Background Juvenile Idiopathic Arthritis (JIA) is the most frequent form of arthritis in children. There are 7 subtypes of JIA in all of which the hand and wrist can be affected (1,2). The consequences of inflammation in the hand and wrist can be far-reaching and may lead to serious impairments and deformities. General problems of hand and wrist are described in 80% of all children with JIA (2) without further specification of the impairments. These impairments need to be further investigated, in order to develop nonpharmacological preventive treatment.
Objectives To investigate the prevalence of specific hand and wrist impairments in children with JIA
Methods Cross-sectional design, in which all children and adolescents (0-21 years) were included, who were diagnosed between January 2003 and January 2008 for JIA at the Departments of Pediatric Rheumatology of the Jan van Breemen Institute and Emma Childrens’ Hospital AMC in Amsterdam, and who have been treated in these clinics since then. During control visits at the outpatient clinic, assessment of complaints such as pain and stiffness and the use of devices, was performed, together with a specialized standardized physical examination of the hand and wrist including scores for tenosynovitis, arthritis and joint deformities.
Results Between October 2006 and March 2010, 169 children met the inclusion criteria, of which 122 (72% of the total cohort) were assessed according to the protocol: mean disease duration 2.4 year (range 0.3-4.5 years), 71% female, mean age 13.7 years (range 3-20 years) and JIA subtypes: Rf-polyarthritis (52%), oligoarthritis (29%), Rf+polyarthritis (7%), psoriatic arthritis (6%), enthesitis related arthritis (6%), systemic (0%) and undifferentiated JIA (0%). The prevalence of any hand and wrist complaint was 56% and 49%, respectively. In 54% the children experienced complaints at school, and in 17% during hobbies. In only 15% and 23% of the children there were signs of active arthritis in hand and wrist joints respectively, and in 3% stenosing tenosynovitis. The prevalence of any hand or wrist impairment was 34%. Most frequent impairments were: limited range of motion of wrist (22%), PIP (18%), and MCP joints (8%). Only 2 children showed Boutonniere deformities; there were no Swanneck deformities, no radiar or ulnar deviations of wrist and finger joints, and no tendon ruptures. Five children showed diminished grip force in both hands. In 18% and 9%, the children were using wrist braces and finger splints respectively, while 43% applied other devices like a laptop (20%) or an adapted pencil (26%) at school.
Conclusions In 122 children with JIA (72% of the total cohort), there was a high prevalence of hand and wrist impairments, also without the presence of active clinical arthritis.
Cassidy JT, Petty RE. Chronic arthritis in childhood. In: Textbook of pediatric rheumatology, 2005; 106-260. Edited JT Cassidy and RE Petty; Philadelphia, Elsevier Saunders.
Ravelli A, Martini A. Early predictors of outcome in JIA. Clin Exp Rheumatol 2003; S89-S93.
Disclosure of Interest None Declared
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