Effect of joint injections in children with juvenile idiopathic arthritis: evaluation by 3D-gait analysis.
OBJECTIVE
To investigate how gait patterns change after intra-articular corticosteroid injections (ICIs) in the lower extremities.


METHODS
Eighteen children, aged 5-16 y, with juvenile idiopathic arthritis (JIA) and lower extremity involvement participated in the study. Sixty-four joints in the lower extremities were treated with ICIs. The Visual Analogue Scale (VAS, 0-100 mm) was used to assess pain. A 3D motion analysis system and two force plates were used to measure gait parameters, kinematics and kinetics. The first gait analysis was performed before treatment with ICIs, and a second one was done 8-17 d after treatment.


RESULTS
The participants' average rating of pain decreased from 26 mm on the VAS before ICI to 11 mm (p = 0.001) after treatment. The self-chosen walking velocity was significantly faster (p = 0.02) after treatment. The range of knee and ankle joint angles during gait increased significantly (p = 0.03 and 0.04) after treatment. At loading response, the hip extension moment increased (p = 0.01) as did knee flexion moment, and plantar flexion moment at pre-swing increased significantly (p = 0.02 and 0.002) after treatment. The ankle also generated more power (p = 0.005) after treatment.


CONCLUSIONS
The study shows positive effects of treatment with ICIs in the lower extremities--especially regarding pain, walking velocity and joint moments. The data indicate that ICI treatment influences the gait pattern also in joints that have not been injected.
Department of Woman and Child Health, Karolinska Institute, Astrid Lindgren Children's Hospital, Stockholm, Sweden. Eva.brostrom@kbh.ki.se
E
E
Broström
S
S
Hagelberg
Y
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Haglund-Akerlind
D000293:Adolescent; D000842:Ankle / Q000503:physiopathology; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001171:Arthritis, Juvenile / Q000188:drug therapy*; D001696:Biomechanical Phenomena; D002648:Child; D002675:Child, Preschool; D005260:Female; D005684:Gait / Q000187:drug effects / Q000502:physiology*; D006801:Humans; D007267:Injections; D007596:Joints / Q000187:drug effects / Q000503:physiopathology; D007717:Knee / Q000503:physiopathology; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage / Q000627:therapeutic use*; D010146:Pain / Q000188:drug therapy; D016896:Treatment Outcome
D000893:Anti-Inflammatory Agents; D008775:Methylprednisolone