Sorokina Lubov S, Avrusin Ilia S, Raupov Rinat K, Lubimova Natalia A, Khrypov Sergey V, Kostik Mikhail M
Department of Hospital Pediatry, Saint-Petersburg State Pediatric Medical University, Saint Petersburg, Russia.
Leningrad Regional Children's Hospital, Saint Petersburg, Russia.
Front Pediatr. 2021 Nov 5;9:747779. doi: 10.3389/fped.2021.747779. eCollection 2021.
To describe the clinical characteristics of hip involvement in juvenile idiopathic arthritis (JIA) from arthritis to hip osteoarthritis (HOA) and total hip arthroplasty (THA). Seven hundred fifty-three patients aged 2-17 years with JIA were included in the study. The comparison analysis was performed between the following subgroups: (i) JIA without hip involvement ( = 600; 79.7%) vs. JIA with hip involvement without HOA ( = 105; 13.9%), (ii) JIA with hip involvement with HOA, but without THA ( = 32; 4.3%) and JIA with hip involvement with HOA and with THA ( = 16; 2.1%). Clinical, laboratory characteristics and treatment regimens compared. Hip involvement was present in 20.3% of patients. HOA was present in 6.4% (121,000 patient-years) of the entire JIA group and 31.4% of patients with hip involvement. Sixteen patients (2.1%; 4.01,000 patient-years) required THA. The following factors were associated with HOA: sJIA (OR = 3.6, = 0.008; HR = 3.0, = 0.002), delayed remission (OR = 4.2, = 0.004; HR = 1.4, = 0.538), delay in biologic therapy initiation (OR = 7.5, = 0.00001; HR = 6.7, = 0.002), alkaline phosphatase <165 U\l (OR = 4.1, = 0.0003; HR = 5.2, = 0.000004), treatment with corticosteroids (CS) (OR = 2.6, = 0.008; HR = 1.2, = 0.670), cumulative corticosteroids >2,700 mg (OR = 4.3, = 0.032; HR = 1.4, = 0.527). The following factors were associated with THA: delay in biologic treatment initiation (OR = 1.04, = 0.0001; HR = 9.1, = 0.034), delayed hip involvement (OR = 5.2, = 0.002; HR = 3.0, = 0.044), and methylprednisolone pulse therapy (OR = 10.8, = 0.0000001; HR = 5.6, = 0.002). Both sJIA and systemic CS, impaired calcium-phosphorus metabolism, and delayed hip arthritis are associated with HOA development in JIA. HOA is considered to be a severe adverse event of CS treatment, especially delayed hip involvement.
描述幼年特发性关节炎（JIA）从关节炎发展至髋关节骨关节炎（HOA）及全髋关节置换术（THA）过程中髋关节受累的临床特征。本研究纳入了753例年龄在2至17岁的JIA患者。对以下亚组进行了比较分析：（i）无髋关节受累的JIA（n = 600；79.7%）与有髋关节受累但无HOA的JIA（n = 105；13.9%），（ii）有髋关节受累且有HOA但未行THA的JIA（n = 32；4.3%）和有髋关节受累且有HOA并已行THA的JIA（n = 16；2.1%）。比较了临床、实验室特征及治疗方案。20.3%的患者存在髋关节受累。整个JIA组中6.4%（121,000患者年）出现HOA，髋关节受累患者中31.4%出现HOA。16例患者（2.1%；4.01,000患者年）需要行THA。以下因素与HOA相关：全身型JIA（OR = 3.6，P = 0.008；HR = 3.0，P = 0.002）、缓解延迟（OR = 4.2，P = 0.004；HR = 1.4，P = 0.538）、生物治疗起始延迟（OR = 7.5，P = 0.00001；HR = 6.7，P = 0.002）、碱性磷酸酶<165 U/L（OR = 4.1，P = 0.0003；HR = 5.2，P = 0.000004）、使用糖皮质激素（CS）治疗（OR = 2.6，P = 0.008；HR = 1.2，P = 0.670）、累积糖皮质激素>2700 mg（OR = 4.3，P = 0.032；HR = 1.4，P = 0.527）。以下因素与THA相关：生物治疗起始延迟（OR = 1.04，P = 0.0001；HR = 9.1，P = 0.034）、髋关节受累延迟（OR = 5.2，P = 0.002；HR = 3.0，P = 0.044）及甲泼尼龙冲击治疗（OR = 10.8，P = 0.0000001；HR = 5.6，P = 0.002）。全身型JIA和全身使用CS、钙磷代谢受损以及髋关节关节炎延迟均与JIA患者HOA的发生相关。HOA被认为是CS治疗的严重不良事件，尤其是髋关节受累延迟。
