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Arthrodiastasis in severe juvenile idiopathic arthritis
  1. L Shapiro1,
  2. G Cleary2,
  3. K Landes3,
  4. N Barnes3,
  5. L James4,
  6. E Baildam2,
  7. L McCann2,
  8. MW Beresford2
  1. 1Paediatrics, Mid Cheshire Hospitals NHS Foundation Trust, Crewe, UK
  2. 2Paediatric Rheumatology, Alder Hey Children's Foundation Trust, Liverpool, UK
  3. 3Paediatric Radiology, Alder Hey Children's Foundation Trust, Liverpool, UK
  4. 4Paediatric Orthopaedics, Alder Hey Children's Foundation Trust, Liverpool, UK

Abstract

Aims We describe successful arthrodiastasis by the means of an Ilizarov frame in two children with juvenile idiopathic arthritis (JIA) with localised destructive disease despite medical therapy.

Methods Case 1 - A 2 year old girl was diagnosed with polyarticular JIA (rheumatoid factor (RF) negative, intermittent antinuclear antibody (ANA) positive). Active symptomatic disease progressed despite combinations of intra-articular steroids, methotrexate (MTX), and biologic agents. Magnetic resonance imaging (MRI) showed erosive change of the left ankle with complete loss of joint space and subtalar joints, and by the age of 13 her mobility was increasingly limited. In order to control pain and prevent permanent arthrodesis, Ilizarov distraction of the left ankle was performed.

Case 2 - A 13 year old girl with 10 year history of polyarticular JIA (ANA positive RF negative) developed destructive arthropathy in her right ankle with bone on bone crepitus despite treatment with MTX and etanercept. Serial MR scans showed progressive destructive disease. The patient was treated with cross ankle distracting Ilizarov frame with a perioperative course of intravenous methyprednisolone (IVMP) to control synovitis. She had minor skin sepsis at pin sites.

Results In both cases, an improvement has been shown post-operatively in terms of reduced pain and improved function. There is radiological evidence of improvement in both patients.

Conclusion JIA is a potentially destructive inflammatory disease. Treatment by a skilled multidisciplinary team with access to disease modifying drugs including biologic therapies usually prevents articular damage and disabling symptoms. Joint destruction is rare, but can significantly impact on the quality of life through pain, deformity, and loss of function. Arthrodiastasis, or joint distraction using an orthopaedic frame, can be used as rescue procedure to avoid arthrodesis in severely painful damaged joints unresponsive to medical therapies.

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