Secondary consequences of juvenile idiopathic arthritis in children and adolescents with knee involvement: physical activity, adiposity, fitness, and functional performance

Nesbitt, Colleen; Kuntze, Gregor; Toomey, Clodagh; Esau, Shane; Brooks, John H M; Mosher, Dianne; Twilt, Marinka; Nettel-Aguirre, Alberto; Palacios-Derflingher, Luz; Ronsky, Janet L.; Benseler, Susanne M.; Emery, Carolyn A.

doi:10.1007/s00296-021-04920-5

Cited by 11 publications

(29 citation statements)

References 46 publications

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“…However, the heterogeneity of patient‐specific disease characteristics, differential responses to clinical management, and differences in assessment techniques may contribute to disparate research findings. While Houghton et al (9) reported impaired postural balance in youth with JIA using an unstable multi‐axis platform, Nesbitt et al (8) did not observe dynamic balance deficits using a triple single‐leg hop, while Merker et al (18) reported improved balance for youth with JIA using a uni‐axis balance platform. Such differences in research findings illustrate the challenges of assessing body structure and function outcomes and highlight the need for additional research to assess the secondary consequences of JIA in youth using validated and reliable protocols and measurement approaches.…”

Section: Introductionmentioning

confidence: 99%

“…Important considerations regarding physical activity participation include secondary consequences of JIA, which may include body structure and function (6), physical activity, and participation outcomes. A growing body of evidence indicates that youth with JIA may experience reduced physical activity (7,8), impaired postural balance (9), alterations in joint biomechanics of gait and jumping (10)(11)(12)(13)(14), decreased physical fitness (15), including bone and muscle structure (16), and strength deficits (17). However, the heterogeneity of patient-specific disease characteristics, differential responses to clinical management, and differences in assessment techniques may contribute to disparate research findings.…”

Section: Introductionmentioning

confidence: 99%

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Vertical Drop Jump Performance in Youth With Juvenile Idiopathic Arthritis

Kuntze

Nettel-Aguirre

Brooks

et al. 2021

Arthritis Care & Research

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Objective Juvenile idiopathic arthritis (JIA) is associated with altered body structure and function outcomes that may expose youth with JIA to a greater risk of secondary joint injury. This study aimed to examine differences in vertical drop jump (VDJ) biomechanics for youth with JIA and healthy youth (control group). Methods The present study was a matched pair cohort study. Youth with JIA (n = 30) and their age‐ and sex‐matched control peers participated in this ethics‐approved study. Lower‐extremity biomechanics information was obtained using a motion analysis system (Motion Analysis) and 2 force plates (AMTI). Biomechanics outcomes included hip, knee, and ankle joint angles, ground reaction forces (GRF), and VDJ phase durations. Other outcomes included disease activity, physical disability, and sports participation. Matched pairs data (JIA–control) were analyzed using a multivariate random coefficient model (version 3.5.0, R Core Team; joint angles, potential confounders) and paired samples t‐tests with Bonferroni correction (α = 0.0125; GRF, VDJ phase durations). Results Youth with JIA had low disease activity, pain, and disability scores. Youth with JIA maintained a more erect posture at the hip (β = –4.0°, P = 0.004), knee (β = 7.5°, P = 0.004) and ankle (β = –2.6°, P = 0.001). GRF and phase durations outcomes did not meet criteria for significant differences. Knee extension increased with participant age (β = –1.0°, P = 0.002), while female participants displayed greater hip flexion (β = –6.6°, P = 0.001) and less ankle dorsiflexion (β = 2.3°, P = 0.006). Conclusion This study provides evidence for a stiff knee landing strategy by youth with JIA. These findings inform targets for physical therapy management to mitigate the risks of a secondary joint injury in sports participation.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Vertical Drop Jump Performance in Youth With Juvenile Idiopathic Arthritis

Kuntze

Nettel-Aguirre

Brooks

et al. 2021

Arthritis Care & Research

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“…A growing body of evidence indicates that the secondary consequences of JIA may include participation in less moderate to vigorous physical activity (8,9), impaired postural balance (10), and decreased physical fitness (11), as well as bone and mus cle structure (12) and strength deficits (13). Further, individuals with JIA appear to be more sensitive to mechanical and thermal stimuli, even in the absence of pain or active disease (14).…”

Section: Introductionmentioning

confidence: 99%

Consequences of Juvenile Idiopathic Arthritis on Single Leg Squat Performance in Youth

Kuntze

Nettel-Aguirre

Brooks

et al. 2021

Arthritis Care & Research

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Objective. Juvenile idiopathic arthritis (JIA) affects body structure and function outcomes that may increase the risk of acute joint injury. The purpose of this study was to examine single leg squat (SLS) biomechanics for youth with JIA and their healthy peers. The study design was a matched pair cohort study.Methods. Sixty-five youth (JIA n = 30; control n = 35) participated in this ethics-approved study. Participants performed 3 sets of 5 consecutive SLS tasks. Disease activity and functional status were assessed using the Juvenile Arthritis Disease Activity Score and Child Health Assessment Questionnaire. Indexed (most-affected leg [JIA]; dominant leg [control]) and contralateral extremity biomechanics were obtained using a 12-camera system. Outcomes included hip flexion/extension (FE), adduction/abduction (AA), and internal/external (IE) rotation range of motion (ROM). Data were analyzed using a multivariate random coefficient model in R (α⍺ = 0.05).Results. A total of 29 matched pairs were analyzed. Youth with JIA had low disease activity and performed the SLS with a more internally rotated hip (indexed leg P = 0.023, β = -1.9°). Female participants displayed greater hip FE (indexed leg P = 0.015, β = -4.3°; contralateral leg P = 0.005, β = -4.8°) and IE ROM (indexed leg P = 0.021, β = -2.1°) than male participants. Associations were observed for body mass index and hip IE ROM (contralateral leg P = 0.001, β = -0.4°), knee flexion angle, and hip FE ROM (indexed leg P = 0.001, β = 0.4°; contralateral leg P = 0.001, β = 0.5°) and AA (indexed leg P = 0.010, β = 0.1°; contralateral leg P = 0.002, β = 0.2°).Conclusion. This study identified functional alterations for an SLS in youth with JIA. These findings support the use of physical therapy as part of a multidisciplinary management approach, to restore normal hip posture and movement.

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“…Van Brussel et al observed that children with JIA had reduced anaerobic capacity [9]. A recent Canadian study in 2022 showed no statistically signi cant decrease in maximal oxygen uptake in a group of adolescents with JIA compared to same-aged controls [14]. Neither a larger Norwegian study in 2019 found a difference in CRF, assessed by a treadmill exercise test, between JIA patients and healthy children [13].…”

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confidence: 97%

“…In a meta-analysis before the era of biologic drugs, maximal oxygen uptake, a measure of cardiorespiratory tness (CRF), was 22% lower in JIA patients than in healthy children [10]. Also, other studies have reported lowered cardiorespiratory and neuromuscular tness in children with JIA despite adequate treatment [11][12][13][14]. Van Brussel et al observed that children with JIA had reduced anaerobic capacity [9].…”

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confidence: 99%

Impaired cardiorespiratory and neuromuscular fitness in children and adolescents with juvenile idiopathic arthritis: A cross-sectional case-control study in the era of biologic drug therapies

Räsänen

Markula-Patjas

Kantanen

et al. 2022

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Background: In recent years, biologic drug therapies have altered the course of juvenile idiopathic arthritis (JIA) possibly also improving the patients’ physical fitness. However, studies measuring both cardiorespiratory and muscular fitness in children with JIA are sparse and have failed to show consistent results. Our aim was to assess both cardiorespiratory and neuromuscular fitness and contributing factors in children and adolescents with JIA in the era of biologic drug therapies. Methods: This cross-sectional study consisted of 73 JIA patients (25 boys, 48 girls) aged 6.8- 17.5 years and 73 healthy age- and sex-matched controls, investigated in 2017-2019. Cardiorespiratory fitness was assessed by maximal ergospirometry and neuromuscular fitness by speed, agility, balance, and muscle strength tests. Results: Means (± SD) of maximal workload (Wmax/kg) and peak oxygen uptake (VO2peak/kg,) were lower in JIA patients than in controls (Wmax/kg: 2.80 ± 0.54 vs. 3.14 ± 0.50 Watts, p<0.01; VO2peak/kg: 38.7 ± 7.53 vs. 45.8 ± 6.59 ml/min/kg, p<0.01). Shuttle-run, sit-up and standing long jump test results were lower in JIA patients than in controls (p<0.01). Mean (±SD) daily activity was lower (89.0 ± 44.7 vs. 112.7 ± 62.1 min/day, p<0.05), and sedentary time was higher (427 ± 213 vs. 343 ± 211 min/day, p<0.05) in JIA patients compared to controls. Physical activity and cardiorespiratory or neuromuscular fitness were not associated with disease activity. Conclusions: Regardless of disease activity, JIA patients were physically less active and had lower cardiorespiratory and neuromuscular fitness than their same aged controls with no JIA. Therefore, JIA patients should be encouraged to engage in physical activities as a part of their multidisciplinary treatment protocols to prevent adverse health risks of low physical activity and fitness. Trial registration: Not applicable.

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Secondary consequences of juvenile idiopathic arthritis in children and adolescents with knee involvement: physical activity, adiposity, fitness, and functional performance

Cited by 11 publications

References 46 publications

Vertical Drop Jump Performance in Youth With Juvenile Idiopathic Arthritis

Vertical Drop Jump Performance in Youth With Juvenile Idiopathic Arthritis

Consequences of Juvenile Idiopathic Arthritis on Single Leg Squat Performance in Youth

Impaired cardiorespiratory and neuromuscular fitness in children and adolescents with juvenile idiopathic arthritis: A cross-sectional case-control study in the era of biologic drug therapies

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