Related Experiment Videos
Shoulder limitation in juvenile rheumatoid arthritis
A K Libby1, D D Sherry, B J Dudgeon
1Children's Hospital and Medical Center, Seattle, WA 98105.
Insights
Juvenile rheumatoid arthritis (JRA) frequently causes shoulder dysfunction, particularly in systemic and polyarticular forms. Early monitoring of shoulder pain and motion limitations is crucial for affected children.
Area of Science:
- Pediatric Rheumatology
- Orthopedic Surgery
- Musculoskeletal Disorders
Background:
- Juvenile rheumatoid arthritis (JRA) is a chronic inflammatory condition affecting children.
- Shoulder involvement in JRA can lead to significant functional limitations.
- Understanding the patterns of JRA-related shoulder dysfunction is essential for effective management.
Purpose of the Study:
- To evaluate the prevalence and characteristics of shoulder dysfunction in children with JRA.
- To identify differences in shoulder involvement based on JRA onset type (pauciarticular, polyarticular, systemic).
- To determine the impact of JRA on specific shoulder movements.
Main Methods:
- A cohort of 100 consecutive children diagnosed with JRA was assessed.
- Shoulder function was evaluated, including pain assessment and passive range of motion (PROM) measurements.
- Data were analyzed based on the subtype of JRA onset.
Main Results:
- Shoulder arthritis was rare in pauciarticular JRA but present in 50% of polyarticular and 80% of systemic JRA cases.
- Most children with shoulder arthritis (95%) experienced bilateral involvement.
- Systemic JRA onset was associated with earlier and more severe PROM limitations, especially in internal rotation and abduction.
Conclusions:
- Shoulder dysfunction is a common complication of polyarticular and systemic JRA.
- Systemic JRA onset presents a higher risk for significant shoulder involvement and limited PROM.
- Clinicians should routinely assess shoulder pain and range of motion in children with JRA, focusing on rotational and planar movements.
Abstract:
One hundred consecutive children with juvenile rheumatoid arthritis (JRA) were evaluated for shoulder dysfunction. Shoulder arthritis was virtually absent in all 45 children with pauciarticular onset JRA. Twenty of 40 children (50%) with polyarticular JRA and 12 of 15 (80%) with systemic onset JRA had shoulder involvement characterized by pain or restricted passive range of motion (PROM). Ninety-five percent of those with shoulder arthritis had bilateral involvement. Children with systemic onset were likely to have shoulder disease within 2.5 years of onset and to have more severely limited PROM. Children with polyarticular onset developed shoulder arthritis any time during the course of their disease. With either type of onset, internal rotation was the most commonly and severely limited motion, followed by abduction. Clinicians treating children with JRA should carefully monitor pain and examine both rotational and planar components of shoulder motion.