Sports & Juvenile Arthritis by Greg Canty, MD Medical Director, Center for Sports Medicine, Assistant Professor of Pediatrics and Orthopaedics

1. Sports & Juvenile Arthritis
2012 National JA Conference
St. Louis, Missouri
Greg Canty, MD
Medical Director, Center for Sports Medicine
Assistant Professor of Pediatrics and Orthopaedics
© 2011 Children’s Mercy Hospitals and Clinics. All Rights Reserved. • June 2011

2. Disclosures
• Neither I, nor any family member, have a
financial relationship with anything discussed
in this presentation
© 2011 Children’s Mercy Hospitals and Clinics. All Rights Reserved. • June 2011

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

4. 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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5. 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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6. Athletes with JA
Kristi McPherson -
Professional Golfer Kristine Holzer - Olympian
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7. 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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8. Your child with JA now wants to play…
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9. 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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10. 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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11. 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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12. 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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13. 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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14. 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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15. Defeating the #1 Myth !
• Exercise does NOT appear to exacerbate
rheumatic disease
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16. 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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17. 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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18. Helping your child with JA
select a sport…
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19. Realities of Sports ?
Football
• 6-17y= 2,867,000
Reality check • Varsity = 1,029,435
✔ • College = 57,593
• NFL = 1643
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20. “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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21. “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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22. 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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23. Dosing
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24. Epidemic of Overuse Injuries !
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25. 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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26. Causes of Overuse Injuries
Extrinsic factors Intrinsic factors
• Nature of the sport • Age
- contact, endurance, etc • Maturation
• Training regimens • Gender
- overtraining • Flexibility
• Coaching • Alignment
• Strength
• Playing surface imbalances
• Equipment • Proprioception
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27. 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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28. The Grand Finale
The Sports Equation
Benefits >>> Risks = Encourage participation !
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29. 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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30. Acknowledgements
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31. Happy Birthday Mom!
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32. Questions & Discussion
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