Osteochondral lesions in children with juvenile idiopathic arthritis

Abstract

BackgroundJoint pain and swelling are typical symptoms in children with juvenile idiopathic arthritis (JIA) and these are often related to inflammation of the joint. Juvenile osteochondritis dissecans (JOCD), that is separation of a bone-cartilage segment from the articular surface, can manifest with similar symptoms.FindingsWe studied thirteen cases of osteochondritis dissecans lesions (OCD) in children with JIA. There were nine girls and four boys with a mean age of 6.5 (2–12) years at the time of diagnosis of JIA. Mean time between diagnosis of JIA and manifestation of OCD was 5.5 (1–11) years. Indications for MRI were the presence of pain or discomfort in the joint, despite otherwise effective treatment, with no evidence from ultrasound examination of any obvious signs of active inflammation. The most common location of osteochondral lesion was the knee, although the ankle joint was affected in one case. Five patients had lesions in both knees. Operative treatment was needed in eight cases (joints).ConclusionsPain, and minor dysfunction of the joint are common complaints of children suffering from JIA. Earlier research has discounted the possibility of children who were not athletes presenting with this condition. However, this study demonstrates that these lesions also seem to be relatively common in patients with JIA. When there is no sign of inflammation, the possibility of OCD must therefore be considered in these children.

Osteochondritis Dissecans in Pediatric Patients with Juvenile Idiopathic Arthritis

“…In contrast to previous epidemiologic studies, this population was mostly female; the distribution of lesions was atypical (the LFC was affected as often as the MFC, and 2 patellar lesions were identified); and 50% of the patients required surgical management. The atypical sex and anatomic distributions are in agreement with previous studies by Kröger, et al 7 and Kubo, et al 8 .…”

Imaging Features of the Juvenile Inflammatory Arthropathies

“…3) • Thickening of the periosteum of the metacarpals, metatarsals, and phalangeal diaphysis that may be the only early sign of inflammatory changes in JIA (►Fig. 4) • Bone cysts, erosions, and joint space narrowing due to the gradual loss of articular cartilage as well as subchondral irregularities appearing with time 16 (►Fig. 5).…”

Osteochondritis Dissecans of the Knee: Etiology and Pathogenetic Mechanisms. A Systematic Review

“…The levels of evidence of the included studies included: 39 case reports, 31 case series, 11 laboratory studies and 5 comparative studies. Among the included studies, 40 articles proposed a biological hypothesis, 9-47 including genetic causes ( n = 27), ossification center deficit ( n = 12), and endocrine disorders ( n = 9). Conversely, 52 articles supported a mechanical hypothesis, 12,13,17,29,34,35,47…”

“…Theories vary from an autosomal dominant pattern of inheritance in older studies, 39,40 to the association with genetic determined diseases 12,27 and to gene mutations causing protein alteration leading to OCD in more recent articles. 20,21,44 Other biological hypothesis concerned a deficit in the ossification center; one of the first theories was described in 1955 34 and was analyzed in 12 studies on 153 patients, or lastly endocrinological factors (including vitamin D deficit, 10,42,43 glucocorticoid alterations, 14 human growth hormone (hGH) deficiency, 18 or association with endocrinologic and sexual abnormalities), 36 stressed in 9 studies reporting data of 180 patients.…”