Background Juvenile idiopathic arthritis (JIA) is a chronic and socially significant disease as it leads to quick disability in childhood despite treatment
Objectives To study the development of joint dysfunction in patients with JIA against the background of standard therapy with methotrexate
Methods The study involved 83 children within 2–18 years with JIA: oligoarthritis in 39,6%, polyarticular form – 37,7%, systemic form – 20,8%, enthesitis-related arthritis – 1,9%. Changes in the joints were assessed depending on the duration of disease: 1–2 years (25 patients), 3–5 years (23 patients), 5–10 years (35 patients). There were 51 females, 33 males. Criteria of decreased function of joints include: amplitude of motion of hands less then 110°; elbows, knees, ankles and wrists – less then 50°, shoulder and hip joints - less than 70°. For the statistic processing of the material, Stagraphics 3.0 was used.
Results With an increase in the duration of the disease despite standard care, the joint tenderness according to Ritchie index and joint pain according to Visual Analogue Scale were decreased, especially after 5 years of illness (p<0,0 5). The most significant signs of joint determination were limitation of motion and function of articular apparatus. It was found that frequency limited to function of joints among our patients was 77.11%, which was a prerequisite of patients' disability. With an increase in duration of disease, frequency of limited function of joints constantly grew and probably greater in comparison with the initial stages of the disease (p<0.05). The most common joints, which lost motion, were knee, radio-wrist, ankle and hip. In stages over three years of course of JIA, limited motion were found in all of the affected joints. Cervical spine lesion was determined in 33.3% of patients typically after 2 years of duration of JIA. In term from one to two years despite treatment in 50% of patients, affection of hip joints were presented. It was determined during the first two years, the changes that correspond to 0 (27,3%) and I stage of the disease by Steinbrocker (72,7%), from 3 year in 45,5% of children II stage was found, from 4th year 15,4% - III, after 6th year 14,7% persons had IV stage. The main stage of deterioration of the radiological changes is the term disease for more than 5 years, when significantly the frequency of the III stage in comparison with the previous period is increased (p<0,01) and the IV stage is appeared.
Conclusions It reflected steadily progressive destructive changes of the musculoskeletal system with limited motion of joints function despite therapy with methotrexate and independent of activity of disease and symptom load.
Disclosure of Interest None declared