Control of susceptibility of F344 rats to adjuvant arthritis: an alternative interpretation

✍ Scribed by Joel D. Taurog; Steven L. Leary

• Publisher: John Wiley and Sons
• Year: 1983
• Tongue: English
• Weight: 204 KB
• Volume: 26
• Category: Article
• ISSN: 0004-3591
• DOI: 10.1002/art.1780260627

✦ Synopsis

Rehabilitation of severe hip damage in juvenile arthritis

To the Editor:

We read with interest Dr. Jacobs' letter (I). He was concerned about our treatment of hip damage in children with juvenile arthritis (JA) (2). Unfortunately, Dr. Jacobs seems to have misunderstood our paper. In none of our patients did severe hip damage follow our program of bed rest, skin traction, and active exercises. On the contrary, those treatment modalities were prescribed after severe changes had already occurred and patients were almost unable to walk. As soon as pain and flexion contractures improved, the patients were encouraged to restart aided ambulation. This approach to the management of hip damage is a recognized treatment program in well-known centers with vast experience in the care of children with chronic arthritis (3,4).

There is no doubt that prolonged bed rest is not an acceptable treatment and that maintenance of weight bearing is the primary goal, no matter how severe the disease. However, weight bearing should be restricted when flexion and adduction deformities are present. In cases such as those reported by us, these contractures should be corrected before restarting ambulation. The knowledge of these basic principles of rehabilitation, well understood by rheumatologists, should be extended to all physicians engaged in the treatment of juvenile chronic arthritis.

Remodeling of the hip joint in JA is indeed an interesting phenomenon; we wish we could say more than that.