Juvenile arthritis
Imaging Approaches for Evaluating Peripheral Joint Abnormalities in Juvenile Idiopathic Arthritis

https://doi.org/10.1016/j.semarthrit.2011.08.004Get rights and content

Objectives

To assess the usefulness of imaging studies for peripheral joint assessment in children with juvenile idiopathic arthritis (JIA), based on a systematic literature review.

Methods

We used PubMed to identify relevant articles published between 2000 and 2011.

Results

Plain radiography is still the reference imaging study for monitoring joint destruction in patients with JIA, and the results correlate well with the clinical findings. Radiographs should be obtained routinely during follow-up and in therapeutic trials. Available scoring methods have been validated in children, but no recommendations are available on the intervals between radiographic assessments. Ultrasonography and magnetic resonance imaging (MRI) can detect inflammatory changes that precede bone destruction. Ultrasonography features in JIA are still being studied. Ultrasonography can detect clinically silent synovitis, which has major implications for determining the JIA subtype. MRI is the only imaging study capable of showing bone marrow edema, which predicts joint destruction.

Conclusions

Although radiography remains the reference standard imaging study for assessing peripheral joint destruction in JIA, ultrasonography and MRI allow the early detection of predestructive changes, the presence of which affects treatment decisions. Much more work is needed to determine the optimal imaging protocols, the best interval between imaging evaluations during follow-up, and the therapeutic implications of imaging study findings.

Section snippets

Methods

To identify studies of peripheral joint evaluation in patients with JIA, we reviewed electronic databases through PubMed, using terms with free-text words. The search terms were “JIA”, “juvenile chronic arthritis”, “juvenile arthritis”, “juvenile rheumatoid arthritis”, “childhood arthritis”, “joint destruction”, “erosion”, “peripheral joint”, “hand”, “foot”, “radiographs”, “radiographic score”, “scoring system”, “sonography”, “ultrasound”, “Doppler” and “magnetic resonance imaging”. All studies

Assessment of Peripheral Joint Abnormalities in JIA Using Conventional Radiography

The reference standard method for assessing joint damage and treatment efficacy in JIA patients is plain radiography. Preventing or limiting joint destruction is a major treatment goal in JIA. However, no guidelines are available, and controlled trials—even those of new agents such as TNF antagonists—failed to evaluate radiographic progression.

In 1995, Lang and coworkers (24) showed that plain radiography identified early destructive changes in children with systemic-onset JIA. The most common

Acknowledgment

The authors sincerely thank Karen Lambot-Juhan (Pediatric Radiology Department, Necker-Enfants Malades Hospital, Paris, France) for help with the relevant imaging example in Figure 2.

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    The authors have no conflicts of interest to disclose.

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