PDF herunterladen
Kinder- und Jugendmedizin 2006; 6(05): 307-311
DOI: 10.1055/s-0037-1617922
Kinderrheumatologie
Schattauer GmbH

Das muskuloskelettale System bei juveniler idiopathischer Arthritis

The musculoskeletal system in juvenile idiopathic arthritis
Johannes Roth
1   Klinik für Pädiatrie mit Schwerpunkt Pneumologie und Immunologie, Charité, Campus Virchow-Klinikum (Direktor: Prof. Dr. med. U. Wahn)
,
Michael Borte
2   Klinik für Kinder- und Jugendmedizin, Städtisches Klinikum „St. Georg“ Leipzig (Chefarzt: Prof. Dr. med. Th. Richter)
› Institutsangaben
Weitere Informationen

Publikationsverlauf

Publikationsdatum:
11. Januar 2018 (online)

    Lizenzen und Reprints

Zusammenfassung

Skelettale Veränderungen bei rheumatischen Erkrankungen des Kindesalters sind bekannt. In den letzten Jahren erfolgte mit neuen Messtechniken eine genauere Charakterisierung dieser Veränderungen. Hierbei zeigte sich auch der entscheidende Einfluss der Muskulatur auf Knochenaufbau und -erhalt. Daraus folgt, dass eine integrale Diagnostik des muskuloskelettalen Systems bei Patienten mit pädiatrisch-rheumatologischen Erkrankungen Teil der Betreuung sein muss und dass sich therapeutische Ansätze am pathogenetischen Zusammenhang von Muskelkraft und Knochenumsatz orientieren sollten. Zusätzlich kann auch die physiotherapeutische Behandlung von kinderrheumatologischen Patienten verstärkt auf das Ziel der muskulären Kraft- und Leistungssteigerung ausgerichtet werden.

Summary

Skeletal alterations have been described in children suffering from rheumatic diseases. New measurement techniques have led to a more detailed characterization in recent years. These studies also showed the major impact of muscle force on bone metabolism. In pediatric rheumatology, the assessment of the musculoskeletal system should therefore be standard of care and therapeutic approaches have to take into account the pathogenetic concepts of muscle and bone interaction. In addition, physiotherapeutic approaches in pediatric rheumatology should also be focused to increase muscle force and power.

Schlüsselwörter

Juvenile idiopathische Arthritis - Osteoporose - Knochendichtemessung - muskuloskelettales System - Osteoporosetherapie

Keywords

Juvenile idiopathic arthritis - osteoporosis - bone densitometry - musculoskeletal system - osteoporosis therapy
 

  • Literatur

  • 1 Bechtold S, Ripperger P, Dalla Pozza R. et al. Musculoskeletal and functional muscle-bone analysis in children with rheumatic disease using peripheral quantitative computed tomography. Osteoporos Int 2005; 16: 757-63.
    CrossrefPubMedGoogle Scholar
  • 2 Chan YY, Bishop NJ. Clinical management of childhood osteoporosis. Int J Clin Pract 2002; 56: 280-6.
    PubMedGoogle Scholar
  • 3 Cimaz R. Osteoporosis in childhood rheumatic diseases: prevention and therapy. Best practice & Research Clinical Rheumatology 2002; 16: 397-409.
    CrossrefGoogle Scholar
  • 4 de Jong Z, Munneke M, Lems WF. et al. Slowing of bone loss in patients with rheumatoid arthritis by long-term high-intensity exercise: results of a randomized, controlled trial. Arthritis Rheum 2004; 50 (04) 1066-76.
    CrossrefPubMedGoogle Scholar
  • 5 Elsasser U, Wilkins B, Hesp R. et al. Bone rarefication and crush fractures in juvenile chronic arthritis. Arch Dis Child 1982; 57: 377-380.
    CrossrefPubMedGoogle Scholar
  • 6 Frost HM, Schoenau E. The “Muscle Bone Unit” in children and adolescents: a 2000 overview. J Ped Endocr Metab 2000; 13: 571-90.
    Google Scholar
  • 7 Häkkinen A, Sokka T, Kautiainen H. et al. Sustained maintenance of exercise induced muscle strength gains and normal bone mineral density in patients with early rheumatoid arthritis: a 5 year follow up. Ann Rheum Dis 2004; 63: 910-16.
    CrossrefPubMedGoogle Scholar
  • 8 Henderson CJ, Cawkwell GD, Specker BL, Sierra RI, Wilmott RW, Campaigne BN, Lovell DJ. Predictors of total body bone mineral density in noncorticosteroid treated prepubertal children with juvenile rheumatoid arthritis. Arthritis Rheum 1997; 40: 1967-75.
    CrossrefPubMedGoogle Scholar
  • 9 Henderson CJ, Specker BL, Sierra RI. et al. Total body bone mineral content in non-corticosteroid treated postpubertal females with juvenile rheumatoid arthritis. Arthritis Rheum 2000; 43: 531-40.
    CrossrefPubMedGoogle Scholar
  • 10 Kotaniemi A, Savolainen A, Kroger H. et al. Weight-bearing physical activity, calcium intake, systemic glucocorticoids, chronic inflammation ad body constitution as determinants of lumbar and femoral bone mineral in juvenile chronic arthritis. Scand J Rheumatol 1999; 28: 19-26.
    PubMedGoogle Scholar
  • 11 Hochberg Z, Bereket A, Davenport M. et al. Consensus Development for the supplementation of vitamin D in childhood and adolescence. Horm Res 2002; 58: 39-51.
    PubMedGoogle Scholar
  • 12 Kotaniemi A, Savolainen A, Kautiainen H, Kroeger H. Estimation of central osteopenia in children with chronic polyarthritis treated with glucocorticoids. Pediatrics 1993; 91: 1127-30.
    PubMedGoogle Scholar
  • 13 Lien G, Flato B, Haugen M. et al. Frequency of osteopenia in adolescents with early-onset juvenile idiopathic arthritis. Arthritis Rheum 2003; 48: 2214-23.
    CrossrefPubMedGoogle Scholar
  • 14 Maillard SM, Jones R, Owens CM. et al. Quantitative assessments of the effects of a single exercise session on muscles in juvenile dermatomyositis. Arthritis Rheum 2005; 53 (04) 558-64.
    CrossrefPubMedGoogle Scholar
  • 15 Munns CF, Rauch F, Ward L. Glorieux FH: Maternal and fetal outcome after long-term pamidronate treatment before conception: a report of two cases. J Bone Miner Res 2004; 19 (10) 1742-5.
    CrossrefPubMedGoogle Scholar
  • 16 Murray KJ, Boyle RJ, Woo P. Pathological fractures and osteoporosis in a cohort of 103 systemic onset juvenile idiopathic arthritis patients. Arthritis Rheum 2000; 43: S119.
    Google Scholar
  • 17 Pepmueller PH, Cassidy JT, Allen SH. et al. Bone mineralization and bone mineral metabolism in children with juvenile rheumatoid arthritis. Arthritis Rheum 1996; 39: 746-57.
    CrossrefPubMedGoogle Scholar
  • 18 Rauch F, Glorieux FH. Osteogenesis imperfecta. Lancet 2004; 363 (9418) 1377-85.
    CrossrefPubMedGoogle Scholar
  • 19 Rauch F, Schoenau E. Changes in bone density during childhood and adolescence: an approach based on bone’s biological organisation. J Bone Miner Res 2001; 16: 1-8.
    CrossrefPubMedGoogle Scholar
  • 20 Reed A, Haugen M, Pachman LM, Langman CB. 25-Hydroxyvitamin D therapy in children with active juvenile rheumatoid arthritis: short term effects on serum osteocalcin levels and bone mineral density. J Pediatrics 1991; 119: 657-60.
    CrossrefPubMedGoogle Scholar
  • 21 Roth J, Bechtold S, Borte G. et al. Osteoporose bei juveniler idiopathischer Arthritis. Monatsschr Kinderheilk 2006; 154: 456-64.
    CrossrefGoogle Scholar
  • 22 Roth J, Palm C, Scheunemann I. et al. Musculoskeletal abnormalities of the forearm in patients with juvenile idiopathic arthritis relate mainly to bone geometry. Arthritis Rheum 2004; 50: 1277-85.
    CrossrefPubMedGoogle Scholar
  • 23 Runge M, Schiessl H, Rittweger J. Klinische Diagnostik des Regelkreises Muskel-Knochen am Unterschenkel Osteologie. 2002; 11: 18-24.
    PubMedGoogle Scholar
  • 24 Schoenau E. Problems of bone analysis in childhood. Pediatr Nephrol 1998; 12: 420-9.
    CrossrefPubMedGoogle Scholar
  • 25 Schoenau E, Neu CM, Beck B. et al. Bone mineral content per muscle cross-sectional area as an index of the functional muscle-bone unit. J Bone Min Res 2002; 17 (06) 1095-1101.
    CrossrefPubMedGoogle Scholar
  • 26 Schoenau E, Saggese G, Peter F. et al. From bone biology to bone analysis. Horm Res 2004; 61: 257-69.
    CrossrefPubMedGoogle Scholar
  • 27 Srivastava T, Alon US. The role of bisphosphonates in diseases of childhood. Eur J Pediatr 2003; 162: 735-51.
    CrossrefPubMedGoogle Scholar
  • 28 Zak M, Hassager C, Lovell DJ. et al. Assessment of bone mineral density in adults with a history of juvenile chronic arthritis. Arthritis Rheum 1999; 42: 790-8.
    CrossrefPubMedGoogle Scholar