scholarly journals The Hip in Juvenile Idiopathic Arthritis

2020 ◽  
Vol 14 (1) ◽  
pp. 88-94
Author(s):  
Stuart B. Goodman
Keyword(s):  
Juvenile Idiopathic Arthritis ◽  
Hip Joint ◽  
Joint Destruction ◽  
Joint Arthroplasty ◽  
Degenerative Arthritis ◽  
Chronic Synovitis ◽  
Inflammatory Drugs ◽  
End Stage ◽  
Corticosteroid Injections ◽  
Polyarticular Disease

The hip joint is commonly affected in Juvenile Idiopathic Arthritis (JIA), especially in cases of systemic polyarticular disease. Chronic synovitis of the hip leads to joint destruction, therefore, systemic and local control of the disease is of paramount importance. Non-steroidal anti-inflammatory drugs, Disease Modifying Anti-Rheumatic Drugs (DMARDs), biologics, intra-articular corticosteroid injections, and physical therapy are the mainstay for controlling ongoing inflammation and hip joint contractures. Synovectomy with soft tissue releases is useful in the early stages of the disease, when the joint cartilage is largely preserved. Total joint arthroplasty (THA) is successful in relieving pain, and improving function, ambulation and range of motion in end-stage degenerative arthritis. With improved designs of smaller prostheses and modern bearing couples, it is hoped that the longevity of THA will facilitate a more normal and enduring lifestyle.

scholarly journals Bone mineral density assessment by DXA in rheumatic patients with end-stage osteoarthritis undergoing total joint arthroplasty

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Moritz Mühlenfeld ◽  
André Strahl ◽  
Ulrich Bechler ◽  
Nico Maximilian Jandl ◽  
Jan Hubert ◽  
...  
Keyword(s):  
Bone Mineral Density ◽  
Bone Mineral ◽  
Rheumatic Diseases ◽  
Total Joint Arthroplasty ◽  
Joint Destruction ◽  
Joint Arthroplasty ◽  
Mineral Density ◽  
T Score ◽  
End Stage ◽  
Rheumatic Patients

Abstract Background Patients with rheumatic diseases have a high risk for joint destruction and secondary osteoarthritis (OA) as well as low bone mineral density (BMD, i.e., osteoporosis). While several factors may lead to low BMD in these patients, the value of BMD measurements in rheumatic patients with end-stage OA scheduled for total joint arthroplasty is unknown. Methods In this retrospective cross-sectional study of 50 adults with secondary OA due to rheumatic diseases, we evaluated dual energy X-ray absorptiometry (DXA) measurements of both hips and the spine performed within 3 months prior to arthroplasty (n = 25 total hip arthroplasty, THA; n = 25 total knee arthroplasty, TKA). We analyzed various demographic and disease-specific characteristics and their effect on DXA results by using group comparisons and multivariate linear regression models. Results Although patients undergoing TKA were younger (63.2 ± 14.2 vs. 71.0 ± 10.8 yr., p = 0.035), osteoporosis was observed more frequently in patients scheduled for TKA than THA (32% vs. 12%). Osteopenia was detected in 13/25 patients (52%) in both the THA and TKA cohort. In the THA cohort, female sex, lower BMI and prednisolone use were associated with lower T-score in the hip. In TKA patients, higher OA grade determined by Kellgren-Lawrence score was associated with lower T-score in the hip of the affected side. Conclusions Osteoporosis is present in a considerable frequency of rheumatic patients with end-stage OA, and THA and TKA patients show distinct frequencies and risk factors of low BMD. Our findings point to a potential value of DXA regarding preoperative evaluation of bone status.

scholarly journals PRIMARY HIP ARTHROPLASTY IN PATIENTS WITH END-STAGE OF CHRONIC KIDNEY DISEASE (LITERATURE REVIEW)

2018 ◽  
Vol 24 (2) ◽  
pp. 146-153 ◽  
Author(s):  
A. N. Tsed ◽  
A. K. Dulaev
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Hip Joint ◽  
Joint Arthroplasty ◽  
Disease Epidemiology ◽  
Joint Pathology ◽  
Specialized Care ◽  
Promising Area ◽  
Number Of Publications ◽  
End Stage

The authors present a review of current national and international literature related to the specifics of primary hip joint arthroplasty in patients with end-stage of chronic kidney disease. epidemiology aspects of such pathology are covered in detail. Screening of the patients with hip joint pathology undergoing substitute renal therapy remains a significant issue. The authors present the outcomes of use of various implant types and their fixation in primary hip joint arthroplasty such as cemented, cementless and monopolar prostheses, as well as consider features and structure of complications following primary replacements in such patients. unfortunately, the national literature lacks sufficient number of publications on the present problem. In addition, the paper presents a promising area for development of specialized care to patients on hemodialysis with hip joint pathology.

scholarly journals Beyond the guidelines management of juvenile idiopathic arthritis: a case report of a girl with polyarticular disease refractory to multiple treatment options and Leri Weill syndrome

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Vana Vukić ◽  
Ana Smajo ◽  
Mandica Vidović ◽  
Rudolf Vukojević ◽  
Miroslav Harjaček ◽  
...  
Keyword(s):  
Juvenile Idiopathic Arthritis ◽  
Case Report ◽  
Treatment Options ◽  
Janus Kinase ◽  
Musculoskeletal Symptoms ◽  
Multiple Treatment ◽  
Number Of Patients ◽  
Systemic Glucocorticoids ◽  
Inflammatory Drugs ◽  
Anti Inflammatory

Abstract Background The last two decades brought new treatment options and high quality guidelines into the paediatric rheumatologic practice. Nevertheless, a number of patients still present a diagnostic and therapeutic challenge due to combination of vague symptoms and unresponsiveness to available treatment modalities. Case presentation We report a case of sixteen years old girl suffering from polyarticular type of juvenile idiopathic arthritis refractory to multiple treatment options. She first presented at the age of 4 with swelling and contractures of both knees. Her symptoms were initially unresponsive to nonsteroidal anti-inflammatory drugs and progressed despite treatment with intraarticular and systemic glucocorticoids and methotrexate. Throughout the years, she received several biologics together with continuous administration of nonsteroidal anti-inflammatory drugs and disease modifying anti-rheumatic drugs as well as intraarticular and systemic glucocorticoids in disease flares. However, none of this options  provided a permanent remission, so various other modalities, as well as other possible diagnoses were constantly being considered. Eventually she became dependent on a daily dose of systemic glucocorticoids. In 2018, the treatment with Janus kinase inhibitor tofacitinib was initiated, which led to gradual amelioration of musculoskeletal symptoms, improvement of inflammatory markers and overall well-being, as well as to the weaning of systemic glucocorticoids. As the swelling of the wrists subsided for the first time in many years, Madelung’s deformity was noticed, first clinically, and later radiographically as well. Genetic analysis revealed short-stature homeobox gene deficiency and confirmed the diagnosis of Leri Weill syndrome. Conclusions This case report emphasizes the need for reporting refractory, complicated cases from everyday clinical practice in order to build-up the overall knowledge and share experience which is complementary to available guidelines. Individual reports of difficult to treat cases, especially when additional diagnoses are involved, can be helpful for physicians treating patients with common rheumatological diseases such as juvenile idiopathic arthritis.

scholarly journals Phenylketonuria and juvenile idiopathic arthritis: a case report

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ting Ting Zhu ◽  
Jin Wu ◽  
Li Yuan Wang ◽  
Xiao Mei Sun
Keyword(s):  
Juvenile Idiopathic Arthritis ◽  
Case Report ◽  
Autoimmune Diseases ◽  
Hip Joint ◽  
Metabolic Disorder ◽  
Rare Case ◽  
Molecular Data ◽  
Methotrexate Therapy ◽  
Case Presentation

Abstract Background Phenylketonuria (PKU) is a genetic metabolic disorder in which patients have no ability to convert phenylalanine to tyrosine. Several autoimmune diseases have been reported to combine with PKU, co-existent of PKU and Juvenile Idiopathic Arthritis (JIA) has not been presented. Case presentation The girl was diagnosed with PKU at the age of 1 month confirmed by molecular data. At the age of 3.5 years, she presented with pain and swelling of her right ankle, right knee, and right hip joint. After a serial of examinations, she was diagnosed with JIA and treated with a nonsteroidal anti-inflammatory drug. Conclusions We report a rare case of a 4-year-old girl with PKU and JIA, which supports a possible interaction between PKU and JIA. Long-term metabolic disturbance may increase the susceptibility to JIA. Further chronic inflammation could alter the metabolism of tryptophan and tyrosine to increase blood Phe concentration. In addition, corticosteroid and methotrexate therapy for JIA may increase blood Phe concentration.

scholarly journals Microvascular Density of Rapidly Destructive Arthropathy of the Hip Joint

2005 ◽  
Vol 13 (1) ◽  
pp. 40-45 ◽  
Author(s):  
T Yamakawa ◽  
A Sudo ◽  
M Tanaka ◽  
A Uchida
Keyword(s):  
Femoral Head ◽  
Hip Joint ◽  
Joint Destruction ◽  
Bone Destruction ◽  
Microvascular Density ◽  
Blood Capillaries ◽  
Secondary Osteoarthritis ◽  
Femoral Heads ◽  
Formalin Fixed Paraffin Embedded ◽  
Destructive Arthropathy

Purpose. To assess the vascularity of the femoral head and determine how it is related to the destruction of the arthritic hip joint. The process of destructive arthropathy in arthritic hip joints is variable. Some patients with osteoarthritis of the hip have rapidly progressive destructive changes resulting in the disappearance of the femoral head. Method. Six femoral heads from patients diagnosed with rapidly destructive arthropathy and 6 femoral heads from patients with secondary osteoarthritis caused by acetabular dysplasia were analysed to reveal the association between blood capillaries and osteoclasts. The von Willebrand Factor immunostaining and counterstaining with Mayer's haematoxylin were used to label the microvessels and osteoclasts in formalin-fixed, paraffin-embedded specimens of femoral heads. The numbers of immunostained microvessels and osteoclasts in selected regions were counted. Result. The microvascular density of the bone surfaces of rapidly progressive arthritic hips was hypervascular. Osteoclasts were also found in increased numbers on the bone surfaces of rapidly progressive arthritic hips. The higher microvascular density coincided with extensive bone destruction and with the increased osteoclast count. Conclusion. These findings suggested that hypervascularity of the granulation in the femoral head may be associated with bone and joint destruction.

scholarly journals Juvenile Idiopathic Arthritis

2021 ◽  
Author(s):  
Vadood Javadi Parvaneh ◽  
Khosro Rahmani
Keyword(s):  
Juvenile Idiopathic Arthritis ◽  
Early Diagnosis ◽  
Joint Destruction ◽  
Joint Inflammation ◽  
Aggressive Treatment ◽  
Synovial Joint ◽  
Management Options ◽  
Biologic Dmards ◽  
Appropriate Treatment ◽  
Outcomes For Children

Juvenile idiopathic arthritis (JIA) is the most common form of chronic synovial joint inflammation in children. It potentially leads to disability and psychosocial outcomes for children and their families. In the absence of appropriate treatment, this can lead to joint destruction and disability. Thus, early diagnosis and aggressive treatment are essential. With the presentation of new biologic DMARDs, based on understanding the disease pathophysiology and molecular pathogenesis, the course of the disease and its outcome have been changed profoundly. In this chapter, the early diagnosis, appropriate treatment, and outcomes approaches are described. These include the latest diagnosis and management options.

Osteoarthritis—management

2013 ◽  
pp. 1187-1196
Author(s):  
Claire Y. J. Wenham ◽  
Philip G. Conaghan
Keyword(s):  
Functional Limitation ◽  
Anatomical Site ◽  
Treatment Goals ◽  
Pain Mechanisms ◽  
Muscle Strengthening ◽  
Inflammatory Drugs ◽  
Topical Capsaicin ◽  
The Impact ◽  
Corticosteroid Injections

Osteoarthritis (OA) is a common condition which often causes pain and functional limitation, significantly impacting on a person’s quality of life. A comprehensive assessment of the impact of OA should be performed before selecting therapies and treatment goals. Current recommended therapies include a combination of pharmacological and non-pharmacological therapies, which should be considered for all people with OA, regardless of anatomical site of involvement. Non-pharmacological treatments include education, muscle strengthening and aerobic exercises, weight loss if appropriate, splints and devices, and aids. Pharmacological therapies include paracetamol, oral and topical non-steroidal anti-inflammatory drugs, topical capsaicin, intra-articular corticosteroid injections, and opioids. Many existing therapies have only a small analgesic effect size and, in the case of drug therapies, may be associated with important side effects, so an individual’s symptoms and comorbidities must be taken into account when selecting therapies. For those who do not respond to these treatments, surgery such as a total joint arthroplasty may be required. There is a strong need for new analgesic treatments for OA. As it is becoming increasingly clear that the sources of pain in OA are complex and multifactorial, future treatments for OA will need to target both peripheral and central pain mechanisms.

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