JUVENILE IDIOPATHIC ARTHRITIS AND FITNESS: A TEAMWORK

Introduction: Patients with Juvenile Idiopathic Arthritis (JIA) have limited fitness and reduced aerobic and anaerobic exercise capacity vs. healthy peers. Furthermore, low intensity exercise programs are safe in children with JIA and may improve fitness, joint excursion and quality of life, reduce pain, fatigue and the employ to antiinflammatory drugs. Objectives: The purpose of the study was to evaluate postural and balance deficits and fitness with specific test battery in children and adolescents affected by JIA. Methods: We enrolled 30 patients with JIA (13 M; 17 F; age: 8-18 years); among those, 7 were evaluated longitudinally in the period 2016-2018, comparing the tests in different periods of the illness. The posturography test was administered with the FreeMed posturography system (the FreeMed baropodometric platform and FreeStep v.1.0.3 software). A specific fitness test battery was used to evaluate the physical fitness level of the patients (Abalakov test, backsaver sit and reach, the toe touch test, sit-up test and hand grip test). Results: 2 M and 5 F was in an acute phase of the disease (1 sJIA; 5 polyarticular JIA; 1 psoriatic JIA). At the posturography test, the distribution of the weight between left and right was pathological in 15 (4 sJIA; 9 polyarticular JIA; 2 oligoarticular JIA). The load distribution between forefoot and hindfoot was pathological in all the patients, with a more severe overload in polyarticular JIA patients. Hand-grip test in 8 patients was <3°Centile; in 11 was < 20°Centile. The patients who performed a regular physical activity program showed fitness test in the normal range, and these parameters were not correlated with the type of JIA and/or the treatment for the arthritis. Among the patients evaluated in follow up, 2 (1 with sJIA and 1 with polyarticular JIA) maintained an asymmetry in the weight distribution between left and right and a reduced fitness. 5 patients (2 M with sJIA and 3 F with polyarticular JIA) normalized their parameters. Conclusion: The persistent asymmetry of the load distribution between left and right foot and the persistent pathological distribution between forefoot and hindfoot was more frequent in patients with polyarticular JIA. A regular physical activity program is the best strategy to maintain an adequate fitness and the best control of the disease.