Foot related impairments and disability in juvenile idiopathic arthritis

1. Foot related impairments and disability in juvenile idiopathic arthritis persist despite modern day treatment paradigms G. Hendry¹*, J. Gardner-Medwin³,G.F. Watt¹, J. Woodburn², J. McColl³, R. Sturrock³1School of Biomedical and Health Sciences, University of Western Sydney, 2Glasgow Caledonian University, Glasgow, UK, 3University of Glasgow, Glasgow, UK • Background & Objectives • Foot problems such as synovitis, limited joint range of motion, and deformity appear prevalent in Juvenile Idiopathic Arthritis (JIA) (Spraul & Koenning, 1994). • The medical management of JIA appears to have improved recently however little is known about the impact of new regimes on the foot • The objectives of this pilot study were to: • (1) assess the presence and severity of foot -related impairment and disability and (2) audit podiatric and medical management in a cohort of children with JIA. • Methods • We studied 30 JIA patients, with a mean age of 11.5 years (SD–3.6 years) and mean disease duration of 4.5 years (SD–3.8 years). JIA disease subtype included polyarticular negative (n=9), oligoarticular (n=7), extended oligoarticular (n=7), psoriatic (n=4), enthesitis related onset JIA (n=2) and undifferentiated (n=1). • The following clinical core set of measurements were undertaken: • The Juvenile Arthritis Foot Disability Index (JAFI) (Andre et al, 2004) was the primary outcome measure of the impact of JIA on the foot. • The Child Health Assessment Questionnaire (CHAQ) and pain VAS were completed by all subjects. • Spatio-temporal gait parameters were measured using an instrumented walkway (GaitRITE) to record walking speed (s) and double support time (s) • The Structural Index (Plattoet al, 1991) was used to calculate summated scores for foot deformity. • Case notes were reviewed and data recorded from the previous 12 months of outpatient care. • Results Figure 2. JAFI likert scale responses indicating frequency of foot related problems in the past week (0=never, 1=occasionally / less than once a week, 2=sometimes / once a week, 3=frequently / 2 or 3 times a week, 4 = always). Figure 1. Two sisters. The girl on the left has polyarticularJIA. Table 1. Median (range) values for foot disease outcomes • JAFI and CHAQ scores represent mild foot related impairments and global disability respectively (table 1 and figure 2). • Mild to moderate foot deformity manifesting as rearfootmalalignment and toe deformity was a common finding • Podiatric treatment was centred on footwear advice, orthotic therapy, and silicone digital splinting together with intrinsic muscle strengthening exercises • Despite DMARD/biologic regimes and podiatry, foot related pain, impairment and disability persist in children with JIA. Further study is required to determine the long-term consequences of these changes found during childhood in the foot. Concluding Remarks 1* gordon.hendry@uws.edu.au UWS, Penrith, Sydney, Locked Bag 1797 Phone: +61 2 4620 3185