Skip to main content

Advertisement

SpringerLink
Log in

Prominent midfoot involvement in children with enthesitis-related arthritis category of juvenile idiopathic arthritis

  • Original Article
  • Published:
Clinical Rheumatology Aims and scope Submit manuscript

Abstract

Foot involvement is common in juvenile idiopathic arthritis (JIA) but is often unrecognized and difficult to treat. This study was done to assess clinical and radiological involvement of the feet and its impact on function in Indian children with enthesitis-related arthritis (ERA). We enrolled consecutive children with ERA with disease duration of less than 5 years. All patients underwent clinical examination of the feet and filled the juvenile arthritis foot index (JAFI) questionnaire. Ultrasound (US) of foot joints and entheses and extremity magnetic resonance imaging (MRI) scan of one foot were done. Fifty-five patients (53 boys), with median 14 years and disease duration 1.9 years, were included. Thirty-seven of 46 were HLA-B27-positive. Mean juvenile spondyloarthritis disease activity (JSpADA) index and juvenile idiopathic arthritis disease activity scrore-10 (JADAS10) scores were 4 and 14.25. Forty-six had history of foot pain, 36 had foot involvement on examination (15 ankle, 8 subtalar, 24 midfoot, 10 forefoot, and 21 tendoachilles), and 7 had plantar fascia involvement. On US (N = 55), 16 had ankle involvement and 8 had subtalar involvement, and 19 patients had midfoot arthritis, 24 had tendoachilles enthesitis, and 11 had plantar fasciitis. On MRI (N = 50), 27 had midfoot involvement. Thirty-three had bone edema. Fourteen had midfoot enthesitis and 17 had tenosynovitis. Clinical and US had 82% concordance at the midfoot and 90% at the ankle. MRI had 74% concordance with examination and 72% with US at the midfoot. The median JAFI scores were as follows: total JAFI = 4 (0–11), impairment = 1, activity limitation = 2, and participation restriction = 1. JAFI total and individual domains correlated with JADAS10, JSpADAS, and childhood health assessment questionnaire (CHAQ) but not duration of foot disease. JAFI was higher in children with midfoot arthritis on US. Foot joints and entheses are involved in a substantial proportion of patients with ERA patients and the midfoot is commonly involved. Foot disease produces significant functional limitation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Abujam B, Mishra R, Aggarwal A (2014) Prevalence of musculoskeletal complaints and juvenile idiopathic arthritis in children from a developing country: a school-based study. Int J Rheum Dis 17(3):256–260

    Article  PubMed  Google Scholar 

  2. Kunjir V, Venugopalan A, Chopra A (2010) Profile of Indian patients with juvenile onset chronic inflammatory joint disease using the ILAR classification criteria for JIA: a community-based cohort study. J Rheumatol 37(8):1756–1762. doi:10.3899/jrheum.090937

    Article  PubMed  Google Scholar 

  3. Petty RE, Southwood TR, Manners P, Baum J, Glass DN, Goldenberg J, He X, Maldonado-Cocco J, Orozco-Alcala J, Prieur A-M (2004) International League of Associations for Rheumatology classification of juvenile idiopathic arthritis: second revision, Edmonton, 2001. J Rheumatol 31(2):390

    PubMed  Google Scholar 

  4. Hendry G, Gardner-Medwin J, Watt GF, Woodburn J (2008) A survey of foot problems in juvenile idiopathic arthritis. Musculoskeletal Care 6(4):221–232

    Article  CAS  PubMed  Google Scholar 

  5. Spraul G, Koenning G (1994) A descriptive study of foot problems in children with juvenile rheumatoid arthritis (JRA). Arthritis Rheum 7(3):144–150

    Article  CAS  Google Scholar 

  6. Arkela-Kautiainen M, Haapasaari J, Kautiainen H, Vilkkumaa I, Mälkiä E, Leirisalo-Repo M (2005) Favourable social functioning and health related quality of life of patients with JIA in early adulthood. Ann Rheum Dis 64(6):875–880

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Cassidy JT, Petty RE, Laxer RM, Lindsley CB (2010) Textbook of pediatric rheumatology. Elsevier Health Sciences,

  8. Magni-Manzoni S (2016) Ultrasound in juvenile idiopathic arthritis. Pediatr Rheumatol 14(1):1

    Article  Google Scholar 

  9. Magni-Manzoni S, Collado P, Jousse-Joulin S, Naredo E, D'Agostino MA, Muratore V, Merli P, Roth J, Paediatric Ultrasound Group of the OUTF (2014) Current state of musculoskeletal ultrasound in paediatric rheumatology: results of an international survey. Rheumatology 53(3):491–496. doi:10.1093/rheumatology/ket368

    Article  PubMed  Google Scholar 

  10. Shenoy S, Aggarwal A (2014) 268. Subclinical sonologic enthesitis in juvenile idiopathic arthritis–enthesitis-related arthritis. Clin Exp Rheumatol 53(suppl 1):i159–i160

    Google Scholar 

  11. Duer-Jensen A, Ejbjerg B, Albrecht-Beste E, Vestergaard A, Døhn UM, Hetland ML, Østergaard M (2009) Does low-field dedicated extremity MRI (E-MRI) reliably detect bone erosions in rheumatoid arthritis? A comparison of two different E-MRI units and conventional radiography with high-resolution CT scanning. Ann Rheum Dis 68(8):1296–1302

    Article  CAS  PubMed  Google Scholar 

  12. André M, Hagelberg S, Stenström CH (2004) The juvenile arthritis foot disability index: development and evaluation of measurement properties. The J Rheumatol 31(12):2488–2493

    PubMed  Google Scholar 

  13. Alvarez-Madrid C, Merino R, De Inocencio J, García-Consuegra J (2008) Tarsitis as an initial manifestation of juvenile spondyloarthropathy. Clin Exp Rheumatol 27(4):691–694

    Google Scholar 

  14. Ravelli A, Viola S, Ruperto N, Corsi B, Ballardini G, Martini A (1997) Correlation between conventional disease activity measures in juvenile chronic arthritis. Ann Rheum Dis 56(3):197–200

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Giannini EH, Ruperto N, Ravelli A, Lovell DJ, Felson DT, Martini A (1997) Preliminary definition of improvement in juvenile arthritis. Arthritis Rheum 40(7):1202–1209

    Article  CAS  PubMed  Google Scholar 

  16. Weiss PF, Colbert RA, Xiao R, Feudtner C, Beukelman T, DeWitt EM, Pagnini I, Wright TB, Wallace CA (2014) Development and retrospective validation of the juvenile spondyloarthritis disease activity index. Arthritis Care Res 66(12):1775–1782

    Article  Google Scholar 

  17. Consolaro A, Ruperto N, Bazso A, Pistorio A, Magni-Manzoni S, Filocamo G, Malattia C, Viola S, Martini A, Ravelli A (2009) Development and validation of a composite disease activity score for juvenile idiopathic arthritis. Arthritis Care Res 61(5):658–666

    Article  Google Scholar 

  18. Tonks S, Marsh S, Bunce M, Bodmer J (1999) Molecular typing for HLA class I using ARMS-PCR: further developments following the 12th International Histocompatibility Workshop. Tissue Antigens 53(2):175–183

    Article  CAS  PubMed  Google Scholar 

  19. Wakefield RJ, Balint PV, Szkudlarek M, Filippucci E, Backhaus M, D'Agostino M-A, Sanchez EN, Iagnocco A, Schmidt WA, Bruyn GA (2005) Musculoskeletal ultrasound including definitions for ultrasonographic pathology. J Rheumatol 32(12):2485–2487

    PubMed  Google Scholar 

  20. Ostergaard M, McQueen FM, Bird P, Ejbjerg B, Lassere MN, Peterfy CG, O'Connor PJ, Haavardsholm E, Shnier R, Genant HK (2005) Magnetic resonance imaging in rheumatoid arthritis advances and research priorities. J Rheumatol 32(12):2462–2464

    PubMed  Google Scholar 

  21. Sarma PK, Misra R, Aggarwal A (2008) Outcome in patients with enthesitis related arthritis (ERA): juvenile arthritis damage index (JADI) and functional status. Pediatr Rheumatol Online J 2008(6):18

    Article  Google Scholar 

  22. Srivastava R, Phatak S, Yadav A, Bajpai P, Aggarwal A (2016) HLA B27 typing in 511 children with juvenile idiopathic arthritis from India. Rheumatol Int 36(10):1407–1411

    Article  CAS  PubMed  Google Scholar 

  23. Mavidrou A, Ansell B, Klenerman L (1991) Conservative management of the hindfoot in juvenile chronic arthritis. Foot 1(3):139–143

    Article  Google Scholar 

  24. Hendry GJ, Gardner-Medwin J, Watt GF, Woodburn J, McColl JH, Sturrock RD (2011) Foot related impairments and disability in juvenile idiopathic arthritis persist despite modern day treatment paradigms. J Foot Ankle Res 4:P24

    Article  PubMed Central  Google Scholar 

  25. Flatø B, Hoffmann-Vold AM, Reiff A, Førre Ø, Lien G, Vinje O (2006) Long-term outcome and prognostic factors in enthesitis-related arthritis: a case–control study. Arthritis Rheum 54(11):3573–3582

    Article  PubMed  Google Scholar 

  26. Shortt CP (2010) Magnetic resonance imaging of the midfoot and forefoot: normal variants and pitfalls. Magn Reson Imaging Clin N Am 18(4):707–715

    Article  PubMed  Google Scholar 

  27. Burgos-Vargas R, Pacheco-Tena C, Vazquez-Mellado J (2001) A short-term follow-up of enthesitis and arthritis in the active phase of juvenile onset spondyloarthropathies. Clin Exp Rheumatol 20(5):727–731

    Google Scholar 

  28. Burgos-Vargas R (1991) Ankylosing tarsitis: clinical features of a unique form of tarsal disease in the juvenile-onset spondyloarthropathies. Arthritis Rheum 34(suppl 9):D196

    Google Scholar 

  29. Seetharaman M, Brent LH (2003) Ankylosing tarsitis. J Rheumatol 30(3):630–631

    PubMed  Google Scholar 

  30. Pacheco-Tena C, Pérez-Tamayo R, Pineda C, González-Chávez SA, Quiñonez-Flores C, Vitelly AU, Inman RD, Aubin JE, Vázquez-Mellado J, Burgos-Vargas R (2015) Bone lineage proteins in the entheses of the midfoot in patients with spondyloarthritis. J Rheumatol 42(4):630–637

    Article  PubMed  Google Scholar 

  31. Pacheco-Tena C, Gonzalez-Chavez SA, Quinonez-Flores C, Burgos-Vargas R (2015) Bone proliferation in ankylosing tarsitis might involve mechanical stress, and hormonal and growth factors. J Rheumatol 42(11):2210–2210

    Article  CAS  PubMed  Google Scholar 

  32. Menon Nisha PG, Puthiyapurayil Ashraf, Nambudakath Cherian, Arakkal Riazudeen (2016) Clinical profile and juvenile arthritis damage index in children with juvenile idiopathic arthritis: a study from a tertiary care center in south India. Int J Rheum Dis.

  33. Rooney ME, McAllister C, Burns JF (2009) Ankle disease in juvenile idiopathic arthritis: ultrasound findings in clinically swollen ankles. J Rheumatol 36(8):1725–1729

    Article  PubMed  Google Scholar 

  34. Tynjälä P, Honkanen V, Lahdenne P (2004) Pediatric rheumatology. Intra-articular steroids in radiologically confirmed tarsal and hip synovitis of juvenile idiopathic arthritis. Clin Exp Rheumatol 22:643–648

    PubMed  Google Scholar 

  35. Pascoli L, Wright S, McAllister C, Rooney M (2010) Prospective evaluation of clinical and ultrasound findings in ankle disease in juvenile idiopathic arthritis: importance of ankle ultrasound. J Rheumatol 37(11):2409–2414

    Article  PubMed  Google Scholar 

  36. Remedios D (1996) Juvenile chronic arthritis: tibio-talar or subtalar involvement? British J Radiol 69:1425–1425

    Google Scholar 

  37. Shirley M, Laxer RM (2012) New advances in juvenile spondyloarthritis. Nat Rev Rheumatol 8(5):269–279

    Article  Google Scholar 

  38. Weiss PF, Klink AJ, Behrens EM, Sherry DD, Finkel TH, Feudtner C, Keren R (2011) Enthesitis in an inception cohort of enthesitis-related arthritis. Arthritis Care Res 63(9):1307–1312

    Article  Google Scholar 

  39. Minden K, Niewerth M, Listing J, Biedermann T, Bollow M, Schöntube M, Zink A (2002) Long-term outcome in patients with juvenile idiopathic arthritis. Arthritis Rheum 46(9):2392–2401

    Article  PubMed  Google Scholar 

  40. Ferrari J (2015) Patient perceptions of foot disability in juvenile idiopathic arthritis: a comparison of the juvenile arthritis foot disability index and the Oxford ankle foot questionnaire for children. Journal of foot and ankle research 8:50. doi:10.1186/s13047-015-0106-5

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226014, India

    Sanat Phatak, Abhishek Zanwar & Amita Aggarwal

  2. Department of Radiodiagnosis, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226014, India

    Namita Mohindra

Authors
  1. Sanat Phatak
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Namita Mohindra
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Abhishek Zanwar
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Amita Aggarwal
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Amita Aggarwal.

Ethics declarations

Disclosures

None.

Funding

This study did not receive any external funding.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Phatak, S., Mohindra, N., Zanwar, A. et al. Prominent midfoot involvement in children with enthesitis-related arthritis category of juvenile idiopathic arthritis. Clin Rheumatol 36, 1737–1745 (2017). https://doi.org/10.1007/s10067-017-3733-3

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10067-017-3733-3

Keywords

Search

Navigation