The inflammation related to juvenile arthritis is sufficient that in poorly controlled disease, it can cause such severe joint damage that patients require prosthetic joint replacement, often at a young age. In one long-term study group (3), prosthetic joint replacement was common, with 49% of the patient group having at least one major prosthetic joint replacement. The frequencies of joint replacement with JIA subset are shown in Table 6. The subgroups of systemic JIA, rheumatoid factor positive and negative polyarticular disease had highest risk of requiring orthopedic interventions. Other joint replacements were comparatively infrequent (shoulder 4.9%, elbow 3.3%, wrist 1.6%, and ankle 1.6%).
Predisposing factors were disease duration, poor function, presence of growth defects, height retardation, and continuing active inflammation. The need for prosthetic joint replacement increases with severity and time. However, the correlation of the need for prosthetic joint surgery with growth defects and height retardation, highlights the influence of severe disease in childhood and the importance of disease control from an early age. With the recent introduction of more effective immunosuppressive agents and earlier aggressive intervention, the proportion of these patients who go on to require surgery is likely to significantly reduce in the future.
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