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Muscle function in Juvenile Idiopathic Arthritis: A two-year follow-up
Linköping University, Department of Clinical and Experimental Medicine, Clinical Neurophysiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Reconstruction Centre, Department of Neurophysiology UHL.
2004 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

This is a study of muscle function in Juvenile Idiopathic Arthritis (JIA). Rheumatoid arthritis (RA) is a disease that primarily affects the synovial membrane of joints. Muscle weakness, atrophy and pain occur in adult RA. This may be a consequence of joint pain, stiffness and immobility. Muscle inflammation and neuropathy occur as complications in adults. Muscle function in JIA has been much less studied.

The aim of the study was to examine whether muscle weakness and atrophy also occur in children with JIA.

This was a longitudinal study over a two-year period, where muscle strength and thickness were measured repeatedly in a group of 20 children and teenagers with JIA. Muscle strength was measured using different methods and in several muscle groups. Muscle biopsies were obtained and nerve conduction velocity studies performed.

The study concludes that, compared to healthy people, children and teenagers with JIA have as a group reduced muscle strength and muscle thickness. For most of these children and teenagers, muscle strength is only slightly lower than expected, but a few have marked muscle weakness. This is most apparent in patients with severe polyarthritis where the weakness seems to be widespread. Patients with isolated arthritis may also have greatly reduced strength and thickness of muscles near the inflamed joint.

There is a risk of decreasing strength in patients with polyarthritis and in muscles near an active arthritis.

Minor changes are common in muscle biopsies, and findings may indicate immunological activity in the muscles.

Atrophy of type II fibres, as in adult RA, was not found in JIA.

No patient had signs of neuropathy.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2004. , 97 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 847
Keyword [en]
arthritis, juvenile rheumatoid, physiopathology, muscle, skeletal, pathology, physiopathology, Muscular atrophy, etiology, physiopathology, arthritis, juvenile rheumatoid, complications
National Category
Clinical Science
Identifiers
URN: urn:nbn:se:liu:diva-5195ISBN: 91-7373-819-0 (print)OAI: oai:DiVA.org:liu-5195DiVA: diva2:21108
Public defence
2004-05-07, Viktoriasalen, Campus US, Linköpings universitet, Linköping, 13:00 (English)
Supervisors
Note
On the day of the public defence the status of article IV was: Submitted.Available from: 2004-05-27 Created: 2004-05-27 Last updated: 2012-01-25Bibliographically approved
List of papers
1. Muscle function in Juvenile Chronic Arthritis
Open this publication in new window or tab >>Muscle function in Juvenile Chronic Arthritis
1995 (English)In: Journal of Rheumatology, ISSN 0315-162X, Vol. 22, no 6, 1159-1165 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE. Muscle strength and thickness were studied in children with juvenile chronic arthritis (JCA) to evaluate their muscle function. METHODS. We studied voluntary isometric, isokinetic, and nonvoluntary isometric muscle strength, as well as muscle thickness, in 20 children with JCA. Thickness of the quadriceps muscle was measured by ultrasound. Results were compared with reference values for healthy children and a matched control group. RESULTS. Isometric muscle strength in knee extensors, elbow flexors, and wrist dorsiflexors was reduced in children with JCA. In muscles near an inflamed joint, the strength was 45-65% of expected value. In muscles without adjacent arthritis, the strength was slightly decreased (80-90% of expected value). Isometric and isokinetic strength in ankle dorsiflexors was reduced only in children with ankle arthritis. Nonvoluntary muscle strength in thumb adductors during electrical stimulation of the ulnar nerve was reduced in children with arthritis in the hand. Thickness of the quadriceps muscle was reduced both in children with and without knee arthritis (75 and 90% of expected). CONCLUSION. Children with JCA have reduced muscle strength and thickness, which is most pronounced in muscles near an inflamed joint.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13644 (URN)
Available from: 2004-05-27 Created: 2004-05-27 Last updated: 2009-08-19
2. Measurement of Quadriceps Muscle Strength and Bulk in Juvenile Chronic Arthritis: A Prospective, Longitudinal, 2 Year Survey
Open this publication in new window or tab >>Measurement of Quadriceps Muscle Strength and Bulk in Juvenile Chronic Arthritis: A Prospective, Longitudinal, 2 Year Survey
1998 (English)In: Journal of Rheumatology, ISSN 0315-162X, Vol. 25, no 11, 2240-2248 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: In a prospective survey over a 2-year period we studied strength and bulk of the quadriceps muscle in the thighs of children with juvenile chronic arthritis (JCA). METHODS: Every third month for 2 years we measured isometric muscle strength in knee extensors with a hand-held dynamometer in 20 children with JCA. Ultrasound equipment was used to measure thigh muscle bulk. A joint evaluation was made using a standard severity score. The children had their ordinary medical treatment and physiotherapy during the observation period. RESULTS: Children with high severity scores in the knee or hip had least strength and muscle bulk. In the 4 children with the highest severity scores muscle strength was reduced to half of that expected. In 10 of the children there were clear variations in severity scores during the study period, for either better or worse. In these children an increase in the severity score correlated significantly with reduction in muscle strength and bulk (p < 0.05). The muscle strength and bulk changed in parallel in these children. Other factors, although not independent, such as polyarticular JCA, long duration of disease, and steroid treatment, also reduced muscle strength. CONCLUSION: The presence and intensity of local arthritis is one important factor affecting muscle function in JCA. Normal muscle strength and bulk is rapidly lost near an inflamed joint. It is difficult to maintain or achieve normal muscle function in the presence of active arthritis despite medical and physical treatment. We assume that the muscle weakness is in part caused by atrophy of the muscle, which is influenced by local arthritis.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13645 (URN)
Available from: 2004-05-27 Created: 2004-05-27 Last updated: 2009-08-19
3. Hand strength in juvenile chronic arthritis: a two-year follow-up
Open this publication in new window or tab >>Hand strength in juvenile chronic arthritis: a two-year follow-up
2003 (English)In: Acta Paediatrica, ISSN 0001-656X, Vol. 92, no 11, 1291-1296 p.Article in journal (Refereed) Published
Abstract [en]

AIM: To describe changes in muscle strength in the hands of children with juvenile chronic arthritis (JCA) and to examine the relationship between muscle strength, presence of local arthritis and disease subtype.

METHODS: Twenty children (10 girls and 10 boys) with JCA aged 7 to 18 y were followed for two years. Isometric muscle strength in wrist dorsiflexors and handgrip strength were measured repeatedly. The results were compared with reference values for the same methods. Arthritis severity in the hand was scored every third month. Nerve conduction velocities were measured twice.

RESULTS: Seven out of 20 patients had initially low or decreasing strength in one or both of the two tests. Five out of 20 children had reduced strength (more than two standard deviations below the mean of the reference group) in at least one test. Four children showed a significant reduction in muscle strength in at least one test during the observation time. The greatest reduction in strength was measured in four children with polyarticular disease. These children also had local arthritis in the hand. A greater proportion of children with polyarthritis had low or decreasing strength compared with children with oligoarthritis. The same was true for children with active arthritis in the hand. Nerve conduction velocities were normal in all cases and did not change.

CONCLUSION: The majority of children with JCA have normal strength in the hand. Some children, especially those with polyarthritis and hand arthritis, have reduced muscle strength in the hand. Risk factors for low or decreasing strength are polyarthritis and/or active arthritis in the hand.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13646 (URN)10.1080/08035250310006340 (DOI)
Available from: 2004-05-27 Created: 2004-05-27 Last updated: 2009-08-19
4. Muscle involvement in juvenile idiopathic arthritis
Open this publication in new window or tab >>Muscle involvement in juvenile idiopathic arthritis
2004 (English)In: Rheumatology, ISSN 1462-0324, Vol. 43, no 12, 1546-1554 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: An observational study of changes in muscle structure and the relation to muscle strength in juvenile idiopathic arthritis (JIA).

METHODS: Fifteen children and teenagers (eight girls and seven boys) with JIA, aged 9-19 yr (mean age 16.1), were studied. Muscle biopsies were obtained from the anterior tibial muscle and were examined using histopathological and immunohistochemical methods. Muscle fibre types were classified and fibre areas measured. As markers of inflammation, the major histocompatibility complex (MHC) class I and class II and the membrane attack complex (MAC) were analysed. Results were compared with biopsies from the gastrocnemius muscle in 33 young (19-23 yr) healthy controls. Isometric and isokinetic muscle strengths were measured in ankle dorsiflexion. Strength was compared with reference values for healthy age-matched controls. Nerve conduction velocities were recorded in the peroneal and sural nerves.

RESULTS: Four of the 15 muscle biopsies were morphologically normal. Eleven biopsies showed minor unspecific changes. Two of these also showed minor signs of inflammation. MHC class II expression was found in 4/15 patients, which was significantly more than in the healthy controls (P = 0.0143). The expression of MHC class I and MAC did not differ from that in the controls. The mean area of type I fibres was lower than that of type IIA fibres in 12/13 biopsies. Muscle strength was significantly reduced in the patient group. There was a significant positive correlation between muscle fibre area and muscle strength. Nerve conduction studies were normal in all cases.

CONCLUSIONS: Changes in leg muscle biopsies appear to be common in children and teenagers with JIA. The presence of inflammatory cells in the muscle and expression of MHC class II on muscle fibres may be a sign of inflammatory myopathy. There are no findings of type II muscle fibre hypotrophy or neuropathy, as in adults with RA.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13647 (URN)10.1093/rheumatology/keh381 (DOI)
Available from: 2004-05-27 Created: 2004-05-27 Last updated: 2009-08-19

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