Juvenile rheumatoid arthritis. Aquatic exercise and lower-extremity function.

This pilot study investigates the effects of aquatic therapeutic exercise on lower-extremity range of motion, gait, balance, and functional mobility in children with juvenile arthritis. Eleven patients, aged 4-13, with lower-extremity joint involvement, diagnosed as functional class I-III, completed a 6-week program of aquatic exercise aimed at increasing lower-extremity range of motion and strength. Despite the small sample size and short duration of the study program, significant improvement was noted in external and internal hip rotation, bilaterally (p < 0.05). Improvement was noted in the median scores for most other parameters; however, these did not reach statistical significance. Aquatic exercises performed in a group setting can serve as an enjoyable and beneficial part of therapy for children with arthritis. Further investigation is recommended to determine fully the effects of aquatic therapeutic exercise on mobility and fitness in children with juvenile arthritis.

Nutritional status and growth in juvenile rheumatoid arthritis.

The specific cause of short stature in juvenile rheumatoid arthritis (JRA) is unknown. One hypothesis links altered growth to inadequate dietary intake. In this study, nutritional status was assessed in 34 children with JRA (8 with systemic JRA, 14 with polyarticular JRA, and 12 with pauciarticular JRA) and 9 healthy controls using 3-day diet records, anthropometrics, and biochemical analyses. Differences in growth were found among the three types of JRA. One third of all subjects were at or below the 10th percentile in height for age (these being predominantly among the systemic and polyarticular groups). With few exceptions, the mean dietary intake for calories and essential nutrients was found to be adequate for each of the three groups. However, more than half of those with systemic JRA reportedly consumed less than the recommended caloric intake for their age and weight. No significant correlations were found linking dietary intake to growth percentiles in any of the groups studied. Biochemical abnormalities were found among the systemic and polyarticular groups. These abnormalities included low plasma levels of vitamins A and C, proteins (albumin, prealbumin, and retinol binding protein) and zinc; and increased levels of copper and glutathione peroxidase activity. Plasma selenium and vitamin E levels were unchanged. The discrepancy between intake and certain circulating nutrient levels may reflect alterations in the requirements, absorption, or use of these nutrients in the presence of chronic inflammation.

The effects of fatigue, distractibility, and absenteeism on school achievement in children with rheumatic diseases.

Children with chronic health impairments have a variety of psychosocial, physical, and medical complications affecting daily life. This study investigated the relationship between the effects of a rheumatic disease (RD) and school functioning. Factors investigated were fatigue, distractibility, and absenteeism. In addition, disease severity and mobility were assessed. Forty-six children with RD and their parents participated in the study. Results indicated that inattention and distractibility were highly related to school achievement. A minimal relationship between fatigue and absenteeism and school performance was noted. In addition, ratings of mobility used by physicians were unrelated to success on math and reading achievement testing.