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The presence of a flexion deformity and extensor weakness correlated to multiple joint involvements in the present series (Table 1).
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A fractional release of hamstrings [14] and gastrocnemius in patients undergoing V-lengthening of quadriceps (especially in AMC and multiple joint involvement in Grade III patients) may reduce the extensor lag by reducing effective strength of the respective muscles.
Multiple joint involvement was common, with the median number of joints affected being four.
We also evaluated the distribution and pattern of multiple joint involvement.
The most frequent pattern of multiple joint involvement was that of bilateral knees.
6 The intervention was based on recommendations for the management of hip and knee OA 7 9 and was tailored to the needs of patients with multiple joint involvement.
Multiple joint involvement does not necessarily imply a non-infectious aetiology of the arthritis, as it occurs in 10% of patients with infectious arthritis [ 12].
These patients with multiple joint involvement could be thought of as having 'undifferentiated spondylarthropathies' who did not fit the picture of a reactive type of arthritis.
This subtype of JRA may be severe, because of both its multiple joint involvement and its capacity to progress rapidly over time.
This lack of an accepted definition makes it difficult to quantify the effect of multiple joint involvement on OA outcomes, leading to the common practice of focusing on a single joint site without considering the contribution of other involved sites.
1 Due to the complex nature of multiple joint involvement in OA 1 4 and the fact that guidelines for hip and knee OA recommend multiple non-pharmacological treatment modalities, an intervention was developed by a multidisciplinary team.
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