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Published on: October 6, 2023
Hip disease in juvenile rheumatoid arthritis
Charles H Spencer1, Bram H Bernstein
1Section of Rheumatology, La Rabida Children's Hospital, University of Chicago Children's Hospital, Pritzker School of Medicine, Chicago, Illinois 60649, USA. spencercharlesh@aol.com
Insights
Juvenile rheumatoid arthritis (JRA) frequently impacts hips, risking future disability. Modern treatments and surgical advances are improving outcomes for children with JRA hip disease.
Area of Science:
- Pediatric Rheumatology
- Orthopedic Surgery
- Clinical Medicine
Background:
- Hip involvement is common in severe, destructive juvenile rheumatoid arthritis (JRA), affecting 30-50% of affected children.
- Hip disease in JRA signifies a risk of future disability due to the joint's weight-bearing role.
- Clinicians face challenges in preventing, halting, and managing JRA-related hip disease, including surgical interventions.
Purpose of the Study:
- To review the challenges and current trends in managing hip disease in juvenile rheumatoid arthritis (JRA).
- To highlight the impact of evolving treatment strategies and surgical improvements on JRA hip disease outcomes.
Main Methods:
- Review of current clinical practices and treatment trends for JRA hip disease.
- Analysis of recent advancements in pediatric rheumatologic care and orthopedic surgery.
Main Results:
- Aggressive treatment approaches and effective medications are reducing the incidence of severe JRA hip disease requiring surgery.
- Improvements in hip arthroplasty techniques have led to better surgical outcomes for children with JRA.
Conclusions:
- Early and aggressive management is crucial for mitigating hip involvement in JRA.
- Advances in both medical and surgical fields are improving the long-term prognosis for children with JRA affecting the hips.
Abstract:
In contrast to adult rheumatoid arthritis, hips are commonly affected joints in severe, destructive, juvenile rheumatoid arthritis (JRA). Hip disease develops in 30 to 50% of children with JRA. Because of the importance of the hip joint in weight bearing the advent of hip disease in a child with JRA warns of future disability [1, 2]. The challenges for the clinician are to prevent significant hip involvement, to halt further damage when hip disease is noted, and in the event that conservative treatment fails, to guide the child and family through hip arthroplasty and rehabilitation. Recent trends suggest that today's more aggressive treatment approach and more effective drugs are resulting in fewer children with JRA developing into severe hip disease requiring hip surgery. Similarly, with improvements in orthopedic surgery, the results of hip arthroplasty have improved.
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