Novel Urinary Biomarkers Outperform Standard Biomarkers In Juvenile Lupus Nephritis: A Prospective Longitudinal Validation Study

1. FOOT ORTHOSES IN JIA: RESULTS FROM A RANDOMIZED CONTROLLED TRIAL Andrea Coda, Joyce Davidson, Peter Fowlie, Jo Walsh, Tom Carline and Derek Santos Queen Margaret University, Edinburgh, Royal Hospital for Sick Children, Edinburgh and Ninewells Hospital, Dundee, UK Correspondence to: acoda@qmu.ac.uk Background: Currently there is limited evidence supporting podiatric treatment of children with JIA. This study aimed to investigate whether pre-formed cost-effective foot orthoses (FOs) impacted on pain, quality of life (primary outcomes) and/or gait parameters (secondary outcomes) in children affected by JIA. Methods: Intervention was blinded to the patients. The trial group was supplied with FOs, with the addition of chairside corrections and the control insole instead was made without corrections. Both insoles had the same black EVA top cover. Primary outcome measures were recorded at each of three data recording appointments over a 6-month period, using validated questionnaires such as VAS, Childhood Health Assessment Questionnaire (CHAQ) and PedsQL. Tekscan equipment (F-Scan and HR Walkway) measured in-shoe pressure and force data with and without orthotic intervention, using same type of sensors of equal resolution. Multiple foot strikes and repetitive gait patterns were compared pre and post-treatment. The HR Walkway captures multiple sequential footsteps during barefoot walking; allowing barefoot and inshoe measurements to be compared. Results: Sixty children were recruited: 48.3% (n1⁄429) control and 51.7% (n1⁄431) active-treatment group. Within the control group 20.7% (n1⁄4 6) of patients were male. Within the active-treatment group, 29% (n1⁄4 9) of subjects were male. Age range was 5–18 years, mean age for the control group was 11.17 (S.D. 3.51) and for the trial group was 10.64 (S.D. 3.84). In order to attribute any effect solely to the FO intervention, details of changes of medication and/or new joint injections were recorded during the trial: 65.5% (n1⁄419) of the control group were on stable medication; 74.2% (n1⁄4 23) of the children receiving active treatment were on stable medication. Overall, 99.4% (n1⁄4179/180) of appointments were completed and contributed to this preliminary data analysis. Significant improvement was identified in the primary outcomes favouring active treatment with regard to pain and quality of life measures: VAS (P< 0.05); CHAQ (P< 0.05); PedsQL paediatricgeneric (P<0.05), Peds paediatric rheumatology (P<0.05); PedsQL parent generic (P< 0.05); PedsQL parent rheumatology (P<0.05). Significant differences were also identified between the groups for gait time, stance time, total plantar surface, heel contact, midfoot, fifth metatarsal head and distal phalanx. Conclusions: The results show that FOs are effective in improving pain, quality of life and most gait parameters in JIA children. This trial also provides new evidence for the role of podiatrists within the multidisciplinary team in paediatric rheumatology and hopes to improve the profile of podiatrists working within paediatric hospitals and private practices. Disclosure statement: The authors have declared no conflict of interest.