Talus Arthritis Pattern in Juvenile Idiopathic Arthritis (JIA)

Abstract

Category: Ankle Arthritis Introduction/Purpose: Juvenile idiopathic arthritis is a broad term that describes a clinically heterogeneous group of arthritides of unknown cause, which begin before 16 years of age persist for more than 6 weeks. It is one of the main diseases affecting Paediatric age group Joints in a form of a chronic, long standing and debilitating disease. It is estimated that 1 in 1000 children present with JIA in the UK alone. Radiographic progression of the disease occurs early, and if not addressed may result in permanent joint destruction and poor functional outcomes. The ankle is frequently involved, but it is unclear whether this is due to synovitis, tenosynovitis. To date, no evidence of combined therapies or integrated care for juvenile idiopathic arthritis patients with F&A problems exists. Methods: JIA patients with ankle involvement presented to orthopedic foot and ankle services between 2012-2017 were include. All patients had weight bearing x-rays ankle measuring Tibio talar angle, also underwent Ankle MRI following standard hospital MRI protocols. The MRI scans were used to measure the affected areas in talus. Talus was divided into 4 anatomical regions (Anterio-medial, Anterio-lateral, posterior-medial, posterolateral). lesion involving wider areas were recorded as two or more regions accordingly, i.e.: AM and PM involvement at the same time were given yes for area of involvement in both region and recorded separately. Bilateral Ankles involvement were also recorded. Tibial growth plate involvement in these patients on the MRI scan was recorded. Demographic data was collected along with side, disease pattern, age at diagnosis and age at presentation to F&A speciality and patients requiring surgical intervention. Measurements were carried out by two in dependent orthopaedics F&A surgeons. Results: 14 patients were included in this study with a total of 17 ankles. 12 were females (N=12, 85.7%). Mean age was between 8-21 years (15.0 ± 4.08, M±SD). Time to presentation was 2.9 to 8.4 years (5.1 ± 1.4 years). 5 had Oligo-articular involvement (37.5%),9 patients had polyA (64.2%). 11/17 Right Ankles (64.7%), 3 left (21.4%). 3 bilateral (21.4%). 11/17 Ankles in Varus (64.7%), 1/17 valgus (5.8%), 5/17 neutral (29.4%). Mean Tibiotalar angle was 80° ± 13.5° (Range 49° - 100°). 12/17(70.5%) had involvement of the antero-medial part of the talus,1/17(5.8%)antero-lateral, 8/17 postero-medial(47.06%), 3/17(17.6%) postero-lateral . All the patients with postero-lateral involvement, they also had postero-medial involvement. (p=0.043). 13/17 ankles (76.4%) had tibial growth plate involvement. 5 patients (35.7%) had subsequent operations. Conclusion: This study shows a pattern of involvement in the talus and the effect this disease has on Tibiotalar alignment. This needs to be confirmed on a larger number of patients. And highlights the need for an earlier presentation of these patients to F&A surgeon to prevent the disease sequela. Further research is required to study the tibial growth plate involvement for its contribution to the varus / valgus deformity in a chronological method. Further research is also required to quantify the time frame for disease and deformity progression in the Tibiotalar Joint.