JÜVENİL İDİYOPATİK ARTRİTLİ ÇOCUKLARDA SKOLYOZ YAYGIN BİR DEFORMİTE MİDİR?

Öz

Amaç: Juvenil İdiyopatik Artrit (JİA), çocukluk çağında en sık görülen kronik romatizmal hastalıktır. JİA eklem tutulumu ile birlikte omurganın asimetrisini etkilediği için JİA'lı çocuklarda skolyoz ortaya çıkabilir. Bu çalışma, JİA’lı çocuklarda omurga taramasını ve sağlıklı kontrollerle karşılaştırmayı ve ebevynlerin bu konudaki farkındalığını değerlendirmeyi amaçlamaktadır. Yöntem: Bu çalışmaya 4-16 yaş arası 218 JİA'lı çocuk (163 kız, 55 erkek) ve 144 sağlıklı kontrol (124 kız, 20 erkek) dahil edildi. Gövde rotasyon açısı, öne eğilme testi uygulanarak bir skolyometre ile ölçüldü. Gövde rotasyon açısı 5˚'den fazla olan çocuklar ortopedist tarafından röntgene yönlendirildi. Ebeveynlerden demografik veri toplamak ve skolyoz farkındalıklarını değerlendirmek için ebeveynler için hazırlanan formlar kullanıldı. Tüm analizlerde Statistical Package for Sciences (SPSS)-24.0 programı kullanıldı. p<0,05 anlamlı olarak kabul edildi. Bulgular: Omurga dışındaki eklemleri etkilenen JİA'lı 218 çocuğun 35'inde (%16,1) skolyoz görüldü. 183 ebeveyn çalışmadan önce skolyozu hiç duymadığını bildirdi. Taramadan önce aileleri skolyozu duymayan 183 çocuğun 25'inde skolyoz görülürken, skolyozu duyan ailelerde 34 çocuktan 10'ununa skolyoz tanısı konuldu. Tartışma: JİA'lı çocukların ebeveynleri sadece eklem ve ekstremitelere değil, omurga ve vücuttaki asimetrilere de dikkat etmelidir. Bununla birlikte, sadece etkilenen eklemi değerlendirmek yerine, JİA'lı çocuklar omurga da dahil olmak üzere kapsamlı bir şekilde değerlendirmelidir. Bu konuda ailelelerin skolyoz hakkındaki farkındalığı büyük önem taşımaktadır.

Anahtar Kelimeler

• farkındalık
• deformite
• jüvenil idiyopatik artrit
• skolyoz
• omurga

IS SCOLIOSIS A COMMON DEFORMITY IN CHILDREN WITH JUVENILE IDIOPATHIC ARTHRITIS?

Abstract

Purpose: Juvenile Idiopathic Arthritis (JIA) is the most common chronic rheumatic disease in childhood. Scoliosis can occur in children with JIA, since it mainly affects joint involvement, and contributes to the asymmetry of body and spine. This study aims to screen scoliosis in JIA, compare it with healthy controls, and evaluate the awareness among parents of children. Methods: 218 children with JIA (163 girls, 55 boys) and 144 healthy controls (124 girls, 20 boys) aged 4-16 years were involved in this study. Angle of Trunk rotation (ATR) was measured by a scoliometer by applying a forward bending test. Children with more than 5˚ ATR were referred to take X-ray. To collect demographic data from parents and assess their awareness of scoliosis, forms designed for parents were used. Results: Scoliosis was seen in 35 of the 218 (16.1%) children with JIA whose joints other than the spine were affected. 183 parents reported that they had never heard of scoliosis before the study. Scoliosis was seen in 25 children of the 183 children whose families had not heard of scoliosis before the examination. In families who had heard of scoliosis before the study, scoliosis was diagnosed in 10 of the 34 children. Conclusion: Parents of children with JIA should pay attention not only to joints and extremities but also to the spine and asymmetries in the body. However, instead of just assessing the affected joint, professionals should evaluate children with JIA comprehensively, including the spine.

Keywords

• scoliosis
• deformity
• awareness
• juvenile idiopathic arthritis
• spine

Kaynakça

1. Ozdogan H, Kasapcopur O, Arisoy N, et al. Prevalence of juvenile chronic arthritis and familial Mediterranean fever in Turkey: a field study. The Journal of rheumatology 1999;26(7),1638-1639
2. Martini, A., Lovell, D. J., Albani, S., Brunner, H. I., Hyrich, K. L., Thompson, S. D., & Ruperto, N. Juvenile idiopathic arthritis. Nature Reviews Disease Primers, 2022; 8(1), 5.
3. Okamoto N, Yokota S, Takei S, et al. Clinical practice guidance for juvenile idiopathic arthritis (JIA). Mod Rheumatol 2018;29
4. Yagci G, Karatel M, Yakut Y. Body Awareness and its Relation to Quality of Life in Individuals with Idiopathic Scoliosis. Perceptual and Motor Skills 2020;127(5), 841-857.
5. Baydogan SN, Tarakci E, Kasapcopur O. Effect of strengthening versus balance-proprioceptive exercises on lower extremity function in patients with juvenile idiopathic arthritis. Am J Phys Med Rehabil 2015;94
6. Lee JG, Yun YC, Jo WJ, Seog TY, Yoon YS. Correlation of Radiographic and Patient Assessment of Spine Following Correction of Nonstructural Component in Juvenile Idiopathic Scoliosis. Ann Rehabil Med. 2018 Dec;42(6):863-871. doi: 10.5535/arm.2018.42.6.863. Epub 2018 Dec 28. PMID: 30613080; PMCID: PMC6325314.
7. Kisa EP, Tarakcı E, Leblebici G, Ozdincler AR, Kasapcopur O. Exercise programs for scoliosis in juvenile idiopathic arthritis: a randomized-controlled study. Rheumatology International, 2023;1-9.
8. Kotecki M, Gietka P, Posadzy M, Sudoł-Szopińska I. Radiographs and MRI of the Cervical Spine in Juvenile Idiopathic Arthritis: A Cross-Sectional Retrospective Study. Journal of Clinical Medicine. 2021; 10(24):5798. https://doi.org/10.3390/jcm10245798

9. Çolak TK, Apti A, Dereli E, et al. Scoliosis screening results of primary school students (11–15 years old group) in the west side of Istanbul. J Phys Ther Sci 2015;27.
10. Suh SW, Modi HN, Yang JH, et al. Idiopathic scoliosis in Korean schoolchildren: A prospective screening study of over 1 million children. Eur Spine J 2011;20.
11. Hulley SB, Cummings SR, Browner WS, Grady DG, Newman TB, Designing Clinical Research, Lippincott Williams & Wilkins, 2013.
12. Otman S. Köse N. Tedavi hareketlerinde temel değerlendirme prensipleri, 2015;4, 20-26.
13. Fraenkel L, Falzer P, Fried T, et al. Measuring pain impact versus pain severity using a numeric rating scale. J Gen Intern Med 2012;27.
14. Murrell GAC, Coonrad RW, Moorman CT, et al. An assessment of the reliability of the scoliometer. Spine 1993;18
15. Coelho DM, Bonagamba GH, Oliveira AS. Scoliometer measurements of patients with idiopathic scoliosis. Brazilian J Phys Ther 2013;17
16. Peng Y, Wang SR, Qiu GX, et al. Research progress on the etiology and pathogenesis of adolescent idiopathic scoliosis. Chinese medical journal 2020;133(4), 483.
17. Tauchi R, Tsuji T, Cahill PJ, et al. Reliability analysis of Cobb angle measurements of congenital scoliosis using X-ray and 3D-CT images. Eur J Orthop Surg Traumatol 2016;26
18. Wang J, Zhang J, Xu R, et al. Measurement of scoliosis Cobb angle by end vertebra tilt angle method. J Orthop Surg Res. 2018;13.
19. Hacquebord JH, Leopold SS. In brief: The risser classification: A classic tool for the clinician treating adolescent idiopathic scoliosis. Clin Orthop Relat Res 2012;470.
20. Indrayan, A. Clinical agreement in quantitative measurements. In Methods of clinical epidemiology, 2013, 17-27. Springer, Berlin, Heidelberg.
21. Kim BR, Ham JH: Awareness and treatment status of scoliosis of middle and high school students in Seosan city. J Korea Contents Assoc 2011;11:204-12
22. Tarakci E, Yeldan I, Kaya Mutlu E, et al. The relationship between physical activity level, anxiety, depression, and functional ability in children and adolescents with juvenile idiopathic arthritis. Clin Rheumatol 2011;30. https://doi.org/10.1007/s10067-011-1832-0
23. Umar A, Nasir S, Tunau K, et al. Awareness and perception of preconception care among women in Usmanu Danfodiyo University Teaching Hospital Sokoto, North-Western Nigeria. J Fam Med Prim Care 2019;8.
24. Altaf F, Drinkwater J, Phan K, Cree AK. Systematic review of school scoliosis screening. Spine Deform 2017;5(5):303-9.
25. Ağartıoğlu G. Results of Scoliosis Screening in Primary School Students. İzmir Kâtip Çelebi Üniversitesi Sağlık Bilimleri Fakültesi Dergisi 2018;3(3):1-6.
26. Martinez C, Beauséjour M, Labelle H. From Systematic Screening Programs to Increased Community Awareness: Past, Present and The Future of Scoliosis Detection in Children. Journal of Eastern Townships Studies 2021;49, 49-119.
27. Lee CF, Fong DY, Cheung KM, Cheng JC, Ng BK, Lam TP, et al. Costs of school scoliosis screening: A large, population-based study. Spine (Phila Pa 1976). 2010;35(26):2266-72.
28. Théroux J, Stomski N, Hodgetts CJ, et al. Prevalence of low back pain in adolescents with idiopathic scoliosis: A systematic review. Chiropr. Man. Ther 2017;25(1),1-6.
29. Weiss JE, Luca NJC, Boneparth A, et al. Assessment and Management of Pain in Juvenile Idiopathic Arthritis. Pediatr Drugs 2014;16.
30. Fraga MM, Terreri MT, Azevedo RT. et al. Pain perception and pain coping mechanisms in children and adolescents with juvenile fibromyalgia and polyarticular juvenile idiopathic arthritis. Rev Paul Pediatr 2019;37:1
31. Rigo M. Differential diagnosis of back pain in adult scoliosis (non operated patients). Scoliosis 2010;5
32. Teles AR, Ocay DD, Bin Shebreen A, et al. Evidence of impaired pain modulation in adolescents with idiopathic scoliosis and chronic back pain. Spine J 2019;19
33. Lonner B, Yoo A, Terran JS, et al. Effect of spinal deformity on adolescent quality of life: Comparison of operative scheuermann kyphosis, adolescent idiopathic scoliosis, and normal controls. Spine 2013;38
34. Nørgaard, M., Herlin, T. Specific Sports Habits, Leisure-Time Physical Activity, and School-Educational Physical Activity in Children With Juvenile Idiopathic Arthritis: Patterns and Barriers. Arthritis Care Res, 2019, 71,271–280. https://doi.org/10.1002/acr.23795