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Lung function abnormalities and respiratory muscle weakness in children with juvenile chronic arthritis
L M Knook1, I M de Kleer, C K van der Ent
1Dept of Immunology, University Hospital for Children and Youth, het Wilhelmina Kinderziekenhuis, Utrecht, The Netherlands.
Insights
Children with juvenile chronic arthritis (JCA) experience reduced respiratory muscle strength, leading to mild lung function abnormalities. This impairment is linked to increased disability scores in affected children.
Area of Science:
- Pediatric Rheumatology
- Pulmonary Medicine
- Clinical Physiology
Background:
- Limited understanding of lung function abnormalities in juvenile chronic arthritis (JCA) compared to adult rheumatoid arthritis (RA).
- Need to investigate the prevalence, nature, and causes of respiratory issues in pediatric arthritis patients.
Purpose of the Study:
- To determine if children with polyarticular and systemic JCA exhibit lung function abnormalities.
- To assess the relationship between these abnormalities and pulmonary disease, thoracic, or muscular involvement.
Main Methods:
- Lung function and disability were assessed in 31 children with polyarticular and systemic JCA.
- Respiratory muscle strength (PI,max, PE,max), thorax expansion, and spine mobility were measured and compared to 32 healthy controls.
Main Results:
- JCA patients showed significantly reduced Peak Expiratory Flow (PEF) and Forced Vital Capacity (FVC) compared to reference values.
- Respiratory muscle pressures (PI,max, PE,max) were significantly lower in JCA patients than in controls.
- Reduced expiratory pressure correlated inversely with disability scores.
Conclusions:
- Children with polyarticular and systemic JCA demonstrate significant impairment in respiratory muscle strength.
- This muscle weakness contributes to mild lung function abnormalities and increased disability in pediatric arthritis patients.
Abstract:
In contrast to adult rheumatoid arthritis (RA) little is known about the prevalence, nature and cause of lung function abnormalities in children with juvenile chronic arthritis (JCA). The aim of this study was to determine whether children with polyarticular and systemic onset JCA have lung function abnormalities and if so, whether they are related to pulmonary disease, thoracic and/or muscular involvement. We determined lung function and disability in 31 children with polyarticular and systemic JCA. Respiratory muscle function, thorax expansion and spine mobility were determined in the same patients, as well as in 32 matched healthy children. Peak expiratory flow (PEF) and forced vital capacity (FVC) were significantly reduced in JCA patients, when compared to reference values. Thorax expansion and spine mobility were normal, compared to paired controls. Maximum inspiratory (PI,max) and expiratory (PE,max) pressures were significantly reduced in patients compared to paired control subjects. A positive correlation was found between PE,max and FVC and PEF, an inverse correlation between expiratory pressure and disability. In conclusion, children with polyarticular and systemic juvenile chronic arthritis show a pronounced impairment in respiratory muscle strength, severe enough to cause mild lung function abnormalities and an increase in disability-scores.