Physical activity in children with juvenile rheumatoid arthritis: Quantification and evaluation

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Objective. To explore physical activity (PA) in adolescents with juvenile idiopathic arthritis (JIA) compared with a healthy population and to examine associations between PA and disease-related factors. Methods. Total energy expenditure (TEE), activity-related energy expenditure (AEE), PA level, and PA pattern were assessed with a 3-day activity diary. Aerobic capacity was assessed using a Symptom Limited Bicycle Ergometry test. Functional ability was assessed with the Childhood Health Assessment Questionnaire. Disease activity was assessed using Paediatric Rheumatology International Trials Organisation core set criteria. Overall well-being was measured using a visual analog scale, and time since diagnosis was assessed by retrospective study from patients' charts. We used a cross-sectional study design. Reference data were collected from healthy Dutch secondary school children. Results. Thirty patients and 106 controls were included (mean ؎ SD age 17.0 ؎ 0.6 and 16.7 ؎ 0.9 years, respectively). TEE, AEE, and PA level were significantly lower in the JIA group. The JIA group spent more time in bed and less time on moderate to vigorous PA. Only 23% of the JIA patients met public health recommendations to perform >1 hour daily moderate to vigorous PA compared with 66% in the reference group. Higher PA was associated with higher levels of well-being and maximal oxygen consumption. Conclusion. Adolescents with JIA have low PA levels and are at risk of losing the benefits of PA. Low PA is not related to disease activity, and control over the disease does not restore previous PA levels. Interventions by pediatric rheumatologists are needed to increase PA levels in patients with JIA.

Section: Introductionmentioning

confidence: 99%

Physical activity in adolescents with juvenile idiopathic arthritis

Lelieveld¹,

Armbrust²,

Leeuwen³

et al. 2008

110

“…These features have been shown to be the results of increased production of tumor necrosis factor ␣ and interleukin-1 (4,5). In addition, it is possible that reduced physical activity during childhood affects the anthropometric variables in children with JIA (6).…”

Section: Introductionmentioning

confidence: 99%

Minor impact of juvenile arthritis on nutritional status in young adult patients

Haugen¹,

Lien²,

Flatø³

et al. 2002

Objective. Growth abnormalities and poor nutritional status have been reported in children with juvenile idiopathic arthritis (JIA). The aim of this study was to evaluate the impact of juvenile chronic rheumatic disease on current nutritional status in adult patients in remission or with active disease. Methods. One hundred thirty-eight women and 82 men, aged >20 years, with JIA were studied after a mean disease duration of 15.5 ؎ 2.3 years. Eighty-four (61%) of the women and 49 (60%) of the men were in remission. Forty-one healthy women and 54 healthy men served as a reference group. Body composition was analyzed by dual-energy x-ray absorptiometry.Results. There was no difference in height or body mass index (BMI) between patients and healthy subjects. However, female patients with systemic disease had significantly reduced BMI compared with those with pauciarticular JIA (P < 0.001), and female patients who used or had been using corticosteroids had significantly lower weight, height, and BMI compared with the patients who had never used corticosteroids (P < 0.05). Female patients in remission had significantly more lean body mass compared with healthy controls (P < 0.05) and significantly less body fat was found in both women and men (P < 0.01 for both). Patients with active disease had the same amount of lean body mass as the healthy controls, but significantly less body fat (P < 0.05 for women and P < 0.01 for men). Conclusion. Adult patients with JIA had attained normal height, weight, and BMI, with the exception of women with systemic JIA and those who were using or had used corticosteroids. Patients with JIA in remission seemed to have a better nutritional status than healthy subjects.

“…Many factors are thought to contribute to diminished bone mass in children with JRA, including the pathology of the disease itself, decreased physical activity due to pain and reduced joint motility (9), and glucocorticoid treatment for inflammation (6,10,11). Early in the course of the disease, JRA often begins as a localized inflammation, which contributes to periarticular osteopenia, a contained loss of bone mineral content (BMC) around the inflamed joint (12).…”

mentioning

confidence: 99%

“…The majority of studies that have evaluated bone mass in patients with JRA have used dual x-ray absorptiometry (DXA) (5,7,8,10,11,17). Although DXA is a practical and common tool for the assessment of bone health, the application of DXA to pediatric populations has several limitations.…”

mentioning

confidence: 99%

Musculoskeletal abnormalities of the tibia in juvenile rheumatoid arthritis

Felin¹,

Prahalad²,

Askew³

et al. 2007

Objective. To characterize local bone geometry, density, and strength, using peripheral quantitative computed tomography (pQCT), compared with general bone characteristics as measured using dual x-ray absorptiometry (DXA), and to assess their relationship to disease-related factors in children with juvenile rheumatoid arthritis (JRA).Methods. Forty-eight children ages 4-18 years with JRA (17 pauciarticular, 23 polyarticular, 8 systemic) were compared with age-matched healthy controls (n ‫؍‬ 266). Measurements included cortical and trabecular bone geometry, density, and strength at the distal and midshaft tibia determined by pQCT, and whole-body, lumbar spine, and femoral neck measurements by DXA.Results. Methotrexate (MTX) was prescribed to 23 of 48 patients (47.9%) and glucocorticoids and MTX were prescribed to 15 of 48 patients (31.3%), with the greatest use in children with systemic JRA. All JRA patients had decreased tibia trabecular bone density, cortical bone size and strength, and muscle mass. Children with systemic JRA had lower femoral neck densities. Systemic JRA was associated with a shorter, less mineralized skeleton, while a narrower, less mineralized skeleton was observed in polyarticular JRA. The tibia diaphysis was narrower with decreased muscle mass, but normal, size-adjusted bone mineral in all subtypes indicated a localized effect of JRA on bone. Patients exposed to glucocorticoids and MTX or to glucocorticoids or MTX alone had greatly reduced trabecular density, cortical bone geometry properties, and bone mineral content, muscle mass, and bone strength.Conclusion. Children with JRA have decreased skeletal size, muscle mass, trabecular bone density, cortical bone geometry, and strength. Not surprisingly, these bone abnormalities are more pronounced in children with greater disease severity.