Musculoskeletal abnormalities of the tibia in juvenile rheumatoid arthritis
- 27 February 2007
- journal article
- Published by Wiley in Arthritis & Rheumatism
- Vol. 56 (3), 984-994
- https://doi.org/10.1002/art.22420
Abstract
Objective To characterize local bone geometry, density, and strength, using peripheral quantitative computed tomography (pQCT), compared with general bone characteristics as measured using dual x‐ray absorptiometry (DXA), and to assess their relationship to disease‐related factors in children with juvenile rheumatoid arthritis (JRA). Methods Forty‐eight children ages 4–18 years with JRA (17 pauciarticular, 23 polyarticular, 8 systemic) were compared with age‐matched healthy controls (n = 266). Measurements included cortical and trabecular bone geometry, density, and strength at the distal and midshaft tibia determined by pQCT, and whole‐body, lumbar spine, and femoral neck measurements by DXA. Results Methotrexate (MTX) was prescribed to 23 of 48 patients (47.9%) and glucocorticoids and MTX were prescribed to 15 of 48 patients (31.3%), with the greatest use in children with systemic JRA. All JRA patients had decreased tibia trabecular bone density, cortical bone size and strength, and muscle mass. Children with systemic JRA had lower femoral neck densities. Systemic JRA was associated with a shorter, less mineralized skeleton, while a narrower, less mineralized skeleton was observed in polyarticular JRA. The tibia diaphysis was narrower with decreased muscle mass, but normal, size‐adjusted bone mineral in all subtypes indicated a localized effect of JRA on bone. Patients exposed to glucocorticoids and MTX or to glucocorticoids or MTX alone had greatly reduced trabecular density, cortical bone geometry properties, and bone mineral content, muscle mass, and bone strength. Conclusion Children with JRA have decreased skeletal size, muscle mass, trabecular bone density, cortical bone geometry, and strength. Not surprisingly, these bone abnormalities are more pronounced in children with greater disease severity.Keywords
This publication has 33 references indexed in Scilit:
- The ?functional muscle-bone unit?: a two-step diagnostic algorithm in pediatric bone diseasePediatric Nephrology, 2005
- Musculoskeletal abnormalities of the forearm in patients with juvenile idiopathic arthritis relate mainly to bone geometryArthritis & Rheumatism, 2004
- Frequency of osteopenia in adolescents with early‐onset juvenile idiopathic arthritis: A long‐term outcome study of one hundred five patientsArthritis & Rheumatism, 2003
- Performance of a new pubertal self‐assessment questionnaire: a preliminary studyPaediatric and Perinatal Epidemiology, 2001
- Influence of weight, age and puberty on bone size and bone mineral content in healthy children and adolescentsActa Paediatrica, 1998
- Protein metabolism in rheumatoid arthritis and aging. Effects of muscle strength training and tumor necrosis factor αArthritis & Rheumatism, 1996
- Mechanical validation of a tomographic (pQCT) index for noninvasive estimation of rat femur bending strengthBone, 1996
- Compendium of Physical Activities: classification of energy costs of human physical activitiesMedicine & Science in Sports & Exercise, 1993
- Validity of self-report of pubertal maturation in early adolescentsJournal of Adolescent Health, 1992
- BONE MINERAL CONTENT IN PATIENTS WITH RHEUMATOID ARTHRITIS: RELATIONSHIP TO LOW-DOSE STEROID THERAPYRheumatology, 1991