title: Musculoskeletal abnormalities of the forearm in patients with juvenile idiopathic arthritis relate mainly to bone geometry.
abstract: OBJECTIVE
  Alterations of the skeletal system, including reduced bone mineral density, increased frequency of fractures, and changes in markers of bone metabolism, have been described in juvenile idiopathic arthritis (JIA), but measurement of volumetric bone density and bone geometry is not possible with the techniques used in most studies. This study was undertaken to obtain a more detailed understanding of the musculoskeletal system in JIA by analyzing bone density, bone geometry, and muscle force as the most important factor in bone development.
  
  
  METHODS
  The technique of peripheral quantitative computed tomography was used in a cross-sectional study of 57 children with the oligoarticular, polyarticular, or systemic form of JIA. Density of trabecular and cortical bone as well as geometric parameters of bone and muscle were measured at the forearm.
  
  
  RESULTS
  Children in all subgroups had significantly reduced muscle cross-sectional area, which was strongly correlated with muscle force and abnormalities in geometric parameters of bone, including a significant reduction in cortical thickness. Trabecular density was affected only in the polyarticular JIA group, and cortical density was normal in all subgroups.
  
  
  CONCLUSIONS
  Our results suggest that an important problem in JIA is the lack of muscle mass and force, together with abnormal bone geometry. The thinned bony cortices might predispose to fractures even though cortical bone density itself is normal. These results might have implications with regard to therapeutic approaches to preserve musculoskeletal integrity in JIA.
authors.affiliation: University Children's Hospital, Tuebingen, Germany. johannes.roth@charite.de
authors.forename: Johannes
authors.initials: J
authors.lastname: Roth
authors.forename: Christian
authors.initials: C
authors.lastname: Palm
authors.forename: Ingo
authors.initials: I
authors.lastname: Scheunemann
authors.forename: Michael B
authors.initials: MB
authors.lastname: Ranke
authors.forename: Roland
authors.initials: R
authors.lastname: Schweizer
authors.forename: Guenther E
authors.initials: GE
authors.lastname: Dannecker
mesh_terms: D000293:Adolescent; D001171:Arthritis, Juvenile / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000473:pathology*; D015519:Bone Density; D001851:Bone Diseases, Metabolic / Q000000981:diagnostic imaging / Q000473:pathology*; D001842:Bone and Bones / Q000000981:diagnostic imaging / Q000473:pathology*; D005260:Female; D005542:Forearm / Q000000981:diagnostic imaging / Q000473:pathology*; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D008297:Male; D009119:Muscle Contraction; D018482:Muscle, Skeletal / Q000000981:diagnostic imaging / Q000473:pathology*; D014057:Tomography, X-Ray Computed
chemical_list: D005938:Glucocorticoids