Introduction

rheumatoid arthritis, JIA, mono-articular knee arthritis, fracture, pain, osteopenia, hemiplegic, Chronic recurrent knee arthritis, RA
RHEUMATOID ARTHRITIS, INFLAMMATORY ARTHRITIS, UNILATERAL KNEE ARTHRITIS, INFLAMMATION, DISEASE, OSTEOPENIA, REMISSION, KNEE ARTHRITIS, ADHESION, JOINT INFLAMMATION
JIA is the commonest chronic inflammatory arthritis in children. Its prevalence is 1/1000. It is characterized by a heterogeneous pattern of joint inflammation for at least 6 weeks. Age at onset is usually < 16 years. The clinical presentation, prognosis, and response to treatment are very heterogeneous. The knee, ankle and wrist are among the commonly involved joints in JIA [JIA is considered a lifelong disease with high morbidity rates. It affects children’s activity level and quality of life. This will later lead to a decrease in muscle power and an increase in osteopenia and fracture risks. The target in JIA is achieving joint remission with full function and range of motion, preventing permanent damage, and maintaining a good quality of life [Chronic recurrent knee arthritis in JIA could lead to cartilage damage and persistent deformity and leg length discrepancy. Furthermore, persistent mono-articular knee arthritis despite remission is relatively common in JIA. Knee arthritis has a great impact on child mobility and quality of life in JIA [The integrity of nerve supply to the joint is essential to keep up the inflammatory cascade in rheumatoid arthritis. Hemiplegia may have a protective effect against the destructive effect of rheumatoid arthritis (RA). The paralyzed limb has lesser perfusion which may also suppress inflammation. It is not clear if this effect is related to impaired vascularity of the hemiplegic side or due to impaired nerve supply or both [There is cumulative evidence that consolidates the anti-inflammatory role of local anesthetics. It is known that local anesthetics can suppress different inflammatory leukocyte functions including adhesion, phagocytosis, and migration [So far, our team has performed one study to evaluate the effect of GNB in adult rheumatoid arthritis. The present study is the first study to test this effect in JIA. The aim of the present clinical trial is to assess the effect of GNB in pediatric patients with JIA who had persistent unilateral knee arthritis regarding pain, range of motion, and inflammation. Furthermore, we attempted to evaluate the sustainability of this effect.