接受足部关节内皮质类固醇注射的幼年特发性关节炎儿童和青少年的自评步行残疾与动态踝关节僵硬情况
Self-rated walking disability and dynamic ankle joint stiffness in children and adolescents with Juvenile Idiopathic Arthritis receiving intraarticular corticosteroid joint injections of the foot.
作者信息
Iversen Maura D, Weidenhielm-Broström Eva, Wang Ruoli, Esbjörnsson Anna-Clara, Hagelberg Stefan, Åstrand Per
机构信息
Department of Women's and Children's Health, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden; Section of Clinical Sciences, Division of Rheumatology, Immunology, & Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, USA; Department of Physical Therapy, Movement and Rehabilitation Sciences, Bouve College of Health Sciences, Northeastern University, Boston, USA.
Department of Women's and Children's Health, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden.
出版信息
Gait Posture. 2019 Jan;67:257-261. doi: 10.1016/j.gaitpost.2018.10.024. Epub 2018 Oct 21.
BACKGROUND
Children and adolescents with Juvenile Idiopathic Arthritis (JIA) exhibit deviations in ankle dynamic joint stiffness (DJS, or moment-angle relationship) compared to healthy peers, but the relationship between ankle DJS and self-reported walking impairments has not been studied. This secondary analysis aimed to investigate the relationship between ankle DJS and self-reported walking disability in juveniles with JIA, and to determine whether intraarticular corticosteroid foot injections (IACI) were associated with long term changes in ankle DJS.
RESEARCH QUESTIONS
Is ankle DJS altered in children with JIA reporting walking difficulties compared to children with JIA reporting no walking difficulties? Are IACIs associated with persistent alterations in ankle DJS?
METHODS
Gait dynamics (DJS), foot pain, and foot-related disability were assessed in 33 children with JIA before intraarticular corticoid foot injection (IACI), and three months after IACI. Using self-reported walking capacity scores, children were classified as either having no walking difficulties (ND) or having walking difficulties (WD). Inferential statistics were used to compare demographics, pain, impairment scores, and ankle DJS between the groups.
RESULTS
Before treatment, in the WD group, ankle DJS was significantly decreased both in the early rising phase (ERP = 0.03+0.02 vs. 0.05+0.02 Nm(kgdeg)) and late rising phase (LRP = 0.11+0.06 vs. 0.24+0.22 Nm(kgdeg)) compared to the ND group. At three months, the ERP was still significantly decreased in the WD group (ERP = 0.03+0.01 vs. 0.05+0.03 Nm(kg*deg)).
SIGNIFICANCE
Among children and adolescents with JIA who reported walking difficulties prior to IACIs, alterations in DJS in early stance phase (decreased ERP) remained three months after IACI suggesting persistent gait adaptations, possibly related to pain. Pre-treatment gait analysis may aid in identifying children who will not have long term benefit from IACIs in terms of improved gait, and therefore, may be informed and have the choice to be spared the risk of side effects associated with this treatment.
背景
与健康同龄人相比，患有幼年特发性关节炎（JIA）的儿童和青少年表现出踝关节动态关节僵硬（DJS，即力矩 - 角度关系）的偏差，但踝关节DJS与自我报告的行走障碍之间的关系尚未得到研究。这项二次分析旨在调查患有JIA的青少年中踝关节DJS与自我报告的行走残疾之间的关系，并确定关节内皮质类固醇足部注射（IACI）是否与踝关节DJS的长期变化相关。
研究问题
与报告无行走困难的JIA儿童相比，报告行走困难的JIA儿童的踝关节DJS是否发生改变？IACI是否与踝关节DJS的持续改变相关？
方法
在33名患有JIA的儿童进行关节内皮质类固醇足部注射（IACI）之前和IACI后三个月，评估其步态动力学（DJS）、足部疼痛和与足部相关的残疾情况。根据自我报告的行走能力得分，将儿童分为无行走困难（ND）或有行走困难（WD）两类。使用推断统计方法比较两组之间的人口统计学、疼痛、损伤评分和踝关节DJS。
结果
治疗前，与ND组相比，WD组在早期上升阶段（ERP = 0.03 + 0.02 vs. 0.05 + 0.02 Nm(kgdeg)）和晚期上升阶段（LRP = 0.11 + 0.06 vs. 0.24 + 0.22 Nm(kgdeg)）的踝关节DJS均显著降低。在三个月时，WD组的ERP仍然显著降低（ERP = 0.03 + 0.01 vs. 0.05 + 0.03 Nm(kg*deg)）。
意义
在IACI前报告行走困难的患有JIA的儿童和青少年中，早期站立阶段DJS的改变（ERP降低）在IACI后三个月仍然存在，提示持续的步态适应，可能与疼痛有关。治疗前的步态分析可能有助于识别那些在改善步态方面不会从IACI中获得长期益处的儿童，因此，他们可以了解情况并选择避免这种治疗相关的副作用风险。
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