Sports & Juvenile Arthritis

© 2011 Children’s Mercy Hospitals and Clinics. All Rights Reserved. • June 2011© 2011 Children’s Mercy Hospitals and Clinics. All Rights Reserved. • June 2011

Sports & Juvenile Arthritis2012 National JA Conference

St. Louis, Missouri

Greg Canty, MD

Medical Director, Center for Sports Medicine

Assistant Professor of Pediatrics and Orthopaedics


Disclosures

• Neither I, nor any family member, have a financial relationship with anything discussed in this presentation


Disclosures


The “Gameplan”

1. Understand the history behind sports participation for kids with JA

2. Recognize the risks and benefits of sports participation for kids with JA

3. Implementing strategies for kids with JA who are involved in sports

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Sports Medicine & JA ?

• Camp Wekandu in the 70s/80s

• Early recommendations were bedrest, along with aspirin, “gold” shots, and prednisone

• Camp Wekandu 2011

• JA National Conference 2012 - methotrexate, biologic agents, and sports medicine!

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Athletes with JA

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Kristine Holzer - OlympianKristi McPherson -Professional Golfer


Sports in America…

• 30 million children participate in organized sports

• > 7.3 million athletes participate at the high school level annually and numbers increasing

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Your child with JA now wants to play…

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Exercise is Medicine!

• Let’s look at some of the risks associated with juvenile arthritis & general lifestyle

• We’ll analyze sports & exercise just like it’s a drug used to treat arthritis

• Potential benefits

• Risks/Contraindications

• Dosing

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General Risks

• Obesity epidemic

• Youths with low levels of physical activity and high body fat are at increased risk for cardiovascular disease indicated by elevated blood pressure and serum cholesterol

• Only 22% of teenagers with JA met daily recommended physical activity levels

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General Risks

• JA patients more likely to have decreased bone mineral composition

• Muscle atrophy, weakness, and anemia may contribute to reduced fitness, but deconditioning from reduced activity appears to be greatest cause

• Deconditioning does not seem to correlate with disease severity

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General Risks

• Lower physical activity levels in adolescents = lower well being scores

• Adolescence is the period of maximal bone mass accumulation

• Physical inactivity = lower quality of life (QOL)

• Habits & JA often persist into adulthood

– Adults have shown physical and social impairment

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Benefits of Sports

• Youths playing sports are more likely to meet physical activity recommendations

• Lower obesity risks = less joint load

• Improved academic performance

• Girls increased professional success

• Improved quality of life (QOL)

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Specific Benefits of Sports for JA

• Exercise can be osteogenic and increase both bone and muscle mass

• Improves energy level

• Reduces pain and medication use

• Exercise can improve immune function

• Socialization and interaction with peers

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Defeating the #1 Myth !

• Exercise does NOT appear to exacerbate rheumatic disease

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Sports risks associated with JA

• Not all JA is the same…multiple, heterogeneous diseases housed together

• Disease flares may need modifications. Exercise goals during a flare may be to preserve motion, muscle strength, and function

• May need to improve general conditioning before trying to play organized sports

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Sports risks associated with JA

• Cervical spine arthritis patients are at greater risk for spinal cord injury with contact sports

– Screen for C1-C2 instability

• Cardiac disease may need further evaluation

• Increased risk of dental injury with TMJ

– Appropriately fitted mouth guards

• Appropriate eye protection (uveitis)

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Helping your child with JA select a sport…

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Realities of Sports ?

Reality check ✔

Football

• 6-17y= 2,867,000

• Varsity = 1,029,435

• College = 57,593

• NFL = 1643

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“Selecting a sport”

• Allow your young athlete to choose a sport or activity of their liking...exposure!

• Consider the demands of each sport

– Collision vs. contact

– Endurance and aerobic demands

– Range of motion/flexibility demands

• Participation needs to be individualized

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“Selecting a sport”

• Do the coaches understand child’s condition?

• Will the athlete be allowed to “self-limit” participation if necessary?

• Any special equipment, orthoses, or adaptive equipment necessary?

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We’re out there playing, now what?

Remember

• “Flares happen”

• Remain active but alter activities if necessary

• Maintain aerobic conditioning if possible

• Beware your athlete with JA may get injuries and conditions like all other athletes…

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Dosing

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© 2011 Children’s Mercy Hospitals and Clinics. All Rights Reserved. • June 2011

Epidemic of Overuse Injuries !

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Why Overuse Injuries?

• Increased risk due to immature bones,

insufficient rest after injury, poor training,

and poor conditioning

• Sports specialization at earlier and earlier

ages

• Year-round participation

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Extrinsic factors

• Nature of the sport

- contact, endurance, etc

• Training regimens

- overtraining

• Coaching

• Playing surface

• Equipment

Causes of Overuse Injuries

Intrinsic factors

• Age

• Maturation

• Gender

• Flexibility

• Alignment

• Strength

imbalances

• Proprioception


Overuse Risk with JA ?

• Elite athletes have been shown to have an increased risk of osteoarthritis

• Any application to JA ?

• Encourage cross-training, alternating sports, and variations of activity

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The Grand Finale

The Sports Equation

Benefits >>> Risks = Encourage participation !

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The “Post-Game” Summary

1. Sports are great for everyone, including those with Juvenile Arthritis!

2. Form a “team” with your child and your rheumatologist when considering sports

3. Remember the benefits of sports & activity far outweight the risks of inactivity

4. Emphasize participation rather than competition!

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Acknowledgements

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Happy Birthday Mom!

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Questions & Discussion

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Health & Medicine

Sports & Juvenile Arthritis