Inspiratory Muscle Training in Juvenile Idiopathic Arthritis
Condition: Juvenile Idiopathic Arthritis
MeSH terms: Arthritis; Arthritis, Juvenile
Study type: Interventional

Summary: 
      The aim of this study is to investigate the effectiveness of inspiratory muscle training
      (IMT) in increasing respiratory muscle strength in patients with juvenile idiopathic
      arthritis.
    

Detailed description: 
      Primary pulmonary involvement is an important aspect that leads to morbidity and mortality in
      adult patients with rheumatoid arthritis [1,2] but is not as frequent in patients with
      juvenile idiopathic arthritis (JIA), (prevalence; 4-8%) [3]. However, a body of evidence
      indicates that respiratory functions are affected in more than 50% of all children with JIA,
      even in those without radiological involvement [1,2,4]. Previous studies comparing children
      with JIA to their healthy peers showed that forced vital capacity (FVC), forced expiratory
      volume in 1 second (FEV1), peak flow rate (PEF), and carbon monoxide diffusion capacity
      (DLCO) are decreased and the maximum inspiratory pressure (PImax) and maximum expiratory
      pressures (PEmax), which are used to assess respiratory muscle strength, are significantly
      lower [2,4]. In addition, it has been reported that disease-modifying drugs (DMARDs) and
      non-steroidal anti-inflammatory drugs (NSAIDs), which are frequently used in the treatment of
      patients with JIA may cause a decrement in respiratory functions [5]. It has been suggested
      that the decrease in the pulmonary functions in patients with JIA without radiological
      involvement of the lung parenchyma or thorax may be caused by the weakness of inspiratory and
      expiratory muscles [2]. Moreover, symptoms and signs such as chronic joint pain and
      stiffness, synovitis, and deformity seen in children with JIA may limit movement, leading to
      an inactive lifestyle. Evidence suggests that children with JIA have lower levels of physical
      activity than age-matched controls [6,7]. This inactive lifestyle accompanying the disease
      process; may cause decline in aerobic and anaerobic capacity, peripheral muscle strength and
      quality of life [8,9].

      Inspiratory muscle training (IMT) is defined as a technique that aims to improve the function
      and strength of respiratory muscles through performing exercises with a specialized device
      [10,11]. There is evidence that the IMT method improves functional status and increases
      respiratory muscle strength, respiratory volumes, and aerobic exercise capacity in adult
      rheumatologic patients [12,13]. IMT seems to increase perfusion and muscle metabolism in both
      respiratory and extremity muscles, provide muscle fiber type conversion, create neural
      plasticity at respiratory synapses in the central nervous system, and modulate dyspnea in
      different populations [14]. Despite this, the effectiveness of IMT has not been investigated
      in patients with JIA.
    

Intervention name(s): Inspiratory muscle training (IMT)
Intervention type(s): Other
Intervention description(s): Treatment group will perform IMT every day for eight weeks. Initial load is going to be set as the 60% of maximal inspiratory pressure (PImax) and is going to be increased by %10 of the initial load every two weeks.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Respiratory muscles; exercise; physiotherapy; respiratory muscle training