Challenges and Opportunities in Arthritis

Challenges and Opportunities in Arthritis

Bjorg Gudjonsdottir, Audur Kristjansdottir, Svanhildur Arna Oskarsdottir, Judith Amalia Gudmundsdottir, Solrun W Kamban, Zinajda Alomerovic Licina, and Drifa Bjork Gudmundsdottir


Purpose: To compare physical activity in children with juvenile idiopathic arthritis and age-matched peers.

Materials and methods: Daily physical activity was measured for seven consecutive days with activPALTM accelerometer in 8–18- year-old children with juvenile idiopathic arthritis (n=28) and age- and sex-matched controls (n=35). The main variables were daily steps and duration of time in moderate to vigorous physical activity. A mixed model analysis of variance was used for statistical analysis.

Results: The groups were comparable in terms of age, height, weight, body mass index and sex ratio. There was no difference in physical activity between the groups, measured in daily steps (p = 0.83) and duration of time in moderate to vigorous physical activity (p = 0.92). Both groups had lower physical activity at weekends than weekdays (p < 0.001). No interaction was observed between groups and days of the week regarding daily steps (p = 0.89) and time spent in moderate to vigorous physical activity (p = 0.60). Neither group met the current physical activity recommendations.

Conclusion: Physical activity of children with juvenile idiopathic arthritis in Iceland is comparable to age-matched peers without juvenile idiopathic arthritis. There is a need for intervention to increase physical activity in both groups.

Dr. Balaji Zacharia, Dr. Sanoj Poulose, Dr. Rose Xavier, Dr. Navaneeth Panarukandy, and Nidhin Chacko Valiyaveetil Hilary


We report a case of Salmonella septic arthritis of the shoulder in an immunocompetent infant one month after COVID-19 infection. An eight-month-old infant presented with intermittent fever for two weeks. She had features of septic arthritis of the left shoulder. She was treated with arthrotomy of the shoulder. The Gram staining and culture were consistent with Salmonella. Ceftriaxone was given parenterally followed by an oral route. She recovered fully without any recurrence. Salmonella septic arthritis is a rare entity. This is the first case of Salmonella septic arthritis reported in an immunocompetent infant after COVID-19 infection.

Iulian Nusem and Marjoree Sehu


Background: Septic arthritis of the hip is an orthopaedic emergency which requires prompt diagnosis and treatment. If treated late or inadequately, it can have devastating consequences for the development of the hip joint. Infection is most commonly caused by Staphylococcus aureus which spreads via the blood stream or from an adjacent area of osteomyelitis. Diagnosing and managing this condition continue to be challenging and poor outcomes may occur. Neonates may present with sepsis and failure to thrive. There may be no fever. The hip is held in flexed, abducted and externally rotated position. The limb is held still and any passive movement causes pain. Older children typically present with a limp or refusal to walk. Children typically have elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels. Needle aspiration is the most specific diagnostic test. Prompt surgical drainage and postoperative antibiotic therapy until signs of infection resolve are necessary to prevent late sequelae.

Objectives: The present review aims to discuss the published evidence related to the diagnosis of septic arthritis of the hip based on history, physical examination, laboratory tests, imaging studies and arthrocentesis, and management including antibiotic treatment and surgical joint debridement.

Conclusion: With prompt diagnosis and appropriate treatment, outcomes are generally good, with only few long-term sequelae. Delay in diagnosis and treatment may result in growth disturbances and joint destruction.

Dr. Balaji Zacharia, Dr. Sanoj Poulosse, Dr. Rose Xavier, Dr. Navaneeth Panarukandy, and Nidhin Chacko Valiyaveetil Hilary


Salmonella infections of the bone and joints are very rare. They are common in hemoglobinopathies and immunocompromised children. The diaphysis and metaphysis of the long bones are common sites. The spine pelvis, ribs, and cranium are rare sites. The clinical course is indolent compared to acute osteomyelitis. Serological tests and culture can be used for the diagnosis. Radiographs are frequently negative early in the disease. CT scans and MRI scans can be used in certain cases. The majority of cases can be managed with antibiotics. In this review, we describe the etiology, clinical features, investigations, and management of Salmonella bone and joint infections. We have described the features of Salmonella bone and joint infections in normal and sickle disease patients. We also present an illustrative case of Salmonella septic arthritis of the shoulder in an immunocompetent infant one month after COVID-19 infection.

Spencer Lofink, BS and Thomas Trumble, MD


Due to its remarkable mechanical properties and excellent biocompatibility, PyrocarbonTM is an ideal material for articular use. Various Pyrocarbon implants for the hand and wrist have been developed over the past 25 years.  The Ensemble implant is unique in that it can be inserted as a minimally invasive hemiarthroplasty technique that does not require any preparation to insert a stem into the thumb metacarpal.  The device has a unique three-dimensional design that locks onto the surface of the trapezium without requiring any internal fixation.  We report on our first 12 cases with 1 year follow-up.  There was significant improvement in the DASH score and pinch strength at 1 year follow-up (p< 0.5) with no significant decrease in thumb motion or instances of dislocation.  One patient was revised due to rapid progression arthritis at the scaphoid trapezial interface that required revision to an arthroplasty with complete removal of the trapezium.

Abdulsatar J Mathkhor, Abdulnasser H Abdullah, Ali H Atwan, and Zahraa Mustafa Kamel


Background: Levels of Vitamin D may impact the development and progression of knee osteoarthritis (OA), a disorder common in elderly people The aim of this study was to investigate the association between serum Vitamin D deficiency and knee OA.

Methods: One hundred twenty (40 male and 80 female) consecutive patients were recruited from the rheumatology outpatient clinic for the study. X-rays in two anterior-posterior and lateral views of the knees were performed for all patients. Staging of knee OA was done according to Kellgren-Lawrence criteria and divided into two groups; group A consisting of grades 1 and 2, and group B, consisting of grades 3 and 4. One hundred (30 male and 70 female) healthy individuals without clinical and radiographic signs of the disease were defined as a control group. Hematological and biochemical investigations, including measurement of 25-hydroxyvitamin D serum level, were performed for all participants. Pain intensity using a visual analog scale (VAS) and disease severity using the Western Ontario and McMaster Universities Arthritis Index was measured for all patients.

Results: The mean age of patients and controls were 60±3.5 and 54±2.6 years, respectively. Vitamin D levels of patients and controls were 13±3.3 and 32±2.5, respectively. More severe disease and diseases with prolonged duration were associated with a lower vitamin D level, and low vitamin D levels were associated with high VAS and WOMAC.

Conclusion: Vitamin D deficiency was associated with the development and the severity of knee OA as well as with the disease duration.

Spencer Lofink, B.S. and Thomas Trumble, M.D.


We compared the effectiveness of Wharton’s jelly versus steroid injection into the carpometacarpophalangeal joint by comparing 60 patients in two cohorts with a follow up evaluation at three months and then at one year. We evaluated preoperative and postoperative grip strength, pinch strength, thumb range of motion, Disabilities of Arm, Shoulder, and Hand (DASH) score and a Visual Analog (VAS) pain score before the injection and then at 3 months and 12 months after injection. The patients in the steroid injection group had substantial improvement in their DASH and VAS pain scores as well as their pinch strength at 3 months p < .05. However, by the 12-month evaluation the benefits of the steroid injection had completely dissipated. The patients in the Wharton’s jelly cohort had improvements at 3 months in terms DASH and VAS score and pinch strength and this improvement persisted at the one-year evaluation. However, grip strength and thumb range of motion did not substantially improve in either group.

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