Osteochondritis dissecans shows a severe course and poor outcome in patients with juvenile idiopathic arthritis: a matched pair study of 22 cases
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Juvenile osteochondritis dissecans (JOCD) and juvenile idiopathic arthritis (JIA) are both common diseases which may affect joints and bony structures in pediatric patients. In some cases, JOCD and JIA occur at the same time. In this study, the course of JOCD in patients with JIA was therefore evaluated to provide possible recommendations for further treatment opportunities and control examinations. From 06/2012 to 03/2018 55 children with JOCD with or without JIA were examined. Inclusion criteria were: (1) age ≤ 16 years, (2) diagnosis of a JOCD with or without JIA and (3) two routine MRI controls. The JOCD evaluation based on the classification according to Bruns and the measurement of the largest extent via MRI. 18 of these 55 children met our criteria: 11 JOCD findings of 7 patients with JIA (group A) were matched according to age and localization of JOCD to 11 patients without JIA (group B). Mean age of disease onset of JIA was 8.2 years (oligo JIA) and of JOCD 11.6 years. The mean time follow-up was 17.7 months. At all observation time points more JOCD findings (with stage III° and IV°, respectively) along with a significant deterioration was seen in group A compared to group B. The comparison of the last MRI control between group A and group B shows a significant smaller defect size (decrease of 54.5%, p = 0.028) in group B (97.9 ± 48.9 mm2) as in group A (185.1 ± 102.9 mm2). In comparison of first (169.7 ± 84.2 mm2) and last MRI (97.9 ± 48.9 mm2) a significant decrease in lesion size of JOCD in group B was seen (decrease of 58.4%, p = 0.048). Patients with JIA show a more progressive and severe course of JOCD. Therefore, we recommend (1) the early use of MRI in patients with JIA and persistent joint pain to detect potential JOCD and (2) in presence of JIA and JOCD regular MRI follow-up controls to identify deteriorating JOCD findings and prevent early joint destruction in pediatric patients.
KeywordsOsteochondritis dissecans Juvenile idiopathic arthritis MRI Progress
HK and PO analyzed data and wrote the paper. MH and HJL collected data. PH analyzed data. RK and HP have initiated and supervised the project. HP revised the manuscript.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no competing interests.
- 2.Hefti F, Beguiristain J, Krauspe R et al (1999) Osteochondritis dissecans: a multicenter study of the European Pediatric Orthopedic Society. J Pediatr Orthop Part B 8:231–245Google Scholar
- 3.Hashimoto Y, Yoshida G, Tomihara T et al (2008) Bilateral osteochondritis dissecans of the lateral femoral condyle following bilateral total removal of lateral discoid meniscus: a case report. Arch Orthop Trauma Surg 128:1265–1268. https://doi.org/10.1007/s00402-007-0499-0 CrossRefPubMedGoogle Scholar
- 4.Mubarak SJ, Carroll NC (1981) Juvenile osteochondritis dissecans of the knee: etiology. Clin Orthop 157:200–211Google Scholar
- 5.Camathias C, Hirschmann MT, Vavken P et al (2014) Meniscal suturing versus screw fixation for treatment of osteochondritis dissecans: clinical and magnetic resonance imaging results. Arthrosc J Arthrosc Relat Surg Off Publ Arthrosc Assoc N Am Int Arthrosc Assoc 30:1269–1279. https://doi.org/10.1016/j.arthro.2014.05.010 CrossRefGoogle Scholar
- 9.Bruns J, Werner M, Habermann C (2017) Osteochondritis dissecans: etiology, pathology, and imaging with a special focus on the knee joint. Cartilage 1947603517715736. https://doi.org/10.1177/1947603517715736
- 14.van Loosdregt J, van Wijk F, Prakken B, Vastert B (2017) Update on research and clinical translation on specific clinical areas from biology to bedside: unpacking the mysteries of juvenile idiopathic arthritis pathogenesis. Best Pract Res Clin Rheumatol 31:460–475. https://doi.org/10.1016/j.berh.2018.02.003 CrossRefPubMedGoogle Scholar
- 25.Yokota S, Imagawa T, Mori M et al (2008) Efficacy and safety of tocilizumab in patients with systemic-onset juvenile idiopathic arthritis: a randomised, double-blind, placebo-controlled, withdrawal phase III trial. Lancet Lond Engl 371:998–1006. https://doi.org/10.1016/S0140-6736(08)60454-7 CrossRefGoogle Scholar
- 26.Brunner HI, Ruperto N, Zuber Z et al (2015) Efficacy and safety of tocilizumab in patients with polyarticular-course juvenile idiopathic arthritis: results from a phase 3, randomised, double-blind withdrawal trial. Ann Rheum Dis 74:1110–1117. https://doi.org/10.1136/annrheumdis-2014-205351 CrossRefPubMedGoogle Scholar
- 29.Barton KI, Heard BJ, Sevick JL et al (2018) Posttraumatic osteoarthritis development and progression in an ovine model of partial anterior cruciate ligament transection and effect of repeated intra-articular methylprednisolone acetate injections on early disease. Am J Sports Med. https://doi.org/10.1177/0363546518765098 PubMedCrossRefGoogle Scholar