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Wrist Arthroscopy in Juvenile Idiopathic Arthritis: A Review of Current Literature and Future Implications
P V Vermaak1, T R Southwood1, T R Lindau2
1Department of Plastic and Reconstructive Surgery, Birmingham Women's and Children's Hospital, Birmingham, United Kingdom.
Insights
Current evidence on wrist arthroscopy and arthroscopic synovectomy (AS) for Juvenile Idiopathic Arthritis (JIA) is limited. While not directly studied in JIA wrists, AS shows promise for refractory cases, potentially preserving joint function.
Area of Science:
- Pediatric Rheumatology
- Orthopedic Surgery
Background:
- Juvenile Idiopathic Arthritis (JIA) is a common childhood rheumatic disease.
- Wrist involvement is frequent in JIA, impacting function and quality of life.
Purpose of the Study:
- To review the existing evidence for wrist arthroscopy and arthroscopic synovectomy (AS) in Juvenile Idiopathic Arthritis.
- To assess the potential role of AS in managing refractory JIA wrist disease.
Main Methods:
- A systematic literature review was conducted.
- Searched databases included Cochrane Library, MEDLINE, EMBASE, and PubMed from 1990 to present.
Main Results:
- No studies were found specifically detailing arthroscopy or AS for JIA wrist involvement.
- Evidence in rheumatoid arthritis suggests AS can reduce pain, improve function, and induce remission.
Conclusions:
- There is a lack of direct evidence for AS in JIA wrists.
- AS may be a safe and effective option for refractory JIA, potentially delaying joint destruction and preserving function.
Abstract:
Introduction Juvenile Idiopathic Arthritis (JIA) is the most common rheumatological condition in children and frequently affects the wrist. The roles for wrist arthroscopy and arthroscopic synovectomy (AS) in JIA are unclear. Our aim was to find the current evidence supporting its use. Methods Systematic literature review of relevant publications from 1990 to present in the Cochrane Library, Clinical Knowledge Summaries, DynaMed, PEMSoft, NICE Guidance, MEDLINE, EMBASE, and PubMed. Results We found no publications detailing the use of arthroscopy or AS specifically in patients with JIA involving the wrist. There is evidence that AS reduces pain, improves function, and induces remission in patients with rheumatoid arthritis resistant to medical management. Discussion and Conclusion Although there is paucity in evidence for the use of AS in the wrists of patients with JIA, studies suggest it to be safe and effective, and could be applied to patients with refractive JIA. It is possible that early identification of patients suffering from JIA with extensive joint destruction and little symptoms could benefit from AS, delaying joint destruction and preserving function.
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