Hip Involvement in Juvenile Idiopathic Arthritis: A Roadmap From Arthritis to Total Hip Arthroplasty or How Can We Prevent Hip Damage?

Abstract

Objectives: To describe the clinical characteristics of hip involvement in juvenile idiopathic arthritis (JIA) from arthritis to hip osteoarthritis (HOA) and total hip arthroplasty (THA).Study Design: Seven hundred fifty-three patients aged 2–17 years with JIA were included in the study. The comparison analysis was performed between the following subgroups: (i) JIA without hip involvement (n = 600; 79.7%) vs. JIA with hip involvement without HOA (n = 105; 13.9%), (ii) JIA with hip involvement with HOA, but without THA (n = 32; 4.3%) and JIA with hip involvement with HOA and with THA (n = 16; 2.1%). Clinical, laboratory characteristics and treatment regimens compared.Results: Hip involvement was present in 20.3% of patients. HOA was present in 6.4% (12*1,000 patient-years) of the entire JIA group and 31.4% of patients with hip involvement. Sixteen patients (2.1%; 4.0*1,000 patient-years) required THA. The following factors were associated with HOA: sJIA (OR = 3.6, p = 0.008; HR = 3.0, p = 0.002), delayed remission (OR = 4.2, p = 0.004; HR = 1.4, p = 0.538), delay in biologic therapy initiation (OR = 7.5, p = 0.00001; HR = 6.7, p = 0.002), alkaline phosphatase <165 U\l (OR = 4.1, p = 0.0003; HR = 5.2, p = 0.000004), treatment with corticosteroids (CS) (OR = 2.6, p = 0.008; HR = 1.2, p = 0.670), cumulative corticosteroids >2,700 mg (OR = 4.3, p = 0.032; HR = 1.4, p = 0.527). The following factors were associated with THA: delay in biologic treatment initiation (OR = 1.04, p = 0.0001; HR = 9.1, p = 0.034), delayed hip involvement (OR = 5.2, p = 0.002; HR = 3.0, p = 0.044), and methylprednisolone pulse therapy (OR = 10.8, p = 0.0000001; HR = 5.6, p = 0.002).Conclusion: Both sJIA and systemic CS, impaired calcium-phosphorus metabolism, and delayed hip arthritis are associated with HOA development in JIA. HOA is considered to be a severe adverse event of CS treatment, especially delayed hip involvement.

Temporomandibular Joint Involvement in Juvenile Idiopathic Arthritis: The Results from a Retrospective Cohort Tertial Center Study

“…In our study, the association between hip osteoarthritis and delayed hip involvement (mentioned possible hip avascular necrosis) and TMJ arthritis was observed. Both conditions had similar predictors (systemic corticosteroid treatment, long JIA course, and longer non-achievement of the remission), so we can suppose similar pathogenic changes in the hip proximal epiphysis and mandibular condylar [ 23 , 24 ]. Patients with JIA and TMJ involvement may have active arthritis (synovial effusion and synovial hyperplasia), but some patients may have TMJ osteoarthritis as a consequence of preceding inflammation.…”

Enthesitis-related arthritis in children: A literature review of the clinical features and differential diagnosis

“…При анализе 753 пациентов с ЮИА обнаружено, что поражение тазобедренного сустава ассоциировано с более поздним дебютом ЮИА, высокой лабораторной активностью и чаще возникало у пациентов с ЭАА и у HLA-B27-положительных пациентов [17]. У пациентов с ЭАА возможен изолированный артрит тазобедренного сустава в дебюте заболевания, тогда как при других формах ЮИА поражение тазобедренного сустава развивается при длительном течении заболевания и при поражении многих групп суставов.…”

Surgical Treatment of Juvenile Idiopathic Arthritis in the Era of Novel Drug Therapies

“…Kahlenberg et al evaluated the number of THAs performed in patients under the age of 21 in the USA: the frequency fell from 27% in 2000 to 4% in 2016 [73]. In a cohort of 753 patients (aged 2 to 17) with JIA, hip involvement was observed in 20.6% and THA was required in 2.1% [74]. THA is associated with a reduction in pain and an increase in range of motion [63,75].…”