Ear involvement in patients affected by juvenile idiopathic arthritis

The incudomalleal and incudostapedial articulations are synovial joints that may be involved in the inflammatory process in patients with juvenile idiophathic arthritis (JIA). The aim of the study was to assess the frequency of hearing impairment and associated risk factors in JIA patients.

We performed a cohort study on 45 patients with three JIA subtype (oligoarticular, polyarticular and psoriatic) aged between 3 and 18years. The control group consisted of 30 healthy sex and age-matched children. Subjects underwent audiological exams and clinical-rheumatologic evaluations, including joint count (Juvenile Arthritis Disease Activity Score=cJADAS10) and inflammatory markers.

Audiological impairment was detected in 16/45 (35.5%) patients with JIA. Hypoacusis was found in a significant number of ears in JIA patients (16/90=17.8%; P<0.05) compared with to control group ears. Hypoacusis was frequently observed in patients with psoriasis (6/16 ears). Abnormal findings in tympanometry were observed in five types of As (with a shallow peak), four with type B (flat pattern), and in two with type C (with a negative pressure). The stapedius reflex was absent in only one patient (3%). JIA patients with hypoacusis had a significantly greater cJADAS10 (P<0.001) and Childhood Health Assessment Questionnaire (CHAQ) (P<0.001), a functional and quality of life assessment tool, than JIA patients with normal audiometry.

Hearing impairment and/or abnormal tympanograms suggest ear involvement in patients with JIA. This may be considered a complication of the disease and/or a marker of JIA activity, according cJADAS10, and could represent a valuable criterion to select the best therapeutic strategy. Therefore, JIA patients should perform an Ear, Nose and Throat (ENT) evaluation to allow early detection of auditory system involvement to prevent the impact of hearing loss.