Причины развития остеоартрита тазобедренного сустава у пациентов с ювенильным идиопатическим артритом: результаты ретроспективного исследования и анализ литературных данных

Abstract

Osteoarthritis (OsA) of the hip joint (HJ) is one of the most serious structural complications of juvenile idiopathic arthritis (JIA). Objective. Assess risk factors for OsA of the HJ in patients with JIA. Patients and methods. This retrospective study included 753 JIA patients aged 2 to 17 years. The diagnosis of JIA was based on the ILAR criteria. The diagnosis of HJ OsA (n = 48) was based on the Dale radiological classification; the indications for joint replacement were formed according to the WOMAC scale and Oxford hip score. Results. The development of HJ OsA was registered within 5 years (range 2,4; 9,4 years) after JIA onset in 6.4% of patients with JIA (n = 48) or 31.4% of patients who had hip joint lesions. The frequency of HJ replacement (n = 16) was 2.1%, 10.5%, 33.3% in all children with JIA, among patients with HJ arthritis, and patients with HJ osteoarthritis, respectively. The main predictors of HJ OsA included systemic arthritis, administration of systemic corticosteroids, >4 active joints, total alkaline phosphatase <165 U/L, long time without remission, involvement of joints of the upper half of the body, and no timely initiation of biologicals. The predictors of HJ replacement were systemic arthritis, pulse therapy with methylprednisolone, and late administration of biologicals. Conclusion. Timely control of JIA activity, achievement of remission, avoidance of glucocorticosteroid therapy or its early replacement with biologicals reduced the risks of developing structural lesions of the HJ in patients with JIA. Key words: osteoarthritis, hip joint, ischemic osteonecrosis, juvenile idiopathic arthritis, risk factors, corticosteroids