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Vasil E, M Nesbitt C, Toomey C, Kuntze G, Esau S, A Emery C, Gabel L. Bone health and physical activity in adolescents with juvenile idiopathic arthritis: a cross-sectional case-control study. Pediatr Rheumatol Online J 2024; 22:45. [PMID: 38641611 PMCID: PMC11031938 DOI: 10.1186/s12969-024-00982-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 04/04/2024] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND Adolescents with juvenile idiopathic arthritis (JIA) tend to engage in less physical activity than their typically developing peers. Physical activity is essential for bone development and reduced physical activity may detrimentally effect bone health. Thus, we examined differences in total body bone mineral content (BMC) and areal bone mineral density (aBMD) between adolescents with JIA and adolescent controls without JIA. We also examined associations between moderate-to-vigorous physical activity (MVPA), lean mass, and bone outcomes. METHODS Participants included 21 adolescents with JIA (14 females, 7 males) and 21 sex- and age-matched controls aged 10-20 years. Assessments included: height; weight; triple-single-leg-hop distance (TSLH); MVPA by accelerometry; and total body BMC, aBMD, and lean mass measured using dual X-ray absorptiometry. Height-adjusted z-scores were calculated for BMC and aBMD and used for all analyses. Multiple linear mixed effects models examined group differences in BMC and aBMD, adjusting for sex, maturity, MVPA, TSLH, and lean mass. Participants clusters, based on sex and age (within 18 months), were considered random effects. RESULTS Adolescents with JIA had lower total body aBMD z-scores [β (95% CI); -0.58 (-1.10 to -0.07), p = 0.03] and BMC z-scores [-0.47 (-0.91 to -0.03), p = 0.04] compared with controls. Mean daily MVPA was 22.0 min/day lower in adolescents with JIA than controls; however, MVPA was not associated with aBMD [-0.01 (-0.01 to 0.01), p = 0.32] or BMC [0.00 (-0.01 to 0.00), p = 0.39]. Lean mass was positively associated with aBMD [0.05 (0.01 to 0.09) g/cm2, p = 0.03] and BMC [0.06 (0.03 to 0.10) g, p < 0.001]. CONCLUSION Adolescents with JIA had lower total body aBMD and BMC compared with sex- and age-matched controls without JIA. Group differences in bone outcomes were not associated with the lower MVPA participation of adolescents with JIA. Despite this, physical activity should still be encouraged as it promotes physical well-being.
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Affiliation(s)
- Egi Vasil
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, 2500 University Dr NW, T2N 1N4, Calgary, AB, Canada
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Canada
| | - Colleen M Nesbitt
- Sport Injury Prevention Research Center, Faculty of Kinesiology, University of Calgary, Calgary, Canada
| | - Clodagh Toomey
- Sport Injury Prevention Research Center, Faculty of Kinesiology, University of Calgary, Calgary, Canada
- School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Gregor Kuntze
- Alberta Bone and Joint Health Institute, Calgary, AB, Canada
| | - Shane Esau
- Sport Injury Prevention Research Center, Faculty of Kinesiology, University of Calgary, Calgary, Canada
| | - Carolyn A Emery
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Canada
- Sport Injury Prevention Research Center, Faculty of Kinesiology, University of Calgary, Calgary, Canada
- Departments of Community Health Sciences and Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada
| | - Leigh Gabel
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, 2500 University Dr NW, T2N 1N4, Calgary, AB, Canada.
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Canada.
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada.
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Ozdemir BC, Savci S, Tanriverdi A, Ozcan Kahraman B, Isguder R, Makay B, Unsal E. Determinants of physical activity level in children and adolescents with juvenile idiopathic arthritis. Z Rheumatol 2024; 83:71-77. [PMID: 37010629 DOI: 10.1007/s00393-023-01340-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2023] [Indexed: 04/04/2023]
Abstract
OBJECTIVE One of the most frequently discussed physical parameters in juvenile idiopathic arthritis (JIA) is physical activity level. There is limited evidence about determinants of physical activity level in JIA. In this study, we aimed to investigate the determinants of physical activity level in children and adolescents with JIA. MATERIALS AND METHODS Thirty-two JIA patients and 18 age- and sex-matched healthy individuals were included in the study. The age range was 8-18 years. Sociodemographic and clinical data of the participants were recorded. In both groups, anthropometry, fatigue, pain, knee extension muscle strength, gait variables, functional exercise capacity assessed by six-minute walk test (6MWT), and arterial stiffness were evaluated. Physical activity level was assessed by an accelerometer. RESULTS The disease activity level of the patients was low. Pain and fatigue scores were significantly higher in the JIA group compared to healthy controls (p < 0.05). Walking speed, physical activity level, time spent in low-intensity physical activity, time spent in moderate-to-vigorous-intensity physical activity, and 6MWT distance were significantly lower than in healthy controls (p < 0.05). Quadriceps muscle strength and arterial stiffness assessment results were similar in both groups (p > 0.05). In the JIA group, there was a positive correlation between physical activity and age, height, fat-free body mass, quadriceps muscle strength, and 6MWT distance (p < 0.05). Also, there was a negative correlation between physical activity and pain, fatigue, and cadence. Physical activity level was independently associated with 6MWT distance (42.9% of the variability). CONCLUSION In mildly affected JIA patients, gait speed, functional exercise capacity, and physical activity level are affected. Functional exercise capacity is a determinant of physical activity level in JIA.
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Affiliation(s)
- Berk Can Ozdemir
- Health Science Institute, Dokuz Eylul University, Izmir, Turkey.
| | - Sema Savci
- Faculty of Physical Therapy and Rehabilitation, Dokuz Eylul University, Izmir, Turkey
| | - Aylin Tanriverdi
- Health Science Institute, Dokuz Eylul University, Izmir, Turkey
- Faculty of Physical Therapy and Rehabilitation, Dokuz Eylul University, Izmir, Turkey
| | - Buse Ozcan Kahraman
- Faculty of Physical Therapy and Rehabilitation, Dokuz Eylul University, Izmir, Turkey
| | - Rana Isguder
- Division of Pediatric Rheumatology, Department of Pediatrics, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Balahan Makay
- Division of Pediatric Rheumatology, Department of Pediatrics, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Erbil Unsal
- Division of Pediatric Rheumatology, Department of Pediatrics, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
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Pella E, Sgouropoulou V, Theodorakopoulou M, Iatridi F, Boutou A, Karpetas A, Papagianni A, Sarafidis P, Dimitroulas T. Cardiorespiratory fitness assessed with cardiopulmonary exercise testing in patients with juvenile idiopathic arthritis: a systematic review and meta-analysis. Rheumatology (Oxford) 2023; 62:3526-3533. [PMID: 37280055 DOI: 10.1093/rheumatology/kead272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 04/22/2023] [Accepted: 05/19/2023] [Indexed: 06/08/2023] Open
Abstract
OBJECTIVES JIA is the most common type of arthritis in children and adolescents, causing joint damage, chronic pain and disability. Deconditioning is also prevalent in patients with JIA due to both inactivity and the disease progression, resulting in reduced cardiorespiratory fitness (CRF). We aimed to evaluate CRF of patients with JIA compared with healthy controls. METHODS This is a systematic review and meta-analysis of studies using cardiopulmonary exercise testing (CPET) to examine differences in determinants of CRF between patients with JIA vs healthy controls. The primary outcome was peak oxygen uptake (VO2peak). Literature search involved PubMed, Web of Science and Scopus databases, manual search of article references and grey literature. Quality assessment was undertaken with Newcastle-Ottawa Scale. RESULTS From 480 literature records initially retrieved, eight studies (538 participants) were included in final meta-analysis. VO2peak was significantly lower in patients with JIA compared with controls [weighted mean difference (WMD): -5.95 ml/kg/min (95% CI -9.26, -2.65)]. Exercise duration and VO2peak (% predicted) were found to be significantly impaired in patients with JIA compared with controls [standardized mean difference: -0.67 (95% CI -1.04, -0.29) and WMD: -11.31% (95% CI -20.09, -2.53), respectively], while no significant differences were found in maximum heart rate. CONCLUSION VO2peak and other CPET variables were lower in patients with JIA compared with controls, indicating reduced CRF in the former. Overall, exercise programs for patients with JIA should be promoted as part of their treatment to improve physical fitness and reduce muscle atrophy. PROSPERO REGISTRATION CRD42022380833.
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Affiliation(s)
- Eva Pella
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vasiliki Sgouropoulou
- 1st Department of Paediatrics, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Marieta Theodorakopoulou
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Fotini Iatridi
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Afroditi Boutou
- Department of Respiratory Medicine, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Aikaterini Papagianni
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Pantelis Sarafidis
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Theodoros Dimitroulas
- 4th Department of Internal Medicine, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Räsänen K, Markula-Patjas K, Kantanen S, Sipilä K, Lakka TA, Arikoski P, Piippo-Savolainen E. Impaired cardiorespiratory and neuromuscular fitness in children and adolescents with juvenile idiopathic arthritis: a cross-sectional case-control study in the era of biologic drug therapies. Pediatr Rheumatol Online J 2023; 21:26. [PMID: 36932386 PMCID: PMC10022213 DOI: 10.1186/s12969-023-00808-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 03/11/2023] [Indexed: 03/19/2023] Open
Abstract
BACKGROUND In recent years, biologic drug therapies have altered the course of juvenile idiopathic arthritis (JIA) possibly also improving the patients' physical fitness. However, studies measuring both cardiorespiratory and muscular fitness in children with JIA are sparse and have failed to show consistent results. Our aim was to assess both cardiorespiratory and neuromuscular fitness and contributing factors in children and adolescents with JIA in the era of biologic drug therapies. METHODS This cross-sectional study consisted of 73 JIA patients (25 boys, 48 girls) aged 6.8- 17.5 years and 73 healthy age- and sex-matched controls, investigated in 2017-2019. Cardiorespiratory fitness was assessed by maximal ergospirometry and neuromuscular fitness by speed, agility, balance, and muscle strength tests. RESULTS Means (± SD) of maximal workload (Wmax/kg) and peak oxygen uptake (VO2peak/kg,) were lower in JIA patients than in controls (Wmax/kg: 2.80 ± 0.54 vs. 3.14 ± 0.50 Watts, p < 0.01; VO2peak/kg: 38.7 ± 7.53 vs. 45.8 ± 6.59 ml/min/kg, p < 0.01). Shuttle-run, sit-up and standing long jump test results were lower in JIA patients than in controls (p < 0.01). Mean (± SD) daily activity was lower (89.0 ± 44.7 vs. 112.7 ± 62.1 min/day, p < 0.05), and sedentary time was higher (427 ± 213 vs. 343 ± 211 min/day, p < 0.05) in JIA patients compared to controls. Physical activity and cardiorespiratory or neuromuscular fitness were not associated with disease activity. CONCLUSIONS JIA patients were physically less active and had lower cardiorespiratory and neuromuscular fitness than their same aged controls with no JIA. Therefore, JIA patients should be encouraged to engage in physical activities as a part of their multidisciplinary treatment protocols to prevent adverse health risks of low physical activity and fitness.
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Affiliation(s)
- Kati Räsänen
- Pediatric Research Unit, University of Eastern Finland and Kuopio University Hospital, Kuopio, PL100, 70029 KYS, Finland.
| | - Kati Markula-Patjas
- Center for Child Health Research, Tampere University and Department of Pediatrics, Tampere University Hospital, Tampere, Finland
| | - Saija Kantanen
- Center for Child Health Research, Tampere University and Department of Pediatrics, Tampere University Hospital, Tampere, Finland
| | - Kalle Sipilä
- Department of Clinical Physiology and Nuclear Medicine, Faculty of Medicine and Health Technology, Tampere University and Tampere University Hospital, Tampere, Finland
| | - Timo A Lakka
- Institute of Biomedicine, School of Medicine, University of Eastern Finland, Kuopio Campus, Finland
- Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, Kuopio, Finland
- Foundation for Research in Health Exercise and Nutrition, Kuopio Research Institute of Exercise Medicine, Kuopio, Finland
| | - Pekka Arikoski
- Pediatric Research Unit, University of Eastern Finland and Kuopio University Hospital, Kuopio, PL100, 70029 KYS, Finland
| | - Eija Piippo-Savolainen
- Pediatric Research Unit, University of Eastern Finland and Kuopio University Hospital, Kuopio, PL100, 70029 KYS, Finland
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Grammatikopoulou MG, Gkiouras K, Syrmou V, Vassilakou T, Simopoulou T, Katsiari CG, Goulis DG, Bogdanos DP. Nutritional Aspects of Juvenile Idiopathic Arthritis: An A to Z for Dietitians. CHILDREN (BASEL, SWITZERLAND) 2023; 10:203. [PMID: 36832332 PMCID: PMC9955348 DOI: 10.3390/children10020203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 01/15/2023] [Accepted: 01/18/2023] [Indexed: 01/25/2023]
Abstract
Juvenile idiopathic arthritis (JIA) represents a chronic, autoimmune, rheumatic musculoskeletal disease with a diagnosis before 16 years of age. Chronic arthritis is a common manifestation in all JIA subtypes. The nature of JIA, in combination to its therapy often results in the development of nutrition-, gastrointestinal (GI)- or metabolic-related issues. The most-common therapy-related nutritional issues involve methotrexate (MTX) and glucocorticosteroids (GCC) adverse events. MTX is a folic acid antagonist, thus supplementation with folic acid in required for improving GI side effects and correcting low serum levels. On the other hand, long-term GCC administration is often associated with hyperglycemia, insulin resistance and growth delay. This relationship is further aggravated when more joints are affected and greater doses of GCC are being administered. Apart from stature, body mass index z-scores are also suboptimal in JIA. Other signs of malnutrition include decreased phase angle and muscle mass, especially among patients with polyarthritis JIA. Evidence also points to the existence of an inverse relationship between disease activity and overweight/obesity. Specific dietary patterns, including the anti-inflammatory diet, might confer improvements in selected JIA outcomes, but the level of available research is yet insufficient to draw safe conclusions. The majority of patients exhibit suboptimal vitamin D status; hence, supplementation is recommended. Collectively, the evidence indicates that, due to the age of onset and the complexity of the disease, along with its pharmacotherapy, children with JIA are prone to the development of several nutritional problems, warranting expert monitoring. Vitamin deficiencies, oral and GI-problems limiting dietary intake, faltering growth, overweight and obesity, physical inactivity, or impaired bone health are among the many nutritional issues in JIA requiring dietitian support.
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Affiliation(s)
- Maria G. Grammatikopoulou
- Immunonutrition Unit, Department of Rheumatology and Clinical Immunology, University General Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, GR-41110 Larissa, Greece
| | - Konstantinos Gkiouras
- Immunonutrition Unit, Department of Rheumatology and Clinical Immunology, University General Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, GR-41110 Larissa, Greece
| | - Vasiliki Syrmou
- Immunonutrition Unit, Department of Rheumatology and Clinical Immunology, University General Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, GR-41110 Larissa, Greece
| | - Tonia Vassilakou
- Department of Public Health Policy, School of Public Health, University of West Attica, 196 Alexandras Avenue, GR-11521 Athens, Greece
| | - Theodora Simopoulou
- Immunonutrition Unit, Department of Rheumatology and Clinical Immunology, University General Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, GR-41110 Larissa, Greece
| | - Chistina G. Katsiari
- Immunonutrition Unit, Department of Rheumatology and Clinical Immunology, University General Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, GR-41110 Larissa, Greece
| | - Dimitrios G. Goulis
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Faculty of Health Sciences, Papageorgiou General Hospital, Aristotle University of Thessaloniki, 76 Agiou Pavlou Str., Pavlos Melas, GR-56429 Thessaloniki, Greece
| | - Dimitrios P. Bogdanos
- Immunonutrition Unit, Department of Rheumatology and Clinical Immunology, University General Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, GR-41110 Larissa, Greece
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de Oliveira RJ, Londe AC, de Souza DP, Marini R, Fernandes PT, Appenzeller S. Physical Activity Influences Health-Related Quality of Life in Adults with Juvenile Idiopathic Arthritis. J Clin Med 2023; 12:jcm12030771. [PMID: 36769423 PMCID: PMC9917453 DOI: 10.3390/jcm12030771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 12/04/2022] [Accepted: 12/30/2022] [Indexed: 01/20/2023] Open
Abstract
This cross-sectional study aimed to evaluate the impact of physical activity and physical fitness on the health-related quality of life (HQoL) of adult patients with Juvenile Idiopathic Arthritis (JIA). Fifty-nine JIA patients and sixty healthy individuals participated in this study. All individuals had the following evaluations performed: body composition (electrical bioimpedance), physical fitness (6 min walk test (6MWT)), physical activity level (International Physical Activity Questionnaire (IPAQ)), and HQoL (Quality of Life Questionnaire in relation to Health-Short Form (SF36)). Thirty-nine (66%) JIA patients were considered sedentary compared with 15 (25%) in the control group (p < 0.01). JIA patients had a lower HQoL compared with the control group in all variables studied (p < 0.05). JIA patients who were very physically active had better HQoL conditions in the categories of functional capacity (p = 0.001), limitations by physical aspects (p = 0.003), and emotional aspects (p = 0.002) compared with sedentary patients. JIA patients had more cardiovascular abnormalities and walked shorter distances compared with healthy controls in the 6MWT. In conclusion, we observed that HQoL was reduced in adults with JIA. A high percentage of JIA patients were sedentary with lower physical fitness, but physically active patients had a better HQoL than sedentary patients. The duration of physical activity, rather than intensity, influenced the mental aspects of HQoL.
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Affiliation(s)
- Rodrigo Joel de Oliveira
- Graduate Program in Child and Adolescent Health, School of Medical Sciences, University of Campinas (UNICAMP), Campinas 13083-970, Brazil
| | - Ana Carolina Londe
- Graduate Program in Child and Adolescent Health, School of Medical Sciences, University of Campinas (UNICAMP), Campinas 13083-970, Brazil
| | - Débora Pessoa de Souza
- Graduate Program in Child and Adolescent Health, School of Medical Sciences, University of Campinas (UNICAMP), Campinas 13083-970, Brazil
| | - Roberto Marini
- Department of Pediatrics, School of Medical Sciences, University of Campinas (UNICAMP), Campinas 3083-970, Brazil
| | - Paula Teixeira Fernandes
- Department of Sport Science, Faculty of Physical Education, University of Campinas (UNICAMP), Campinas 13083-851, Brazil
| | - Simone Appenzeller
- Department of Orthopedics, Rheumatology and Traumatology—School of Medical Sciences, University of Campinas (UNICAMP), Campinas 3083-970, Brazil
- Correspondence: ; Fax: +55-19-3289-1818
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Kuntze G, Nettel-Aguirre A, Brooks J, Esau S, Nesbitt C, Mosher D, Twilt M, Benseler S, Ronsky JL, Emery CA. Consequences of Juvenile Idiopathic Arthritis on Single Leg Squat Performance in Youth. Arthritis Care Res (Hoboken) 2020; 73:1187-1193. [PMID: 32407563 DOI: 10.1002/acr.24254] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 05/05/2020] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Juvenile idiopathic arthritis (JIA) affects body structure and function outcomes that may increase the risk of acute joint injury. The purpose of this study was to examine single leg squat (SLS) biomechanics for youth with JIA and their healthy peers. The study design was a matched pair cohort study. METHODS Sixty-five youth (JIA n = 30; control n = 35) participated in this ethics-approved study. Participants performed 3 sets of 5 consecutive SLS tasks. Disease activity and functional status were assessed using the Juvenile Arthritis Disease Activity Score and Child Health Assessment Questionnaire. Indexed (most-affected leg [JIA]; dominant leg [control]) and contralateral extremity biomechanics were obtained using a 12-camera system. Outcomes included hip flexion/extension (FE), adduction/abduction (AA), and internal/external (IE) rotation range of motion (ROM). Data were analyzed using a multivariate random coefficient model in R (α⍺ = 0.05). RESULTS A total of 29 matched pairs were analyzed. Youth with JIA had low disease activity and performed the SLS with a more internally rotated hip (indexed leg P = 0.023, β = -1.9°). Female participants displayed greater hip FE (indexed leg P = 0.015, β = -4.3°; contralateral leg P = 0.005, β = -4.8°) and IE ROM (indexed leg P = 0.021, β = -2.1°) than male participants. Associations were observed for body mass index and hip IE ROM (contralateral leg P = 0.001, β = -0.4°), knee flexion angle, and hip FE ROM (indexed leg P = 0.001, β = 0.4°; contralateral leg P = 0.001, β = 0.5°) and AA (indexed leg P = 0.010, β = 0.1°; contralateral leg P = 0.002, β = 0.2°). CONCLUSION This study identified functional alterations for an SLS in youth with JIA. These findings support the use of physical therapy as part of a multidisciplinary management approach, to restore normal hip posture and movement.
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Affiliation(s)
| | | | - Julia Brooks
- Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Shane Esau
- University of Calgary, Calgary, Alberta, Canada
| | | | - Dianne Mosher
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Marinka Twilt
- Cumming School of Medicine, University of Calgary, and Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Susanne Benseler
- Cumming School of Medicine, University of Calgary, and Alberta Children's Hospital, Calgary, Alberta, Canada
| | | | - Carolyn A Emery
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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