Abstract
The hip joint is commonly affected in Juvenile Idiopathic Arthritis (JIA), especially in cases of systemic polyarticular disease. Chronic synovitis of the hip leads to joint destruction, therefore, systemic and local control of the disease is of paramount importance. Non-steroidal anti-inflammatory drugs, Disease Modifying Anti-Rheumatic Drugs (DMARDs), biologics, intra-articular corticosteroid injections, and physical therapy are the mainstay for controlling ongoing inflammation and hip joint contractures. Synovectomy with soft tissue releases is useful in the early stages of the disease, when the joint cartilage is largely preserved. Total joint arthroplasty (THA) is successful in relieving pain, and improving function, ambulation and range of motion in end-stage degenerative arthritis. With improved designs of smaller prostheses and modern bearing couples, it is hoped that the longevity of THA will facilitate a more normal and enduring lifestyle.
Highlights
Juvenile Idiopathic Arthritis (JIA) is the most common rheumatologic disease in children less than 16 years of age and has an incidence of approximately 16-150 cases per 100,000 children worldwide [1, 2]
The hip joint is commonly affected in JIA; in approximately 20-40% of JIA patients, the hip joint will be afflicted by chronic synovitis that leads to pain and stiffness due to ongoing inflammation and progressive joint destruction [2, 3]
A recent study has shown that JIA patients treated medically after the year 2000 with newer biologic therapies had less disability than previously; 25% of the patients were in remission
Summary
Juvenile Idiopathic Arthritis (JIA) is the most common rheumatologic disease in children less than 16 years of age and has an incidence of approximately 16-150 cases per 100,000 children worldwide [1, 2]. Two years after the diagnosis of systemic JIA is made, clinical hip involvement can be expected in about 50% of patients [2]. These events lead to disuse atrophy and regional osteoporosis, contractures and difficulties with ambulation and function. In younger patients usually below the age of 9, local inflammation of the hip joint stimulates growth, resulting in a coxa magna, as well as a very elongated femoral neck with excessive anteversion (“pseudovalgus”) [3]. When the disease is initiated or worsens after approximately age 9 when much growth has been completed, the growth plate of the capital epiphysis may close prematurely, leading to coxa magna but shortening and varus alignment of the femoral neck and overgrowth of the trochanteric apophysis.
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