Wrist Arthroscopy in Juvenile Idiopathic Arthritis: A Review of Current Literature and Future Implications

Abstract

Juvenile Idiopathic Arthritis (JIA) is the most common rheumatological condition in children and frequently affects the wrist. The roles for wrist arthroscopy and arthroscopic synovectomy (AS) in JIA are unclear. Our aim was to find the current evidence supporting its use. Systematic literature review of relevant publications from 1990 to present in the Cochrane Library, Clinical Knowledge Summaries, DynaMed, PEMSoft, NICE Guidance, MEDLINE, EMBASE, and PubMed. We found no publications detailing the use of arthroscopy or AS specifically in patients with JIA involving the wrist. There is evidence that AS reduces pain, improves function, and induces remission in patients with rheumatoid arthritis resistant to medical management. Although there is paucity in evidence for the use of AS in the wrists of patients with JIA, studies suggest it to be safe and effective, and could be applied to patients with refractive JIA. It is possible that early identification of patients suffering from JIA with extensive joint destruction and little symptoms could benefit from AS, delaying joint destruction and preserving function.

Role of Wrist Arthroscopy in Juvenile Inflammatory Arthritis

“…13 Indeed, its use in JIA is limited to a few case series and a systematic review by the authors of this article. 13…”

“…Majority of patients in this cohort were noted to be negative for RF and had polyarthritis, which is somewhat in contradiction to previous case series wherein RF positivity and oligoarthritis were commoner. 13…”

“…A recent systematic review, reported no literature on the use of wrist arthroscopy in JIA patients. 13 In addition to being a safe procedure, advantages of arthroscopy over open procedures include reduced invasiveness, lower morbidity rates, and earlier functional recovery. 14 15…”

Arthroscopic Treatment of an Juvenile Idiopathic Arthritis of the Wrist

“…Juvenile idiopathic arthritis (JIA) comprises a group of arthritic diseases of various etiologies with onsets before 16 years of age. JIA is the most common chronic rheumatic condition in pediatric patients 1 , 2 . The International League of Associations for Rheumatology 2001 classification of JIA includes the following subtypes: systemic-onset arthritis, oligoarthritis, extended oligoarthritis, polyarthritis (rheumatoid factor [RF]-negative), polyarthritis (RF-positive), psoriatic arthritis, enthesitis-related arthritis, and undifferentiated arthritis 3 .…”

“…The wrist joint is the fourth most commonly affected joint in JIA, followed by the knee, ankle, and elbow joints 1 . Early involvement of the wrist joint has been established as a poor prognostic factor 1 , 2 , 3 . However, the role of arthroscopy in the JIA wrist is ambiguous.…”