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Background. Handgrip strength (HGS) and physical activity (PA) reflect an individual’s overall health and can predict morbidity and mortality. The purpose of the study was to investigate the level of PA and HGS and associated factors in young adults with juvenile idiopathic arthritis (JIA) and determine the connection with body composition parameters. Materials and methods. We conducted a cross-sectional monocentric study of 40 young adults aged 18–30. We collected data on PA and anthropometric and clinical measurements, including disease activity and articular and extra-articular damages. All patients had the following evaluations performed: body composition (dual X-ray absorptiometry), PA level (International Physical Activity Questionnaire), and HGS measurement (using manual hand dynamometer). Results. Sixteen (40 %) patients were considered sedentary, and 32 (80 %) JIA patients had low HGS. The reduced HGS was likely in women, patients with lower body mass index, higher disease activity, and articular damage. In contrast, bone mineral density (BMD) and lean mass were protective factors for reduced HGS (p < 0.05). The level of PA was positively correlated with BMD and lean mass and negatively correlated with fat mass, swollen joint count, and articular damage (p < 0.05). Conclusions. JIA leads to changes in body composition parameters, particularly lean (muscle) mass and muscle strength, and therefore is a risk factor for the development of sarcopenia.

Sarcopenia is characterized by a loss of skeletal muscle mass, a decrease in muscle strength and/or physical performance, and is one of the main causes for limiting daily activities in the elderly. This is associated with an increased incidence of many adverse events such as dysfunction, falls, frailty, hospitalization, disability, and mortality. Primary (considered as a part of the aging process) and secondary sarcopenia (due to malabsorption, immobility/bed rest, starvation, hypothyroidism, osteoporosis, immune-mediated rheumatic diseases) are united by a chronic inflammatory process of different degrees. Sarcopenia supports one of the most widely accepted theories that low-grade chro­nic inflammation is important in the pathogenesis of many di­seases. For a long time, sarcopenia was considered an age-related disease, but recently it has been reported to be more common in young subjects with autoimmune diseases. In particular, the relationship between sarcopenia and rheumatic diseases such as rheumatoid arthritis has been studied in detail. Although the pathogenesis of sarcopenia in autoimmune diseases is not fully understood, it is believed that a chronic inflammatory process contri­butes to the development of loss of muscle mass and strength, and is different depending on the underlying disease. The definition of sarcopenia varies between studies, which complicates and li­mits direct comparisons. Therefore, in this review, we demonstrate various diagnostic criteria for sarcopenia, focusing on its pre­valence in patients with rheumatic diseases, including rheumatoid arthritis, juvenile idiopathic arthritis, axial spondylitis, psoriatic arthritis, and systemic sclerosis. We developed a structured search strategy for English language publications in PubMed using the term “sarcopenia” in combination with the following keywords: “inflammation”, “diagnosis”, “criteria”, “muscle mass”, “strength”, “outcomes”, “disability”, “mortality”, “pathophysiology”, “rheumatoid arthritis”, “juvenile arthritis”, “axial spondylitis”, “psoriatic arthritis”, “systemic sclerosis”. We focused on clinical trials, meta-analyses and review articles. Articles published only after 2000 year were included, however, we did not include major contributions published before. The search was completed on October 8, 2022.

Reactive arthritis (ReA) remains an important problem in the practice of rheumatology, and is one of the most common types of acute arthritis in young people. The relevance of ReA is due to its high frequency, difficulties of diagnosis, a chronicity with an insufficiently effective treatment. The article discusses current literature data on Yersinia arthritis, features of pathogenesis, diagnosis and treatment. The occurrence of ReA is most often associated with gastrointestinal or urogenital infection, which precedes the development of joint syndrome. Among the ReAs associated with intestinal infection, Yersinia is quite common. Intestinal yersiniosis is severe, has a significant duration with a tendency to chronicity, involvement of various organs and systems in the pathological process. The features of Yersiniosis pathogens in combination with infectious conditions cause a wide variety of clinical manifestations. The disease has a frequent association with HLA-B27 antigen. Among the common clinical symptoms of ReA there are asymmetric arthritis of the lower extremities, sausage-like toe deformity, tendonitis, enthesitis (most commonly heel tendon enthesitis), and asymmetric sacroiliitis. The frequency and severity of extra-articular manifestations may be different: lesions of the eyes, skin, mucous membranes, urogenital or gastrointestinal tract. First-line drugs in the treatment of ReA are NSAIDs. Patients with an active source of infection also require a long-term treatment with antibacterial therapy, sulfosalazine is added in case of a chronic arthritis. The article presents a clinical case of Yersiniosis reactive arthritis, emphasizes the multidisciplinary approach in the management of the patient.

Background. Juvenile Idiopathic Arthritis (JIA) is a term used to classify a group of heterogeneous pediatric rheumatic diseases. Many of these conditions persist through adulthood. Presence of chronic inflammatory disease along with a glucocorticoid treatment is the risk factor of osteoporosis in young adult males. The purpose was to study the bone mineral density (BMD), T- and Z-scores in young adult males with JIA. Materials and methods. The study included 50 patients aged 19–25 years, divided into two groups: I — 25 apparently healthy young males; ІІ — 25 young men from different regions of Ukraine with a history of JIA in childhood, regardless of the presence or absence of active inflammation at the time of the observation. Two-energy X-ray densitometry (Prodigy, GE Lunar, Madison, USA) was performed at the D.F. Chebotarev Institute of Ge­rontology, Ukrainian Scientific-Medical Centre for the Problems of Osteoporosis, together with analysis of BMD, T- and Z-scores at different skeletal areas. Results. Young men with JIA and healthy individuals did not differ in age, height, weight and body mass index. Four patients with JIA (16 %) had fractures, while in the control group, there were no fractures. Negative impact of the JIA on the BMD was found in group II compared to group I. Lumbar spine BMD in group II was lower (p < 0.01) than in healthy subjects, as well as the Z-score (p < 0.001) in the L1-L4 lumbar spine region. BMD, T- and Z-scores in femoral neck region were lower in group II than in group I (p < 0.001; p < 0.001; p < 0.01, respectively). Significant differences between the two groups were found in total body BMD (p < 0.001), T-score (p < 0.01), Z-score (p < 0.05). Patients with JIA had lower BMD (p < 0.01) and T-score (p < 0.05) of the ultradistal radius. Decrease of BMD up to the level of osteopenia (Z-score < –2 SD) was found in 20 % patients at the level of L1-L4 lumbar spine, in 8 % — at femoral neck, in 12 % — at total body and in 8 % patients at the level of ultradistal radius. Conclusions. Young men with JIA aged 19–25 years had reduced total body BMD, T- and Z-scores, which indicate the negative impact of the disease on the bone tissue compared with healthy men of the corresponding age.

Background. Study of bone mineral density (BMD) in young adults with juvenile idiopathic arthritis (JIA) is important because long-term administration of glucocorticoids and the presence of chronic systemic inflammation can lead to loss of bone tissue in young people with chronic inflammatory disease in anamnesis. Objective: the study of BMD in young female with juvenile onset of JIA. Materials and methods. Ninety-nine female patients aged 19 to 39 years were divided into two groups: І — 59 healthy young female, ІІ — 40 young female with JIA. The following parameters were evaluated: the age of the disease onset, the duration of delayed diagnosis, disease duration, the ILAR-variant in the disease onset, the BMD in different areas and their T and Z scores. Results. It was found that the onset of JIA was at the age of 11.16 ± 4.34 years, it took 23.52 ± 21.37 months from the beginning of the first clinical manifestations to the time of diagnosis, the disease duration was 11.9 ± 9.4 years, persistant oligoarthritis was detected in 25 % of patients, RF-negative polyarthritis in 22.5 %, extended oligoarthritis in 10 %, RF-positive polyarthritis in 10 %, systemic-onset JIA in 12.5 %, enthesitis-related JIA in 15 %, undifferentiated arthritis in 10 %, psoriatic arthritis in 5 % of patients. BMD (p < 0.000001), T (p = 0.00001) and Z scores in the lumbar spine were lower in female with JIA than in healthy people. Femoral neck BMD (p < 0.000001) and T score (p = 0.00002), total body BMD (p < 0.000001), T- (p = 0.00009) and Z-scores (p < 0.000001) were lower in patients with JIA than in healthy people. However, ultradistal forearm BMD in the female patients differed from healthy ones’ only in T and Z scores (p = 0.004). Z score < –2 SD in young adults was detected in 40 % of patients in the lumbar spine, in 24 % of patients in the femoral neck, in 35.5 % of patients in the total body and in 52.9 % of patients in ultra­distal forearm, and T score < –2.5 SD in 3.3 % patinets in lumbar spine, in 3.4 % patients in the femoral neck, in 36.7 % patients in the total body, in 23.5 % patients in the ultradistal forearm. Osteopenia by T score at the lumbar spine was found in 43.3 %, the femoral neck in 41.4 %, the total body in 36.7 %, ultradistal forearm in 23.5 % of patients. Conclusions. А significant decrease of bone mineral density, T- and Z-scores was observed in young female with JIA in the lumbar spine, femoral neck and total body, compared to healthy female patients of the corresponding age. The presence of JIA in childhood negatively affects the formation of peak bone mass and leads to a decrease of the BMD in adulthood, that requires the active observation and appointment of prophylactic therapy in childhood and, if necessary, treatment to prevent osteoporotic complications.