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  • 1. Sports & Juvenile Arthritis 2012 National JA Conference St. Louis, Missouri Greg Canty, MD Medical Director, Center for Sports MedicineAssistant 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 JA2. Recognize the risks and benefits of sports participation for kids with JA3. Implementing strategies for kids with JA who are involved in sports © 2011 Children’s Mercy Hospitals and Clinics. All Rights Reserved. • June 2011 4
  • 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! © 2011 Children’s Mercy Hospitals and Clinics. All Rights Reserved. • June 2011 5
  • 6. Athletes with JA Kristi McPherson - Professional Golfer Kristine Holzer - Olympian © 2011 Children’s Mercy Hospitals and Clinics. All Rights Reserved. • June 2011 6
  • 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 © 2011 Children’s Mercy Hospitals and Clinics. All Rights Reserved. • June 2011 7
  • 8. Your child with JA now wants to play… © 2011 Children’s Mercy Hospitals and Clinics. All Rights Reserved. • June 2011 8
  • 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 © 2011 Children’s Mercy Hospitals and Clinics. All Rights Reserved. • June 2011 9
  • 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 © 2011 Children’s Mercy Hospitals and Clinics. All Rights Reserved. • June 2011 10
  • 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 © 2011 Children’s Mercy Hospitals and Clinics. All Rights Reserved. • June 2011 11
  • 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 © 2011 Children’s Mercy Hospitals and Clinics. All Rights Reserved. • June 2011 12
  • 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) © 2011 Children’s Mercy Hospitals and Clinics. All Rights Reserved. • June 2011 13
  • 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 © 2011 Children’s Mercy Hospitals and Clinics. All Rights Reserved. • June 2011 14
  • 15. Defeating the #1 Myth !• Exercise does NOT appear to exacerbate rheumatic disease © 2011 Children’s Mercy Hospitals and Clinics. All Rights Reserved. • June 2011 15
  • 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 © 2011 Children’s Mercy Hospitals and Clinics. All Rights Reserved. • June 2011 16
  • 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) © 2011 Children’s Mercy Hospitals and Clinics. All Rights Reserved. • June 2011 17
  • 18. Helping your child with JA select a sport… © 2011 Children’s Mercy Hospitals and Clinics. All Rights Reserved. • June 2011 18
  • 19. Realities of Sports ? Football • 6-17y= 2,867,000Reality check • Varsity = 1,029,435 ✔ • College = 57,593 • NFL = 1643 © 2011 Children’s Mercy Hospitals and Clinics. All Rights Reserved. • June 2011 19
  • 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 © 2011 Children’s Mercy Hospitals and Clinics. All Rights Reserved. • June 2011 20
  • 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? © 2011 Children’s Mercy Hospitals and Clinics. All Rights Reserved. • June 2011 21
  • 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… © 2011 Children’s Mercy Hospitals and Clinics. All Rights Reserved. • June 2011 22
  • 23. Dosing © 2011 Children’s Mercy Hospitals and Clinics. All Rights Reserved. • June 2011 23
  • 24. Epidemic of Overuse Injuries ! © 2011 Children’s Mercy Hospitals and Clinics. All Rights Reserved. • June 2011 24
  • 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 © 2011 Children’s Mercy Hospitals and Clinics. All Rights Reserved. • June 2011 25
  • 26. Causes of Overuse InjuriesExtrinsic 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 © 2011 Children’s Mercy Hospitals and Clinics. All Rights Reserved. • June 2011
  • 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 © 2011 Children’s Mercy Hospitals and Clinics. All Rights Reserved. • June 2011 27
  • 28. The Grand Finale The Sports Equation Benefits >>> Risks = Encourage participation ! © 2011 Children’s Mercy Hospitals and Clinics. All Rights Reserved. • June 2011 28
  • 29. The “Post-Game” Summary1. Sports are great for everyone, including those with Juvenile Arthritis!2. Form a “team” with your child and your rheumatologist when considering sports3. Remember the benefits of sports & activity far outweight the risks of inactivity4. Emphasize participation rather than competition! © 2011 Children’s Mercy Hospitals and Clinics. All Rights Reserved. • June 2011 29
  • 30. Acknowledgements © 2011 Children’s Mercy Hospitals and Clinics. All Rights Reserved. • June 2011 30
  • 31. Happy Birthday Mom! © 2011 Children’s Mercy Hospitals and Clinics. All Rights Reserved. • June 2011 31
  • 32. Questions & Discussion © 2011 Children’s Mercy Hospitals and Clinics. All Rights Reserved. • June 2011 32