = -4.0°, P = 0.004), knee (β = 7.5°, P = 0.004) and ankle (β = -2.6°, P = 0.001). GRF and phase durations outcomes did not meet criteria for significant differences. Knee extension increased with participant age (β = -1.0°, P = 0.002), while female participants displayed greater hip flexion (β = -6.6°, P = 0.001) and less ankle dorsiflexion (β = 2.3°, P = 0.006). CONCLUSION This study provides evidence for a stiff knee landing strategy by youth with JIA. These findings inform targets for physical therapy management to mitigate the risks of a secondary joint injury in sports participation.
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Affiliation(s)
| | | | - Julia Brooks
- Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Shane Esau
- University of Calgary, Calgary, Alberta, Canada
| | | | - Dianne Mosher
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Marinka Twilt
- Cumming School of Medicine, University of Calgary, and Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Susanne Benseler
- Cumming School of Medicine, University of Calgary, and Alberta Children's Hospital, Calgary, Alberta, Canada
| | | | - Carolyn A Emery
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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19
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Risum K, Edvardsen E, Godang K, Selvaag AM, Hansen BH, Molberg Ø, Bollerslev J, Holm I, Dagfinrud H, Sanner H. Physical Fitness in Patients With Oligoarticular and Polyarticular Juvenile Idiopathic Arthritis Diagnosed in the Era of Biologics: A Controlled Cross-Sectional Study. Arthritis Care Res (Hoboken) 2020; 71:1611-1620. [PMID: 30474929 DOI: 10.1002/acr.23818] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 11/20/2018] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To perform a comprehensive evaluation of and identify correlates for physical fitness in consecutive patients with juvenile idiopathic arthritis (JIA) who have been diagnosed in the era of biologics and to compare the results with those obtained in healthy controls. METHODS The study cohort included 60 patients with JIA (50 girls) ages 10-16 years and 60 age- and sex-matched controls. The JIA group included 30 patients with persistent oligoarticular JIA and 30 patients with extended oligoarticular or polyarticular disease. Measures of physical fitness included cardiorespiratory fitness (CRF) by peak oxygen uptake (Vo2peak ) during a continuous graded treadmill exercise test, muscle strength by isokinetic and isometric knee and hand grip evaluations, and bone mineral density (BMD) and body composition by dual-energy x-ray absorptiometry. Physical activity was assessed by accelerometry. RESULTS Forty-two percent of the patients were being treated with biologic drugs. Patients with JIA demonstrated lower muscle strength and total body BMD compared to controls, but there were no differences in CRF and body composition. Physical fitness was comparable between the persistent oligoarticular and extended oligoarticular/polyarticular-JIA groups. In patients with JIA, we identified associations between higher vigorous physical activity and higher CRF and muscle strength, but did not find any association between physical fitness and disease variables. CONCLUSION In this cohort of patients with JIA, we found suboptimal muscle strength and BMD compared to controls, but no differences in CRF and body composition. Vigorous physical activities appeared important for optimizing muscle strength and CRF in patients with JIA; the importance of such activities should be highlighted in patient education.
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Affiliation(s)
- Kristine Risum
- Oslo University Hospital, Rikshospitalet and University of Oslo, Oslo, Norway
| | - Elisabeth Edvardsen
- Oslo University Hospital, Ullevål and Norwegian School of Sports Sciences, Oslo, Norway
| | | | | | | | - Øyvind Molberg
- Oslo University Hospital, Rikshospitalet and University of Oslo, Oslo, Norway
| | - Jens Bollerslev
- Oslo University Hospital, Rikshospitalet and University of Oslo, Oslo, Norway
| | - Inger Holm
- Oslo University Hospital, Rikshospitalet and University of Oslo, Oslo, Norway
| | | | - Helga Sanner
- Oslo University Hospital, Rikshospitalet and Bjørknes University College, Oslo, Norway
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20
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Hayworth JL, Turk MA, Nevskaya T, Pope JE. The frequency of uveitis in patients with juvenile inflammatory rheumatic diseases. Joint Bone Spine 2019; 86:685-690. [DOI: 10.1016/j.jbspin.2019.06.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Accepted: 06/05/2019] [Indexed: 12/14/2022]
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21
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Shaw N, Crabtree N. Bone density in children: what are we measuring? Arch Dis Child 2019; 104:1108-1111. [PMID: 31023705 DOI: 10.1136/archdischild-2019-316940] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 03/12/2019] [Accepted: 03/22/2019] [Indexed: 11/04/2022]
Abstract
The measurement of bone density is a frequent request in the assessment of children with concerns about bone health due to chronic disease or recurrent fractures. Dual energy X-ray absorptiometry (DXA) remains the recommended modality and is widely available. However, the interpretation and reporting of results in growing individuals needs to be undertaken by individuals who are familiar with scanning children and the potential pitfalls.
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Affiliation(s)
- Nick Shaw
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK.,Department of Endocrinology & Diabetes, Birmingham Children's Hospital, Birmingham, West Midlands, UK
| | - Nicola Crabtree
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK.,Department of Endocrinology & Diabetes, Birmingham Children's Hospital, Birmingham, West Midlands, UK
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22
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Pellegrino F, Zatelli MC, Bondanelli M, Carnevale A, Cittanti C, Fortini M, Gamberini MR, Giganti M, Ambrosio MR. Dual-energy X-ray absorptiometry pitfalls in Thalassemia Major. Endocrine 2019; 65:469-482. [PMID: 31300960 DOI: 10.1007/s12020-019-02003-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 07/01/2019] [Indexed: 01/19/2023]
Abstract
BACKGROUND Low mineral mass and reduced bone strength with increased fracture risk are the main causes of morbidity in Thalassemia Major (TM). The pathogenesis is multifactorial and includes ineffective erythropoiesis with medullary expansion, multiple endocrine dysfunctions, direct iron bone deposition, deferoxamine-induced bone dysplasia, and reduced physical activity associated with disease complications. Dual-energy X-ray absorptiometry (DXA) is the "gold standard" for bone mineral density (BMD) assessment and for bone strength and quality evaluation. This method identifies patients at greater risk of fragility fractures, guiding treatment and monitoring response to therapy. In TM, DXA shows limitations concerning BMD calculation accuracy and fracture risk prediction. One of the main challenges in the assessment of bone health in patients with TM is the accurate interpretation of densitometric results. PURPOSE This review investigates the major pitfalls in DXA implementation and interpretation in TM. METHODS Available literature has been assessed. CONCLUSIONS DXA shows limitations in assessing bone mineral "status" in TM, especially in the paediatric population, due to the peculiar characteristics of bone architecture and deformities associated with the disease. A radiological technique adjustment in this population is mandatory.
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Affiliation(s)
- Fabio Pellegrino
- Department of Morphology, Surgery and Experimental Medicine, Section of Radiology, University of Ferrara, Ferrara, Italy
| | - Maria Chiara Zatelli
- Department of Medical Sciences, Section of Endocrinology and Internal Medicine, University of Ferrara, Ferrara, Italy
| | - Marta Bondanelli
- Department of Medical Sciences, Section of Endocrinology and Internal Medicine, University of Ferrara, Ferrara, Italy
| | - Aldo Carnevale
- Department of Morphology, Surgery and Experimental Medicine, Section of Radiology, University of Ferrara, Ferrara, Italy
| | - Corrado Cittanti
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - Monica Fortini
- Unit of Thalassaemia and Haemoglobinopathies Day Hospital, Regional HUB Centre, Department of Medicine, Azienda Ospedaliero Universitaria S. Anna, Cona - Ferrara, Italy
| | - Maria Rita Gamberini
- Unit of Thalassaemia and Haemoglobinopathies Day Hospital, Regional HUB Centre, Department of Medicine, Azienda Ospedaliero Universitaria S. Anna, Cona - Ferrara, Italy
| | - Melchiore Giganti
- Department of Morphology, Surgery and Experimental Medicine, Section of Radiology, University of Ferrara, Ferrara, Italy
| | - Maria Rosaria Ambrosio
- Department of Medical Sciences, Section of Endocrinology and Internal Medicine, University of Ferrara, Ferrara, Italy.
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Aeberli D, Fankhauser N, Zebaze R, Bonel H, Möller B, Villiger PM. Effect of rheumatoid arthritis and age on metacarpal bone shaft geometry and density: A longitudinal pQCT study in postmenopausal women. Semin Arthritis Rheum 2019; 50:220-227. [PMID: 31466837 DOI: 10.1016/j.semarthrit.2019.08.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 06/27/2019] [Accepted: 08/05/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE This study aimed to elucidate the effects of changes in the geometry and density of the metacarpal bone of patients with rheumatoid arthritis (RA). METHODS This prospective study included consecutive postmenopausal RA patients who met the American College of Rheumatology Criteria and healthy controls (HC). Peripheral quantitative computed tomography scans at 50% of the total metacarpal shaft (third metacarpal bone) were obtained at baseline and follow-ups. Use of bisphosphonates (BP), glucocorticoids (GC), biologics, and disease-modifying anti-rheumatic drugs (DMARD) was monitored (baseline to follow-up). Total cross-sectional area (CSA), cortical-transitional zone and compact zone CSA, cortical volumetric bone mineral density, and compact cortex porosity were measured. A linear mixed-effects model was used to determine significant differences in the rate of change in the RA and control groups and in RA patient subgroups. RESULTS Thirty-nine RA patients and 42 consecutive postmenopausal HC were followed for 63 months. RA and HC depicted a time-dependent increase of medullary CSA (+0.41 mm2/year, P < 0.0001), while total CSA remained stable (P = 0.2). RA status was associated with a loss of cortical bone mineral density (interaction: -3.08 mg/mm3; P = 0.014). In RA subgroup analysis, GC use ≥5 mg/day was positively correlated with a fourfold increase of medullary CSA (0.67 mm2/year P = 0.009), which resulted in a three- to fourfold loss of cortical density (-6.6 mg/mm3/year; P = 0.002) and cortical CSA (-0.57 mm2/year, P = 0.004). Patients with high disease activity and high GC dose at baseline demonstrated an increase in the total CSA (0.29 mm2/y; P = 0.049) and a loss of cortical BMD (-5.73 mg/mm3/y; P = 0.05) despite good clinical response. CONCLUSION Increase in medullary metacarpal CSA and thinning of the cortical CSA are physiological and time dependent. RA status is associated with loss in cortical density. Even upon biological therapy, low glucocorticoid dose affects metacarpal bone shaft geometry and density over time.
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Affiliation(s)
- D Aeberli
- Department of Rheumatology, Immunology and Allergology, University Hospital and University of Bern, 3010 Bern Switzerland.
| | - N Fankhauser
- Clinical Trial Unit (CTU), University of Bern, 3012 Bern, Switzerland
| | - R Zebaze
- Department of Endocrinology, Austin Health, University of Melbourne, Melbourne, Australia; Department of Medicine, School of Clinical Sciences, Monash Health, Monash University, Melbourne, Australia
| | - H Bonel
- Department of Radiology, University Hospital and University of Bern, Switzerland
| | - B Möller
- Department of Rheumatology, Immunology and Allergology, University Hospital and University of Bern, 3010 Bern Switzerland
| | - P M Villiger
- Department of Rheumatology, Immunology and Allergology, University Hospital and University of Bern, 3010 Bern Switzerland
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Sule SD, Fontaine KR. Slow speed resistance exercise training in children with polyarticular juvenile idiopathic arthritis. Open Access Rheumatol 2019; 11:121-126. [PMID: 31191051 PMCID: PMC6535082 DOI: 10.2147/oarrr.s199855] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Accepted: 04/16/2019] [Indexed: 11/23/2022] Open
Abstract
Background: Juvenile idiopathic arthritis (JIA) is an inflammatory autoimmune disease that can cause severe impairment and disability. Exercise is recommended to preserve joint mobility and function. Our objectives were to assess the safety, feasibility, and effects of slow speed resistance exercise in children with polyarticular JIA. Methods: Patients were recruited from a pediatric rheumatology clinic at an urban hospital and randomized to exercise or control groups. In the intervention group, slow speed resistance exercise with individualized instruction by a certified trainer was performed 1-2 times per week for 12 weeks. The control group performed home-based aerobic exercise 3 days per week for 12 weeks. Pre and post-body composition measurements by dual-energy X-ray absorptiometry; aerobic fitness by peak oxygen uptake during cycle ergometry; isometric muscle strength; and quality of life measures were obtained. Results: In the exercise group, 9/17 (53%) completed any exercise training. Of these nine subjects, five (55%) completed all 12 weeks of the protocol. In the control group, 8/16 (50%) reported compliance with the recommended aerobic exercise training at least one time per week. Only 2 subjects (12%) reported exercising more than once per week. There was no significant difference between pre- and post-measurements in any category in the exercise group. There was also significantly elevated body fat in both groups with only 17% in the control group and 23% in the exercise group meeting recommended <30% total body fat levels. Conclusions: Children with JIA participated safely in this resistance exercise protocol. The exercise was well-tolerated with no serious adverse events noted. While individual subjects reported improvement in fatigue and improved energy, there was no statistical difference in pre- and post-exercise measures of body composition or quality of life. Identifying ways to improve adherence and encourage exercise in children with JIA is important.
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Affiliation(s)
- Sangeeta D Sule
- Division of Rheumatology, Children’s National Health System, Washington, DC20010, USA
| | - Kevin R Fontaine
- Department of Public Health, School of Public Health, University of Alabama at Birmingham, Birmingham, AB, USA
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25
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Mostoufi-Moab S, Ward LM. Skeletal Morbidity in Children and Adolescents during and following Cancer Therapy. Horm Res Paediatr 2019; 91:137-151. [PMID: 30481777 PMCID: PMC6536370 DOI: 10.1159/000494809] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 10/23/2018] [Indexed: 01/07/2023] Open
Abstract
Skeletal abnormalities are common in children and adolescents diagnosed and treated for a malignancy. The spectrum ranges from mild pain to debilitating osteonecrosis and fractures. In this review, we summarize the impact of cancer therapy on the developing skeleton, provide an update on therapeutic strategies for prevention and treatment, and discuss the most recent advances in musculoskeletal research. Early recognition of skeletal abnormalities and strategies to optimize bone health are essential to prevent long-term skeletal sequelae and diminished quality of life in childhood cancer survivors.
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Affiliation(s)
- Sogol Mostoufi-Moab
- Department of Pediatrics, The Children's Hospital of Philadelphia, The University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA,
| | - Leanne M. Ward
- Department of Pediatrics, The Children’s Hospital of Eastern Ontario, University of Ottawa, Ontario, Canada, K1H 8L1
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26
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Houghton KM, Macdonald HM, McKay HA, Guzman J, Duffy C, Tucker L. Feasibility and safety of a 6-month exercise program to increase bone and muscle strength in children with juvenile idiopathic arthritis. Pediatr Rheumatol Online J 2018; 16:67. [PMID: 30348221 PMCID: PMC6198360 DOI: 10.1186/s12969-018-0283-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 10/10/2018] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Arthritis in childhood can be associated with muscle weakness around affected joints, low bone mass and low bone strength. Exercise is recognized as an important part of management of children with juvenile idiopathic arthritis (JIA) but the exercise prescription to best promote bone and muscle health is unknown. We therefore aimed to: 1. assess feasibility and safety of a 6-month home- and group-based exercise program for children with JIA; 2. estimate the effect of program participation on bone mass and strength, muscle function and clinical outcomes and 3. determine if any positive changes in bone and muscle outcomes are maintained 6 months later. METHODS We recruited 24 children with JIA who were part of the Linking Exercise, Physical Activity and Pathophysiology in Childhood Arthritis (LEAP) study to participate in a 6-month home-based exercise program involving jumping and handgrip exercises, resistance training and one group exercise session per month. We assessed lumbar spine bone mass (dual energy X-ray absorptiometry), distal tibia and radius bone microarchitecture and strength (high-resolution peripheral quantitative computed tomography), muscle function (jumping mechanography, dynamometry) and clinical outcomes (joint assessment, function, health-related quality of life) at baseline, 6- and 12-months. Adherence was assessed using weekly activity logs. RESULTS Thirteen children completed the 6-month intervention. Participants reported 9 adverse events and post-exercise pain was rare (0.4%). Fatigue improved, but there were no other sustained improvements in muscle, bone or clinical outcomes. Adherence to the exercise program was low (47%) and decreased over time. CONCLUSION Children with JIA safely participated in a home-based exercise program designed to enhance muscle and bone strength. Fatigue improved, which may in turn facilitate physical activity participation. Prescribed exercise posed adherence challenges and efforts are needed to address facilitators and barriers to participation in and adherence to exercise programs among children with JIA. TRIAL REGISTRATION Data of the children with JIA are from the LEAP study (Canadian Institutes of Health Research (CIHR; GRANT# 107535 ). http://www.leapjia.com/.
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Affiliation(s)
- Kristin M. Houghton
- 0000 0001 0684 7788grid.414137.4Division of Rheumatology, K4-123 ACB, British Columbia Children’s Hospital, 4480 Oak Street, Vancouver, BC V6H 3V4 Canada ,0000 0001 2288 9830grid.17091.3eDepartment of Pediatrics, University of British Columbia, Vancouver, BC Canada
| | - Heather M. Macdonald
- 0000 0001 2288 9830grid.17091.3eDepartment of Family Practice, University of British Columbia, Vancouver, BC Canada ,0000 0004 0384 4428grid.417243.7Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, BC Canada
| | - Heather A. McKay
- 0000 0001 2288 9830grid.17091.3eDepartment of Family Practice, University of British Columbia, Vancouver, BC Canada ,0000 0004 0384 4428grid.417243.7Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, BC Canada ,0000 0001 2288 9830grid.17091.3eDepartment of Orthopaedics, University of British Columbia, Vancouver, BC Canada
| | - Jaime Guzman
- 0000 0001 0684 7788grid.414137.4Division of Rheumatology, K4-123 ACB, British Columbia Children’s Hospital, 4480 Oak Street, Vancouver, BC V6H 3V4 Canada ,0000 0001 2288 9830grid.17091.3eDepartment of Pediatrics, University of British Columbia, Vancouver, BC Canada
| | - Ciarán Duffy
- 0000 0000 9402 6172grid.414148.cDivision of Rheumatology, Department of Pediatrics, Children’s Hospital of Eastern Ontario and University of Ottawa, Ottawa, Canada
| | - Lori Tucker
- 0000 0001 0684 7788grid.414137.4Division of Rheumatology, K4-123 ACB, British Columbia Children’s Hospital, 4480 Oak Street, Vancouver, BC V6H 3V4 Canada ,0000 0001 2288 9830grid.17091.3eDepartment of Pediatrics, University of British Columbia, Vancouver, BC Canada
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Jackson TJ, Mostoufi-Moab S, Hill-Kayser C, Balamuth NJ, Arkader A. Musculoskeletal complications following total body irradiation in hematopoietic stem cell transplant patients. Pediatr Blood Cancer 2018; 65. [PMID: 29286549 DOI: 10.1002/pbc.26905] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 10/31/2017] [Accepted: 10/31/2017] [Indexed: 01/13/2023]
Abstract
Total body irradiation (TBI) is commonly used in conditioning regimens for allogeneic hematopoietic stem cell transplantation (HSCT) to treat benign and malignant disease. Though life-saving, these therapies place patients at risk for important side effects, including musculoskeletal complications such as short stature, osteonecrosis, slipped capital femoral epiphysis, and the development of benign and malignant bone tumors. With an increasing number of HSCT survivors, there is a growing need for awareness of the musculoskeletal complications of HSCT and TBI.
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Affiliation(s)
- Taylor J Jackson
- Division of Orthopaedics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Sogol Mostoufi-Moab
- Department of Pediatric Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Pediatric Endocrinology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Christine Hill-Kayser
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Naomi J Balamuth
- Department of Pediatric Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Alexandre Arkader
- Division of Orthopaedics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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28
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Abstract
PURPOSE OF REVIEW Osteoporosis is an under-recognized complication of chronic illness in childhood. This review will summarize recent literature addressing the risk factors, evaluation, and treatment for early bone fragility. RECENT FINDINGS Criteria for the diagnosis of pediatric osteoporosis include the presence of low trauma vertebral fractures alone or the combination of low bone mineral density and several long bone fractures. Monitoring for bone health may include screening for vertebral fractures that are common but often asymptomatic. Pharmacologic agents should be offered to those with fragility fractures especially when spontaneous recovery is unlikely. Controversies persist about the optimal bisphosphonate agent, dose, and duration. Newer osteoporosis drugs have not yet been adequately tested in pediatrics, though clinical trials are underway. The prevalence of osteoporosis is increased in children with chronic illness. To reduce the frequency of fragility fractures requires increased attention to risk factors, early intervention, and additional research to optimize therapy and potentially prevent their occurrence.
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Affiliation(s)
- Monica Grover
- Department of Pediatrics, Division of Endocrinology, School of Medicine, Stanford University, Room H314, Stanford, CA, 94305, USA
| | - Laura K Bachrach
- Department of Pediatrics, Division of Endocrinology, School of Medicine, Stanford University, Room H314, Stanford, CA, 94305, USA.
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29
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Patti A, Maggio MC, Corsello G, Messina G, Iovane A, Palma A. Evaluation of Fitness and the Balance Levels of Children with a Diagnosis of Juvenile Idiopathic Arthritis: A Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14070806. [PMID: 28753965 PMCID: PMC5551244 DOI: 10.3390/ijerph14070806] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 07/14/2017] [Accepted: 07/16/2017] [Indexed: 12/18/2022]
Abstract
Background: Juvenile idiopathic arthritis is a main cause of physical disability and has high economic costs for society. The purpose of this study was to assess the fitness levels and the postural and balance deficits with a specific test battery. Methods: Fifty-six subjects were enrolled in this study. Thirty-nine healthy subjects were included in the control group and seventeen in the juvenile idiopathic arthritis group. All subjects were evaluated using a posturography system. The fitness level was evaluated with a battery of tests (Abalakov test, sit-up test, hand grip test, backsaver sit and reach, the toe touch test). An unpaired t-test was used to determine differences. Pearson’s correlation coefficient was used to evaluate the correlation between the tests. Results: The battery of tests demonstrated that subjects in the juvenile idiopathic arthritis group have lower fitness levels compared to the control group. The juvenile idiopathic arthritis group showed low postural control with respect to the control group. Pearson analysis of the juvenile idiopathic arthritis group data showed significant correlations between variables. Pearson’s results from the control group data showed a similar trend. Conclusions: The results suggest that the battery of tests used could be an appropriate tool. However, we highlight that these conclusions need to be supported by other studies with a larger population scale.
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Affiliation(s)
- Antonino Patti
- Department of Psychology and Educational Science, University of Palermo, 90133 Palermo, Italy.
| | - Maria Cristina Maggio
- Department of Science for the Promotion of Health and Infant Maternal "G. D'Alessandro", University of Palermo, 90133 Palermo, Italy.
| | - Giovanni Corsello
- Department of Science for the Promotion of Health and Infant Maternal "G. D'Alessandro", University of Palermo, 90133 Palermo, Italy.
| | - Giuseppe Messina
- Department of Psychology and Educational Science, University of Palermo, 90133 Palermo, Italy.
- Posturalab Italy, 90131 Palermo, Italy.
| | - Angelo Iovane
- Department of Psychology and Educational Science, University of Palermo, 90133 Palermo, Italy.
| | - Antonio Palma
- Department of Psychology and Educational Science, University of Palermo, 90133 Palermo, Italy.
- Regional Sport School of Sicily CONI (Olympic National Italian Committee), 90141 Palermo, Italy.
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30
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Manos CK, Xiao R, Brandon TG, Burnham JM, Zemel BS, Weiss PF. Obesity and Pediatric Psoriatic Arthritis. ACTA ACUST UNITED AC 2017; 6:34-40. [PMID: 29644116 DOI: 10.5455/apr.031320170835] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective Studies in adults have shown a significant association between obesity and psoriatic arthritis, however the association of obesity with pediatric psoriatic arthritis is unknown. We aimed to evaluate obesity in pediatric psoriatic arthritis. Methods We conducted a cross-sectional study of children with psoriasis and psoriatic arthritis evaluated at a single center between 6/2010 and 9/2014. Two healthy reference populations were utilized: 1) local reference population from the surrounding community and 2) a national reference population derived from NHANES. Age and sex-specific z-scores for weight, height, and body mass index (BMI) were calculated. Differences in clinical and demographic characteristics between groups were assessed. Results During the study period, 48 children with psoriatic arthritis and 231 patients with psoriasis were evaluated. Three (6.2%) and 5 (10.4%) of the children with psoriatic arthritis were overweight or obese, respectively. In comparison to the reference healthy groups and psoriasis patients, the mean BMI z-score of children with psoriatic arthritis was not statistically different. However, patients with psoriasis were more likely to be obese than the community reference population (p-value <0.001). Conclusions Children with psoriasis were more obese than the healthy reference population, however there was no statistically significant difference in obesity between children with psoriatic arthritis and psoriasis or psoriatic arthritis and the reference population. This lack of association may be reflective of true differences in pediatric and adult-onset disease and warrants further investigation.
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Affiliation(s)
- Cynthia K Manos
- Division of Rheumatology, Children's Hospital of Philadelphia.,Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania
| | - Rui Xiao
- Department of Biostatistics and Epidemiology, University of Pennsylvania
| | - Timothy G Brandon
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania
| | - Jon M Burnham
- Division of Rheumatology, Children's Hospital of Philadelphia
| | - Babette S Zemel
- Nutrition and Growth Laboratory, Children's Hospital of Philadelphia
| | - Pamela F Weiss
- Division of Rheumatology, Children's Hospital of Philadelphia.,Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania
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31
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Race DL, Sims-Gould J, Tucker LB, Duffy CM, Feldman DE, Gibbon M, Houghton KM, Stinson JN, Stringer E, Tse SM, McKay HA. 'It might hurt, but you have to push through the pain': Perspectives on physical activity from children with juvenile idiopathic arthritis and their parents. J Child Health Care 2016; 20:428-436. [PMID: 26907570 DOI: 10.1177/1367493516632616] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Our primary objective was to gather perspectives of children diagnosed with juvenile idiopathic arthritis (JIA) and their parents as they relate to physical activity (PA) participation. To do so, we conducted a study on 23 children diagnosed with JIA and their parents ( N = 29). We used convenience sampling to recruit participants and qualitative method- logies (one-on-one semi-structured interviews). We adopted a five-step framework analysis to categorize data into themes. Children and their parents described factors that act to facilitate or hinder PA participation. Pain was the most commonly highlighted PA barrier described by children and their parents. However, children who were newly diagnosed with JIA and their parents were more likely to highlight pain as a barrier than were child/parent dyads where children had been previously diagnosed.
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Affiliation(s)
| | | | - Lori B Tucker
- 2 British Columbia Children's Hospital, Vancouver, Canada
| | - Ciaran M Duffy
- 3 University of Ottawa, Ottawa, Canada
- 4 Children's Hospital of Eastern Ontario, Ottawa, Canada
| | | | - Michele Gibbon
- 4 Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Kristin M Houghton
- 1 University of British Columbia, Vancouver, Canada
- 2 British Columbia Children's Hospital, Vancouver, Canada
| | - Jennifer N Stinson
- 6 The Hospital for Sick Children, Toronto, Canada
- 7 University of Toronto, Toronto, Canada
| | | | - Shirley Ml Tse
- 6 The Hospital for Sick Children, Toronto, Canada
- 7 University of Toronto, Toronto, Canada
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32
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Stagi S, Cavalli L, Cavalli T, de Martino M, Brandi ML. Peripheral quantitative computed tomography (pQCT) for the assessment of bone strength in most of bone affecting conditions in developmental age: a review. Ital J Pediatr 2016; 42:88. [PMID: 27670687 PMCID: PMC5037897 DOI: 10.1186/s13052-016-0297-9] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 09/15/2016] [Indexed: 12/13/2022] Open
Abstract
Peripheral quantitative computed tomography provides an automatical scan analysis of trabecular and cortical bone compartments, calculating not only their bone mineral density (BMD), but also bone geometrical parameters, such as marrow and cortical Cross-Sectional Area (CSA), Cortical Thickness (CoTh), both periosteal and endosteal circumference, as well as biomechanical parameters like Cross-Sectional Moment of Inertia (CSMI), a measure of bending, polar moment of inertia, indicating bone strength in torsion, and Strength Strain Index (SSI). Also CSA of muscle and fat can be extracted. Muscles, which are thought to stimulate bones to adapt their geometry and mineral content, are determinant to preserve or increase bone strength; thus, pQCT provides an evaluation of the functional 'muscle-bone unit', defined as BMC/muscle CSA ratio. This functional approach to bone densitometry can establish if bone strength is normally adapted to the muscle force, and if muscle force is adequate for body size, providing more detailed insights to targeted strategies for the prevention and treatment of bone fragility. The present paper offers an extensive review of technical features of pQCT and its possible clinical application in the diagnostic of bone status as well as in the monitoring of the skeleton's health follow-up.
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Affiliation(s)
- Stefano Stagi
- Health Sciences Department, University of Florence, Anna Meyer Children’s University Hospital, viale Pieraccini 24, 50139 Florence, Italy
| | - Loredana Cavalli
- Department of Surgery and Translational Medicine, Endocrinology Unit, University of Florence, Florence, Italy
| | - Tiziana Cavalli
- Department of Surgery and Translational Medicine, Emergency and Digestive Surgery with Oncological and Functional Address Unit, University of Florence, Florence, Italy
| | - Maurizio de Martino
- Health Sciences Department, University of Florence, Anna Meyer Children’s University Hospital, viale Pieraccini 24, 50139 Florence, Italy
| | - Maria Luisa Brandi
- Department of Surgery and Translational Medicine, Endocrinology Unit, University of Florence, Florence, Italy
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Huber AM, Ward LM. The impact of underlying disease on fracture risk and bone mineral density in children with rheumatic disorders: A review of current literature. Semin Arthritis Rheum 2016; 46:49-63. [PMID: 27020068 DOI: 10.1016/j.semarthrit.2016.02.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 10/16/2015] [Accepted: 02/20/2016] [Indexed: 11/17/2022]
Abstract
Childhood rheumatic diseases are associated with negative impacts on the skeleton, related to both the underlying illness and complications of therapy. The effects of medications like corticosteroids are well recognized, leading to reductions in bone mineral density and bone strength and concomitant increases in bone fragility and fracture risk. The impact of factors directly attributable to the underlying disease is not as well recognized. In this article, we review relevant literature to identify data which can contribute to an understanding of the impact of childhood rheumatic disease on the skeleton. We conclude that childhood rheumatic diseases are associated with reductions in bone mineral density and increased risk of vertebral and non-vertebral fractures. These data are strongest for juvenile arthritis, while conclusions are more limited for other rheumatic illnesses, like juvenile systemic lupus erythematosus or juvenile dermatomyositis, due to small numbers of patients studied. Finally, we make recommendations for areas in need of further research. These include the need for long-term longitudinal studies and for data to be collected in patients who have not been treated with corticosteroids.
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Affiliation(s)
- Adam M Huber
- Division of Pediatric Rheumatology, IWK Health Centre and Dalhousie University, 5850 University Ave, Halifax, Nova Scotia, Canada B3K 6R8.
| | - Leanne M Ward
- Division of Pediatric Endocrinology, Children׳s Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario, Canada
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34
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Lewiecki EM, Baron R, Bilezikian JP, Gagel RE, Leonard MB, Leslie WD, McClung MR, Miller PD. Proceedings of the 2015 Santa Fe Bone Symposium: Clinical Applications of Scientific Advances in Osteoporosis and Metabolic Bone Disease. J Clin Densitom 2016; 19:102-16. [PMID: 26750746 PMCID: PMC6706250 DOI: 10.1016/j.jocd.2015.11.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 11/19/2015] [Indexed: 12/30/2022]
Abstract
The 2015 Santa Fe Bone Symposium was a venue for healthcare professionals and clinical researchers to present and discuss the clinical relevance of recent advances in the science of skeletal disorders, with a focus on osteoporosis and metabolic bone disease. Symposium topics included new developments in the translation of basic bone science to improved patient care, osteoporosis treatment duration, pediatric bone disease, update of fracture risk assessment, cancer treatment-related bone loss, fracture liaison services, a review of the most significant studies of the past year, and the use of telementoring with Bone Health Extension for Community Healthcare Outcomes, a force multiplier to improve the care of osteoporosis in underserved communities.
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Affiliation(s)
- E Michael Lewiecki
- New Mexico Clinical Research & Osteoporosis Center, Albuquerque, NM, USA.
| | - Roland Baron
- Harvard Medical School and Massachusetts General Hospital, Harvard School of Dental Medicine, Boston, MA, USA
| | - John P Bilezikian
- Columbia University College of Physicians and Surgeons, New York City, NY, USA
| | - Robert E Gagel
- University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | | | - William D Leslie
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Paul D Miller
- Colorado Center for Bone Research, Lakewood, CO, USA
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Clinical Observation of Employment of Umbilical Cord Derived Mesenchymal Stem Cell for Juvenile Idiopathic Arthritis Therapy. Stem Cells Int 2015; 2016:9165267. [PMID: 26770214 PMCID: PMC4684881 DOI: 10.1155/2016/9165267] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 07/31/2015] [Accepted: 08/06/2015] [Indexed: 12/30/2022] Open
Abstract
Juvenile idiopathic arthritis (JIA), known as Juvenile rheumatoid arthritis, is the most common type of arthritis in children aged under 17. It may cause sequelae due to lack of effective treatment. The goal of this study is to explore the therapeutic effect of umbilical cord mesenchymal stem cells (UC-MSCs) for JIA. Ten JIA patients were treated with UC-MSCs and received second infusion three months later. Some key values such as 28-joint disease activity score (DAS28), TNF-α, IL-6, and regulatory T cells (Tregs) were evaluated. Data were collected at 3 months and 6 months after first treatment. DAS28 score of 10 patients was between 2.6 and 3.2 at three months after infusion. WBC, ESR, and CRP were significantly decreased while Tregs were remarkably increased and IL-6 and TNF-α were declined. Similar changes of above values were found after 6 months. At the same time, the amount of NSAIDS and steroid usage in patients was reduced. However, no significant changes were found comparing the data from 3 and 6 months. These results suggest that UC-MSCs can reduce inflammatory cytokines, improve immune network effects, adjust immune tolerance, and effectively alleviate the symptoms and they might provide a safe and novel approach for JIA treatment.
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Bone health of patients with juvenile idiopathic arthritis: a comparison between dual-energy X-ray absorptiometry and digital X-ray radiogrammetry. Eur J Radiol 2015; 84:1999-2003. [DOI: 10.1016/j.ejrad.2015.06.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 06/03/2015] [Accepted: 06/16/2015] [Indexed: 01/01/2023]
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LeBlanc CMA, Ma J, Taljaard M, Roth J, Scuccimarri R, Miettunen P, Lang B, Huber AM, Houghton K, Jaremko JL, Ho J, Shenouda N, Matzinger MA, Lentle B, Stein R, Sbrocchi AM, Oen K, Rodd C, Jurencak R, Cummings EA, Couch R, Cabral DA, Atkinson S, Alos N, Rauch F, Siminoski K, Ward LM. Incident Vertebral Fractures and Risk Factors in the First Three Years Following Glucocorticoid Initiation Among Pediatric Patients With Rheumatic Disorders. J Bone Miner Res 2015; 30:1667-75. [PMID: 25801315 PMCID: PMC4556451 DOI: 10.1002/jbmr.2511] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 03/10/2015] [Accepted: 03/13/2015] [Indexed: 12/21/2022]
Abstract
Vertebral fractures are an important yet underrecognized manifestation of osteoporosis in children with chronic, glucocorticoid-treated illnesses. Our goal was to determine the incidence and clinical predictors of vertebral fractures in the 3 years following glucocorticoid initiation among pediatric patients with rheumatic disorders. Incident vertebral fractures were evaluated according to the Genant semiquantitative method on lateral radiographs at baseline and then annually in the 3 years following glucocorticoid initiation. Extended Cox models were used to assess the association between vertebral fractures and clinical risk predictors. A total of 134 children with rheumatic disorders were enrolled in the study (mean ± standard deviation (SD) age 9.9 ± 4.4 years; 65% girls). The unadjusted vertebral fracture incidence rate was 4.4 per 100 person-years, with a 3-year incidence proportion of 12.4%. The highest annual incidence occurred in the first year (6.0%; 95% confidence interval (CI) 2.9% to 11.7%). Almost one-half of the patients with fractures were asymptomatic. Every 0.5 mg/kg increase in average daily glucocorticoid (prednisone equivalents) dose was associated with a twofold increased fracture risk (hazard ratio (HR) 2.0; 95% CI 1.1 to 3.5). Other predictors of increased vertebral fracture risk included: (1) increases in disease severity scores between baseline and 12 months; (2) increases in body mass index Z-scores in the first 6 months of each 12-month period preceding the annual fracture assessment; and (3) decreases in lumbar spine bone mineral density Z-scores in the first 6 months of glucocorticoid therapy. As such, we observed that a clinically significant number of children with rheumatic disorders developed incident vertebral fractures in the 3 years following glucocorticoid initiation. Almost one-half of the children were asymptomatic and thereby would have been undiagnosed in the absence of radiographic monitoring. In addition, discrete clinical predictors of incident vertebral fractures were evident early in the course of glucocorticoid therapy.
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Affiliation(s)
| | - Jinhui Ma
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Monica Taljaard
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Johannes Roth
- Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada
| | | | - Paivi Miettunen
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada
| | - Bianca Lang
- Department of Pediatrics, Dalhousie University, Halifax, NS, Canada
| | - Adam M Huber
- Department of Pediatrics, Dalhousie University, Halifax, NS, Canada
| | - Kristin Houghton
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Jacob L Jaremko
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, AB, Canada
| | - Josephine Ho
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada
| | - Nazih Shenouda
- Department of Medical Imaging, University of Ottawa, Ottawa, ON, Canada
| | | | - Brian Lentle
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Robert Stein
- Department of Pediatrics, University of Western Ontario, London, ON, Canada
| | | | - Kiem Oen
- Department of Pediatrics, University of Manitoba, Winnipeg, MB, Canada
| | - Celia Rodd
- Department of Pediatrics, University of Manitoba, Winnipeg, MB, Canada
| | - Roman Jurencak
- Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada
| | | | - Robert Couch
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - David A Cabral
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | | | - Nathalie Alos
- Department of Pediatrics, Université de Montréal, Montréal, QC, Canada
| | - Frank Rauch
- Department of Pediatrics, McGill University, Montreal, QC, Canada
| | - Kerry Siminoski
- Department of Radiology and Diagnostic Imaging, and Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Leanne M Ward
- Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada
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Avitabile CM, Goldberg DJ, Zemel BS, Brodsky JL, Dodds K, Hayden-Rush C, Whitehead KK, Goldmuntz E, Rychik J, Leonard MB. Deficits in bone density and structure in children and young adults following Fontan palliation. Bone 2015; 77:12-6. [PMID: 25882907 PMCID: PMC4447577 DOI: 10.1016/j.bone.2015.04.012] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Revised: 04/01/2015] [Accepted: 04/06/2015] [Indexed: 01/07/2023]
Abstract
BACKGROUND Survival of patients with congenital heart disease has improved such that there are now more adults than children living with these conditions. Complex single ventricle congenital heart disease requiring Fontan palliation is associated with multiple risk factors for impaired bone accrual. Bone density and structure have not been characterized in these patients. METHODS Tibia peripheral quantitative computed tomography (pQCT) was used to assess trabecular and cortical volumetric bone mineral density (vBMD), cortical dimensions, and calf muscle area in 43 Fontan participants (5-33 years old), a median of 10 years following Fontan palliation. pQCT outcomes were converted to sex- and race-specific Z-scores relative to age based on >700 healthy reference participants. Cortical dimensions and muscle area were further adjusted for tibia length. RESULTS Height Z-scores were lower in Fontan compared to reference participants (mean ± SD: -0.29 ± 1.00 vs. 0.25 ± 0.93, p < 0.001); BMI Z-scores were similar (0.16 ± 0.88 vs. 0.35 ± 1.02, p = 0.1). Fontan participants had lower trabecular vBMD Z-scores (-0.85 ± 0.96 vs. 0.01 ± 1.02, p < 0.001); cortical vBMD Z-scores were similar (-0.17 ± 0.98 vs. 0.00 ± 1.00, p = 0.27). Cortical dimensions were reduced with lower cortical area (-0.59 ± 0.84 vs. 0.00 ± 0.88, p<0.001) and periosteal circumference (-0.50 ± 0.82 vs. 0.00 ± 0.84, p < 0.001) Z-scores, compared to reference participants. Calf muscle area Z-scores were lower in the Fontan participants (-0.45 ± 0.98 vs. 0.00 ± 0.96, p = 0.003) and lower calf muscle area Z-scores were associated with smaller periosteal circumference Z-scores (R = 0.62, p < 0.001). Musculoskeletal deficits were not associated with age, Fontan characteristics, parathyroid hormone or vitamin D levels. CONCLUSIONS Children and young adults demonstrate low trabecular vBMD, cortical structure and muscle area following Fontan. Muscle deficits were associated with smaller periosteal dimensions. Future studies should determine the fracture implications of these deficits and identify interventions to promote musculoskeletal development.
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Affiliation(s)
- Catherine M Avitabile
- Division of Cardiology, Children's Hospital of Philadelphia, 34(th) and Civic Center Boulevard, Philadelphia, PA 19104, USA.
| | - David J Goldberg
- Division of Cardiology, Children's Hospital of Philadelphia, 34(th) and Civic Center Boulevard, Philadelphia, PA 19104, USA; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, 415 Curie Boulevard, Philadelphia, PA 19104, USA
| | - Babette S Zemel
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, 415 Curie Boulevard, Philadelphia, PA 19104, USA; Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia, 34(th) and Civic Center Boulevard, Philadelphia, PA 19104, USA
| | - Jill L Brodsky
- Mid-Hudson Medical Group, 30 Columbia Street, Poughkeepsie, NY 12601, USA
| | - Kathryn Dodds
- Division of Cardiology, Children's Hospital of Philadelphia, 34(th) and Civic Center Boulevard, Philadelphia, PA 19104, USA
| | - Christina Hayden-Rush
- Division of Cardiology, Children's Hospital of Philadelphia, 34(th) and Civic Center Boulevard, Philadelphia, PA 19104, USA
| | - Kevin K Whitehead
- Division of Cardiology, Children's Hospital of Philadelphia, 34(th) and Civic Center Boulevard, Philadelphia, PA 19104, USA; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, 415 Curie Boulevard, Philadelphia, PA 19104, USA
| | - Elizabeth Goldmuntz
- Division of Cardiology, Children's Hospital of Philadelphia, 34(th) and Civic Center Boulevard, Philadelphia, PA 19104, USA; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, 415 Curie Boulevard, Philadelphia, PA 19104, USA
| | - Jack Rychik
- Division of Cardiology, Children's Hospital of Philadelphia, 34(th) and Civic Center Boulevard, Philadelphia, PA 19104, USA; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, 415 Curie Boulevard, Philadelphia, PA 19104, USA
| | - Mary B Leonard
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, 415 Curie Boulevard, Philadelphia, PA 19104, USA; Division of Nephrology, Children's Hospital of Philadelphia, 34(th) and Civic Center Boulevard, Philadelphia, PA 19104, USA; Department of Biostatistics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, 415 Curie Boulevard, Philadelphia, PA 19104, USA
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Simon D. Puberté et maladies inflammatoires. Arch Pediatr 2015; 22:163-4. [DOI: 10.1016/s0929-693x(15)30081-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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von Scheven E, Corbin KJ, Stagi S, Cimaz R. Glucocorticoid-associated osteoporosis in chronic inflammatory diseases: epidemiology, mechanisms, diagnosis, and treatment. Curr Osteoporos Rep 2014; 12:289-99. [PMID: 25001898 DOI: 10.1007/s11914-014-0228-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Children with chronic illnesses such as Juvenile Idiopathic Arthritis and Crohn's disease, particularly when taking glucocorticoids, are at significant risk for bone fragility. Furthermore, when childhood illness interferes with achieving normal peak bone mass, life-long fracture risk is increased. Osteopenia and osteoporosis, which is increasingly recognized in pediatric chronic disease, likely results from numerous disease- and treatment-related factors, including glucocorticoid exposure. Diagnosing osteoporosis in childhood is complicated by the limitations of current noninvasive techniques such as DXA, which despite its limitations remains the gold standard. The risk:benefit ratio of treatment is confounded by the potential for spontaneous restitution of bone mass deficits and reshaping of previously fractured vertebral bodies. Bisphosphonates have been used to treat secondary osteoporosis in children, but limited experience and potential long-term toxicity warrant caution in routine use. This article reviews the factors that influence loss of normal bone strength and evidence for effective treatments, in particular in patients with gastrointestinal and rheumatologic disorders who are receiving chronic glucocorticoid therapy.
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Affiliation(s)
- Emily von Scheven
- Pediatric Rheumatology, University of California, San Francisco, 505 Parnassus Avenue, Box 0105, San Francisco, CA, 94143, USA,
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Abstract
Skeletal abnormalities are commonly seen in children and adolescents with leukemia. The spectrum ranges from mild pain to debilitating osteonecrosis (ON) and fractures. In this review, we summarize the skeletal manifestations, provide an update on therapeutic strategies for prevention and treatment, and discuss the most recent advances in musculoskeletal research. Early recognition of skeletal abnormalities and strategies to optimize bone health are essential to prevent long-term skeletal sequelae and diminished quality of life observed in children and adolescents with leukemia.
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Affiliation(s)
- Sogol Mostoufi-Moab
- Department of Pediatrics, The Children’s Hospital of Philadelphia, The University of Pennsylvania Perelman School of Medicine, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104 USA
| | - Jacqueline Halton
- Department of Pediatrics, The Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario Canada K1H8L1
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Bechtold S, Simon D. Growth abnormalities in children and adolescents with juvenile idiopathic arthritis. Rheumatol Int 2014; 34:1483-8. [PMID: 24760485 DOI: 10.1007/s00296-014-3022-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Accepted: 04/09/2014] [Indexed: 10/25/2022]
Abstract
In patients with juvenile idiopathic arthritis (JIA) growth impairment and variance in body composition are well-known long-term complications. In the active phases of the disease, particular patients with systemic and polyarticular JIA reveal growth impairment. Some experience "catch-up" growth following reduction in disease activity and lower glucocorticoid doses. Although new therapeutic options are available, there are still 10-20 % of patients with severe forms of the disease who show continuous growth disturbance. Only few studies have specifically addressed body composition in JIA. Bone mass deficits in part could be related to the deficits of muscle mass. Study data on growth hormone treatment in short children with JIA are promising in respect of growth development, final height and body composition. The major goal for physicians is optimal disease control while maintaining normal growth and body composition. Early recognition of patients who develop prolonged growth and body composition disturbances is important as these abnormalities contribute to long-term morbidity and need to be addressed both diagnostically and therapeutically.
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Affiliation(s)
- Susanne Bechtold
- Division of Pediatric Endocrinology and Diabetology, University Children's Hospital, Munich, Germany,
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Adams JE, Engelke K, Zemel BS, Ward KA. Quantitative computer tomography in children and adolescents: the 2013 ISCD Pediatric Official Positions. J Clin Densitom 2014; 17:258-74. [PMID: 24792821 DOI: 10.1016/j.jocd.2014.01.006] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 01/14/2014] [Indexed: 12/24/2022]
Abstract
In 2007, International Society of Clinical Densitometry Pediatric Positions Task Forces reviewed the evidence for the clinical application of peripheral quantitative computed tomography (pQCT) in children and adolescents. At that time, numerous limitations regarding the clinical application of pQCT were identified, although its use as a research modality for investigation of bone strength was highlighted. The present report provides an updated review of evidence for the clinical application of pQCT, as well as additional reviews of whole body QCT scans of the central and peripheral skeletons, and high-resolution pQCT in children. Although these techniques remain in the domain of research, this report summarizes the recent literature and evidence of the clinical applicability and offers general recommendations regarding the use of these modalities in pediatric bone health assessment.
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Affiliation(s)
- Judith E Adams
- Department of Clinical Radiology, The Royal Infirmary, Central Manchester University Hospitals NHS Foundation Trust, Oxford Road, Manchester, England, UK.
| | - Klaus Engelke
- Institute of Medical Physics, University of Erlangen, Erlangen, Germany and Synarc A/S, Germany
| | - Babette S Zemel
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Kate A Ward
- MRC Human Nutrition Research, Elsie Widdowson Laboratory, Cambridge, UK
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Stagi S, Cavalli L, Signorini C, Bertini F, Cerinic MM, Brandi ML, Falcini F. Bone mass and quality in patients with juvenile idiopathic arthritis: longitudinal evaluation of bone-mass determinants by using dual-energy x-ray absorptiometry, peripheral quantitative computed tomography, and quantitative ultrasonography. Arthritis Res Ther 2014; 16:R83. [PMID: 24684763 PMCID: PMC4060444 DOI: 10.1186/ar4525] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Accepted: 03/18/2014] [Indexed: 12/03/2022] Open
Abstract
Introduction Our objective was to evaluate longitudinally the main bone-mass and quality predictors in young juvenile idiopathic arthritis (JIA) patients by using lumbar spine dual-energy X-ray absorptiometry (DXA) scan, radius peripheral quantitative computed tomography (pQCT), and phalangeal quantitative ultrasonography (QUS) at the same time. Methods In total, 245 patients (172 females, 73 males; median age, 15.6 years: 148 oligoarticular, 55 polyarticular, 20 systemic, and 22 enthesitis-related-arthritis (ERA) onset) entered the study. Of these, 166 patients were evaluated longitudinally. Data were compared with two age- and sex-matched control groups. Results In comparison with controls, JIA patients, but not with ERA, had a reduced spine bone-mineral apparent density (BMAD) standard deviation score (P < 0.001) and musculoskeletal deficits, with significantly lower levels of trabecular bone mineral density (TrabBMD) (P < 0.0001), muscle cross-sectional area (CSA) (P < 0.005), and density-weighted polar section modulus (SSIp) (P < 0.05). In contrast, JIA showed fat CSA significantly higher than controls (P < 0.0001). Finally, JIA patients had a significant reduced amplitude-dependent speed of sound (AD-SoS) (P < 0.001), and QUS z score (P < 0.005). Longitudinally, we did not find any difference in all JIA patients in comparison with baseline, except for the SSIp value that normalized. Analyzing the treatments, a significant negative correlation among spine BMAD values, TrabBMD, AD-SoS, and systemic and/or intraarticular corticosteroids, and a positive correlation among TNF-α-blocking agents and spine BMAD, TrabBMD, and AD-SoS were observed. Conclusions JIA patients have a low bone mass that, after a first increase due to the therapy, does not reach the normal condition over time. The pronounced bone deficits in JIA are greater than would be expected because of reduction in muscle cross-sectional area. Thus, bone alterations in JIA likely represent a mixed defect of bone accrual and lower muscle forces.
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Weber DR, Moore RH, Leonard MB, Zemel BS. Fat and lean BMI reference curves in children and adolescents and their utility in identifying excess adiposity compared with BMI and percentage body fat. Am J Clin Nutr 2013; 98:49-56. [PMID: 23697708 PMCID: PMC3683820 DOI: 10.3945/ajcn.112.053611] [Citation(s) in RCA: 207] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Accepted: 04/08/2013] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Body mass index (BMI) and percentage body fat (%BF) are widely used to assess adiposity. These indexes fail to account for independent contributions of fat mass (FM) and lean body mass (LBM) to body weight, which vary according to age, sex, pubertal status, and population ancestry in the pediatric population. OBJECTIVE The objective was to develop pediatric reference curves for fat mass index (FMI) and lean body mass index (LBMI) and evaluate the effects of population ancestry and LBM on measures of excess adiposity (BMI, %BF, and FMI). DESIGN Sex-specific FMI and LBMI reference curves relative to age for children and adolescents aged 8-20 y were generated from cross-sectional body-composition data measured by dual-energy X-ray absorptiometry from NHANES. RESULTS The mean LBMI z score was higher in blacks (males: 0.26; females: 0.45) than in whites (males: -0.07; females: -0.09) and Mexican Americans (males: 0.05; females: -0.09). The positive predictive value of overweight by BMI to identify excess adiposity defined by FMI was lower in blacks (males: 35.9%; females: 30.3%) than in whites (males: 65.4%; females: 52.2%) and Mexican Americans (males: 73.3%; females: 68.3%). Participants classified as having excess adiposity by FMI but normal adiposity by %BF had significantly higher BMI, LBMI, and height z scores than did those classified as having excess adiposity by %BF but normal adiposity by FMI. CONCLUSIONS Relative to FMI, the prevalence of excess adiposity is overestimated by BMI in blacks and underestimated by %BF in individuals with high LBM. The use of FMI and LBMI improves on the use of %BF and BMI by allowing for the independent assessment of FM and LBM.
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Affiliation(s)
- David R Weber
- Department of Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA 19104, USA
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Kostik MM, Smirnov AM, Demin GS, Mnuskina MM, Scheplyagina LA, Larionova VI. Genetic polymorphisms of collagen type I α1 chain (COL1A1) gene increase the frequency of low bone mineral density in the subgroup of children with juvenile idiopathic arthritis. EPMA J 2013; 4:15. [PMID: 23763832 PMCID: PMC3693906 DOI: 10.1186/1878-5085-4-15] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Accepted: 05/27/2013] [Indexed: 11/10/2022]
Abstract
BACKGROUND Collagen type I is one of the key proteins involved in the maturation, development and mineralization of bone. Genetic polymorphisms of collagen type I alpha-1 chain (COL1A1) gene are associated with low bone mineral density and higher risk of fractures in adults and children. We hypothesize that the polymorphic alleles and genotypes of COL1A1 gene influence bone mineralization and metabolism in children with juvenile idiopathic arthritis (JIA). METHODS We recruited 196 children with JIA in our study. Bone mineral density (BMD) was measured by lumbar spine dual-energy X-ray absorptiometry. Osteocalcin, Ca, Ca2+ and inorganic phosphate (Pi) were utilized for the assessment of bone metabolism. Molecular testing: Sp1 (rs1800012) and -1997G/T (rs1107946) polymorphisms of COL1A1 gene were detected RFLP. RESULTS No differences in genotype, allele and haplotype distribution of COL1A1 were detected among children with normal and low BMD (LBMD; <-2 standard deviation). The presence of GG genotype of Sp1 increased the incidence of LBMD in Tanner II to III children (odds ratio (OR) = 9.7 [95% confidence interval (CI), 1.2; 81.7], p = 0.02) as well as GG genotype of -1997G/T increased the frequency of LBMD in Tanner IV to V children (OR = 4.5 [95% CI, 0.9; 22.0], p = 0.048). Tanner I children with -1997GG genotype had lower Ca2+ and osteocalcin and higher Pi compared with carriers of -1997Т allele. Tanner IV to V children with -1997GG genotype had lower BMD and BMD-Z score than carriers of -1997Т. CONCLUSIONS The evaluation of the biologic effects of the GG Sp1 and GG of -1997G/T polymorphism of COL1A1 has shown negative effect on BMD and mineral turnover related to pubertal stage.
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Affiliation(s)
- Mikhail M Kostik
- Hospital Pediatric Department, Saint-Petersburg State Pediatric Medical University, Lytovskaya 2, Saint-Petersburg 194100, Russia
| | | | - Grigory S Demin
- Genetic systems, Ltd, Saint-Petersburg 195027, Russian Federation
| | - Marina M Mnuskina
- Department of biochemistry, Diagnostic Center#1 for adults, Saint-Petersburg, 194354, Russian Federation
| | - Larisa A Scheplyagina
- Moscow scientific and research clinical institute named M.F, Vladimirskiy, Moscow 129110, Russian Federation
| | - Valentina I Larionova
- Department of molecular diagnostics, Turner's Scientific and Research Institute for Children's Orthopedics, Saint-Petersburg 196603, Russian Federation
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Baker JF, Davis M, Alexander R, Zemel BS, Mostoufi-Moab S, Shults J, Sulik M, Schiferl DJ, Leonard MB. Associations between body composition and bone density and structure in men and women across the adult age spectrum. Bone 2013; 53:34-41. [PMID: 23238122 PMCID: PMC3552077 DOI: 10.1016/j.bone.2012.11.035] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Revised: 10/06/2012] [Accepted: 11/20/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND/PURPOSE The objective of this study was to identify independent associations between body composition and bone outcomes, including cortical structure and cortical and trabecular volumetric bone mineral density (vBMD) across the adult age spectrum. METHODS This cross-sectional study evaluated over 400 healthy adults (48% male, 44% black race), ages 21-78years. Multivariable linear regression models evaluated associations between whole-body DXA measures of lean body mass index (LBMI) and fat mass index (FMI) and tibia peripheral quantitative CT (pQCT) measures of cortical section modulus, cortical and trabecular vBMD and muscle density (as a measure of intramuscular fat), adjusted for age, sex, and race. All associations reported below were statistically significant (p<0.05). RESULTS Older age and female sex were associated with lower LBMI and muscle strength. Black race was associated with greater LBMI but lower muscle density. Greater FMI was associated with lower muscle density. Cortical section modulus was positively associated with LBMI and muscle strength and negatively associated with FMI. Adjustment for body composition eliminated the greater section modulus observed in black participants and attenuated the lower section modulus in females. Greater LBMI was associated with lower cortical BMD and greater trabecular BMD. FMI was not associated with either BMD outcome. Greater muscle density was associated with greater trabecular and cortical BMD. Associations between body composition and bone outcomes did not vary by sex (no significant tests for interaction). CONCLUSIONS These data highlight age-, sex- and race-specific differences in body composition, muscle strength and muscle density, and demonstrate discrete associations with bone density and structure. These data also show that age-, sex- and race-related patterns of bone density and strength are independent of differences in body composition. Longitudinal studies are needed to examine the temporal relations between changes in bone and body composition.
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Affiliation(s)
- Joshua F Baker
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA.
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Sandstedt E, Fasth A, Eek MN, Beckung E. Muscle strength, physical fitness and well-being in children and adolescents with juvenile idiopathic arthritis and the effect of an exercise programme: a randomized controlled trial. Pediatr Rheumatol Online J 2013; 11:7. [PMID: 23432796 PMCID: PMC3614532 DOI: 10.1186/1546-0096-11-7] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Accepted: 02/09/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Decreased muscle strength, fitness and well-being are common in children and adolescents with juvenile idiopathic arthritis (JIA) compared to healthy peers. Biological drugs have improved health in children with JIA, but despite this pain is still a major symptom and bone health is reported as decreased in the group. The improvement made by the biological drugs makes it possible to more demanding exercises. To jump is an exercise that can improve bone heath, fitness and muscle strength. The aim of the study was to see if an exercise programme with jumps had an effect on muscle strength, physical fitness and well-being and how it was tolerated. METHODS Muscle strength and well-being were studied before and after a 12-week exercise programme in 54 children and adolescents with JIA, 9-21 years old. The participants were randomized into an exercise and a control group. Muscle strength, fitness and well-being were documented before and after the training period and at follow-up after 6 months. Physical activity in leisure time was documented in diaries. The fitness/exercise programme was performed at home three times a week and included rope skipping and muscle strength training exercises.Assessment included measurement of muscle strength with a handheld device, and with Grip-it, step-test for fitness with documentation of heart rate and pain perception and two questionnaires (CHAQ, CHQ) on well-being. RESULTS There were no differences between exercise and control group regarding muscle strength, grip strength, fitness or well-being at base line. Muscle weakness was present in hip extensors, hip abductors and handgrip. For the exercise group muscle strength in hip and knee extensors increased after the 12-week exercise programme and was maintained in knee extensors at follow-up. There was no change in fitness tested with the individually adapted step-test. The CHQ questionnaire showed that pain was common in the exercise group and in the control group. There were only small changes in the CHAQ and CHQ after the training period. The fitness/exercise programme was well tolerated and pain did not increase during the study. CONCLUSIONS A weight bearing exercise programme, with muscle strength training with free weights and rope skipping was well tolerated without negative consequences on pain. It also improved muscle strength in the legs and can be recommended for children and adolescents with JIA.
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Affiliation(s)
- Eva Sandstedt
- Department of Paediatrics, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden.
| | - Anders Fasth
- Department of Paediatrics, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Meta Nyström Eek
- Department of Paediatrics, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Eva Beckung
- Department of Neuroscience and Physiotherapy, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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