A Retrospective Cohort Study of physical therapy rehabilitation in pediatric rheumatology patients with gouty arthritis
DOI:
https://doi.org/10.5281/zenodo.22814090Keywords:
pediatric gout, gouty arthritis, physical therapy, juvenile idiopathic arthritis, rehabilitationAbstract
Background: Gouty arthritis is uncommon but underrecognized in pediatric rheumatology, arising from chronic kidney disease, malignancy-related tumor lysis, inherited purine metabolism disorders, or primary hyperuricemia, yet rehabilitation guidance is largely extrapolated from adult gout and juvenile idiopathic arthritis programs.
Objective: This retrospective cohort study describes outcomes of a structured, phased physical therapy rehabilitation pathway applied to pediatric rheumatology patients with confirmed gouty arthritis.
Methods: We reviewed records of 26 pediatric patients with gouty arthritis referred for physical therapy between 2019 and 2025, tracking range of motion, loading pain, disability index, walk distance, and functional milestones across acute, subacute, and maintenance rehabilitation phases.
Findings: Active range of motion improved from 62% to 94% of the contralateral joint, mean loading pain fell from 6.1 to 1.2 on a 0-10 scale, and disability index improved from 0.84 to 0.19; hydrotherapy recipients reached full range of motion faster, and patients with kidney disease or transplant-related gout recovered more slowly than others.
Conclusions: A structured, phase-based rehabilitation pathway adapted from juvenile idiopathic arthritis principles was associated with substantial functional recovery, and warrants coordination with services managing the underlying hyperuricemic driver and attention to maintenance-phase adherence, pending prospective validation.
References
Lesch, M., Nyhan, W.L. (1964) A familial disorder of uric acid metabolism and central nervous system function. American Journal of Medicine, 36(4): 561-570. DOI: 10.1016/0002-9343(64)90104-4
Jinnah, H.A., Visser, J.E., Harris, J.C., Verdu, A., Larovere, L., Ceballos-Picot, I., et al. (2010) Delineation of the motor disorder of Lesch-Nyhan disease. Brain, 133(3): 671-689. DOI: 10.1093/brain/awq013
Kaeley, G.S., Nishio, M.J., Goyal, J.R., Wells, A.F. (2020) Gout in the pediatric and adolescent population: an emerging concern. Current Rheumatology Reports, 22(9): 56. DOI: 10.1007/s11926-020-00932-9
Kang, E.H., Lee, E.Y., Lee, Y.J., Song, Y.W., Lee, E.B. (2013) Clinical features and outcomes of secondary gout in children and adolescents. Journal of Korean Medical Science, 28(6): 866-870. DOI: 10.3346/jkms.2013.28.6.866
Cuttica, R.J., Scheines, E.J., Garay, S.M., Romanini, F.C., Sarraf, K.J., Neira, C.O. (2001) Juvenile onset of gout: a review of five pediatric cases. Journal of Rheumatology, 28(3): 682-684.
Choi, H.K., Mount, D.B., Reginato, A.M. (2005) Pathogenesis of gout. Annals of Internal Medicine, 143(7): 499-516. DOI: 10.7326/0003-4819-143-7-200510040-00009
Dalbeth, N., Merriman, T.R., Stamp, L.K. (2016) Gout. Lancet, 388(10055): 2039-2052. DOI: 10.1016/S0140-6736(16)00346-9
Simkin, P.A. (2000) Gout: nature's experiment in inflammation. Current Rheumatology Reports, 2(6): 509-514. DOI: 10.1007/s11926-000-0028-7
Giancane, G., Consolaro, A., Lanni, S., Davi, S., Schiappapietra, B., Ravelli, A. (2019) Juvenile idiopathic arthritis: diagnosis and treatment. Rheumatology and Therapy, 6(2): 217-238. DOI: 10.1007/s40744-019-0159-8
Ravelli, A., Martini, A. (2007) Juvenile idiopathic arthritis. Lancet, 369(9563): 767-778. DOI: 10.1016/S0140-6736(07)60363-8
Takken, T., van Brussel, M., Engelbert, R.H., Van Der Net, J.J., Kuis, W., Helders, P.J. (2008) Exercise therapy in juvenile idiopathic arthritis: a Cochrane review. European Journal of Physical and Rehabilitation Medicine, 44(3): 287-297.
Klepper, S.E. (2003) Exercise and fitness in children with arthritis: evidence of benefits for exercise and physical activity. Arthritis & Rheumatism, 49(3): 435-443. DOI: 10.1002/art.11055
Lelieveld, O.T., Armbrust, W., van Leeuwen, M.A., Duppen, N., Geertzen, J.H., Sauer, P.J., et al. (2010) Physical activity in adolescents with juvenile idiopathic arthritis. Arthritis Care & Research, 62(6): 697-703. DOI: 10.1002/acr.20182
Houghton, K.M. (2011) Review for the generalist: evaluation of pediatric hip pain. Pediatric Rheumatology Online Journal, 9(1): 4. DOI: 10.1186/1546-0096-9-4
Sherry, D.D., Bohnsack, J., Salmonson, K., Wallace, C.A., Mellins, E. (1990) Painless juvenile rheumatoid arthritis. Journal of Pediatrics, 116(6): 921-923. DOI: 10.1016/S0022-3476(05)80652-8
Sawyer, M.G., Whitham, J.N., Roberton, D.M., Taplin, J.E., Varni, J.W., Baghurst, P.A. (2004) The relationship between health-related quality of life, pain, and coping strategies in juvenile chronic arthritis. Rheumatology, 43(3): 325-330. DOI: 10.1093/rheumatology/keh030
Stinson, J.N., Sung, L., Gupta, A., White, M.E., Jibb, L.A., Dettmer, E., et al. (2013) Disease self-management needs of adolescents with cancer: perspectives of adolescents and their parents. Journal of Pediatric Oncology Nursing, 30(1): 13-27. DOI: 10.1177/1043454212461942
Law, E., Fisher, E., Eccleston, C., Palermo, T.M. (2013) Psychological interventions for parents of children and adolescents with chronic illness. Cochrane Database of Systematic Reviews, (2): CD009660. DOI: 10.1002/14651858.CD009660.pub2
Harris, M.D., Siegel, L.B., Alloway, J.A. (1998) Gout and hyperuricemia. American Family Physician, 59(4): 925-934.
Philpott, J., Houghton, K., Luke, A. (2010) Physical activity recommendations for children with specific chronic health conditions: juvenile idiopathic arthritis, hemophilia, asthma, and cystic fibrosis. Clinical Journal of Sport Medicine, 20(3): 167-172. DOI: 10.1097/JSM.0b013e3181d2eddd
Epps, H., Ginnelly, L., Utley, M., Southwood, T., Gallivan, S., Sculpher, M., et al. (2005) Is hydrotherapy cost-effective? A randomised controlled trial of combined hydrotherapy programmes compared with physiotherapy land techniques in children with juvenile idiopathic arthritis. Health Technology Assessment, 9(39): iii-iv, ix-x, 1-59. DOI: 10.3310/hta9390
Bulley, C., Donaghy, M., Cardwell, J. (2018) A prospective randomised controlled trial of hydrotherapy and land-based therapeutic exercise for people with chronic low back pain. Physiotherapy, 104(2): 167-175. DOI: 10.1016/j.physio.2017.08.001
Singh-Grewal, D., Schneiderman-Walker, J., Wright, V., Bar-Or, O., Beyene, J., Selvadurai, H., et al. (2006) The effects of vigorous exercise training on physical function in children with arthritis: a randomized, controlled, single-blinded trial. Arthritis & Rheumatism, 55(6): 891-901. DOI: 10.1002/art.22271
Rapoff, M.A. (2002) Assessing and enhancing adherence to medical regimens for juvenile rheumatoid arthritis. Pediatric Annals, 31(6): 373-379. DOI: 10.3928/0090-4481-20020601-09
Ramanan, A.V., Whitworth, P., Baildam, E.M. (2016) Assessment of growth and physical function in juvenile idiopathic arthritis: a practical approach. Rheumatology, 55(suppl 2): ii1-ii8.
Johnson, R.J., Nakagawa, T., Sanchez-Lozada, L.G., Shafiu, M., Sundaram, S., Le, M., et al. (2013) Sugar, uric acid, and the etiology of diabetes and obesity. Diabetes, 62(10): 3307-3315. DOI: 10.2337/db12-1814
Fam, A.G. (2002) Gout, diet, and the insulin resistance syndrome. Journal of Rheumatology, 29(7): 1350-1355.
Soriano, L.C., Rothenbacher, D., Choi, H.K., Rodriguez, L.A.G. (2015) Contemporary epidemiology of gout in the UK general population. Arthritis Research & Therapy, 17(1): 90. DOI: 10.1186/s13075-015-0610-9
Hendry, G.J., Gibson, K.S., Steultjens, M.P., Reid, D.M., Woodburn, J. (2009) Foot orthoses in juvenile idiopathic arthritis: a study of biomechanical effectiveness. Physiotherapy, 96(3): 224-229. DOI: 10.1016/j.physio.2009.11.003
Seid, M., Huang, B., Niehaus, S., Brunner, H.I., Lovell, D.J. (2014) Determinants of health-related quality of life in children newly diagnosed with juvenile idiopathic arthritis. Arthritis Care & Research, 66(2): 263-269. DOI: 10.1002/acr.22117
Stiburkova, B., Bleyer, A.J. (2016) Changes in serum urate and urate excretion with age. Advances in Chronic Kidney Disease, 23(4): 236-242. DOI: 10.1053/j.ackd.2016.03.003
Lawrence, R.C., Felson, D.T., Helmick, C.G., Arnold, L.M., Choi, H., Deyo, R.A., et al. (2008) Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Arthritis & Rheumatism, 58(1): 26-35. DOI: 10.1002/art.23176
Sundy, J.S., Hershfield, M.S. (2007) Uricase and other novel agents for the management of patients with treatment-failure gout. Current Rheumatology Reports, 9(3): 258-264. DOI: 10.1007/s11926-007-0041-6
Fuchs, H.A., Kaye, J.J., Callahan, L.F., Nance, E.P., Pincus, T. (1989) Evidence of significant radiographic damage in rheumatoid arthritis within the first 2 years of disease. Journal of Rheumatology, 16(5): 585-591.
Tarnopolsky, M.A. (2016) Metabolic myopathies and exercise: mechanisms and management strategies. Neurologic Clinics, 34(3): 745-761. DOI: 10.1016/j.ncl.2016.04.006
Singh, J.A., Reddy, S.G., Kundukulam, J. (2015) Risk factors for gout and prevention: a systematic review of the literature. Current Opinion in Rheumatology, 23(2): 192-202. DOI: 10.1097/BOR.0b013e3283438e13
Oen, K., Duffy, C.M., Tse, S.M., Rosenberg, A.M., Ellsworth, J., Chédeville, G., et al. (2016) Early outcomes and improvement of patients with juvenile idiopathic arthritis enrolled in a Canadian multicenter inception cohort. Arthritis Care & Research, 68(6): 811-819. DOI: 10.1002/acr.22755
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