Juvenile idiopathic arthritis surgery
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Dheeraj Makkar, M.D.[2]
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Juvenile idiopathic arthritis Microchapters |
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Differentiating Juvenile idiopathic arthritis from other Diseases |
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Surgical Management
Surgery is not a primary treatment modality for juvenile idiopathic arthritis (JIA) but may be indicated in selected patients with refractory disease, structural joint damage, or functional impairment despite optimal medical therapy. Surgical intervention is typically considered after careful multidisciplinary evaluation.
Indications
- Persistent pain or functional limitation despite adequate medical management
- Progressive joint deformity or contractures
- Severe joint destruction affecting mobility or activities of daily living
- Growth-related complications, including limb-length discrepancy
- Temporomandibular joint dysfunction with significant functional or facial deformity
Common Surgical Procedures
- Synovectomy: Performed to reduce synovial inflammation and pain in selected joints, most commonly the knee or wrist
- Soft-tissue procedures: Tendon releases or lengthening to correct contractures and improve joint motion
- Osteotomy: Used to correct angular deformities or malalignment resulting from asymmetric growth
- Joint arthroplasty: Reserved for adolescents or young adults with end-stage joint disease; most commonly hip or knee replacement
- Temporomandibular joint surgery: Considered in severe cases with ankylosis, pain, or impaired mandibular growth
Special Considerations
- Timing of surgery should account for skeletal maturity and disease activity
- Active inflammation should be optimally controlled prior to elective procedures
- Perioperative management requires coordination with pediatric rheumatology to manage immunosuppressive therapy
- Long-term outcomes may be influenced by ongoing disease activity and growth potential
Overall, surgical management in JIA is individualized and aimed at pain relief, correction of deformity, and preservation or restoration of function within the context of comprehensive medical care.
References
- ↑ Sandborg CI, Schulert GS, Kimura Y. Juvenile Idiopathic Arthritis. N Engl J Med. 2025;392:XXX–XXX. doi:10.1056/NEJMra2402073.
- ↑ Lovell DJ, Giannini EH. Advances in the treatment of juvenile rheumatoid arthritis. Arthritis Rheum. 2001;44:193–199.
- ↑ Rosenberg AM. Surgical management of juvenile idiopathic arthritis. Best Pract Res Clin Rheumatol. 2002;16:381–399.
- ↑ Giannini EH, Ilowite NT. Juvenile idiopathic arthritis: management and prognosis. Rheum Dis Clin North Am. 2002;28:619–640.
- ↑ Berend KR, Lombardi AV Jr. Joint arthroplasty in patients with juvenile idiopathic arthritis. J Arthroplasty. 2010;25:435–441.