Imaging of juvenile idiopathic arthritis: a multimodality approach.

Juvenile idiopathic arthritis (JIA) is a heterogeneous group of diseases characterized by synovial inflammation and is the most common rheumatic complaint in children. To facilitate research and treatment, JIA has been further classified on the basis of the number of joints involved, additional symptoms, family history, and serologic findings. Imaging in patients with JIA has historically relied on radiography, which allows the accurate assessment of chronic changes of JIA, including growth disturbances, periostitis, and joint malalignment. However, radiographic findings of active inflammation are nonspecific, and, in the past, clinical evaluation has taken precedence over imaging of acute disease. Recent advances in disease-modifying therapeutic agents that can help prevent long-term disability in patients with JIA have led to greater emphasis on the detection of early joint-centered inflammation that cannot be accurately assessed radiographically and may not be evident clinically. Both contrast material-enhanced magnetic resonance (MR) imaging and Doppler ultrasonography (US) are well suited for this application and are playing an increasingly important role in diagnosis, risk stratification, treatment monitoring, and problem solving. Contrast-enhanced MR imaging is the most sensitive technique for the detection of synovitis and is the only modality that can help detect bone marrow edema, both of which indicate active inflammation. US is more sensitive than radiography for the detection of synovial proliferation and effusions and is particularly useful in the evaluation of small peripheral joints. The complexity of the temporomandibular and sacroiliac joints limits the usefulness of radiographic or US evaluation, and contrast-enhanced MR imaging is the preferred modality for evaluation of these structures.

Sheybani EF ，Khanna G ，White AJ ，Demertzis JL ... -  《-》

Physical findings associated with active temporomandibular joint inflammation in children with juvenile idiopathic arthritis.

To identify the physical findings associated with active temporomandibular joint (TMJ) inflammation (ie, synovitis) in children with juvenile idiopathic arthritis (JIA). This was a retrospective study of children with JIA evaluated at Boston Children's Hospital. The patients were included if they had a confirmed diagnosis of JIA and had undergone a TMJ magnetic resonance imaging (MRI) study with contrast. Medical records and imaging studies were reviewed to document the demographic, physical (ie, facial asymmetry, joint noises, maximal incisal opening, deviation on opening, occlusal cant), and MRI findings. The outcome variable was TMJ synovitis on the MRI study. Descriptive and bivariate statistics were computed. Multiple regression models were used to identify associations (P ≤ .05, significance). A total of 51 patients with JIA were evaluated during the study period. Of these, 43 patients (33 girls) with a mean age of 11.4 years met the inclusion criteria. MRI demonstrated TMJ synovitis in 27 patients. The age-adjusted limited maximal incisal opening (MIO) and deviation on opening were the only physical findings significantly associated with synovitis on MRI (P = .003 and P = .043, respectively). Using these parameters as predictors of synovitis, a limited MIO and deviation on opening had a high specificity (86% and 94%, respectively). Patients with a limited MIO were 6.7 times more likely to have synovitis than those with a normal MIO. All patients with a limited MIO and deviation on opening had TMJ synovitis on the MRI scan. The results of this study indicate that, in children with JIA, limited MIO and deviation on opening can be used to predict the presence of TMJ synovitis. Documentation of these parameters should be an essential part of the clinical examination and longitudinal follow-up of children with JIA.

Abramowicz S ，Susarla HK ，Kim S ，Kaban LB ... -  《-》

Spectrum of magnetic resonance imaging appearances of juvenile temporomandibular joints (TMJ) in non-rheumatic children.

Tzaribachev N ，Fritz J ，Horger M 《-》

Imaging assessment of children presenting with suspected or known juvenile idiopathic arthritis: ESSR-ESPR points to consider.

Hemke R ，Herregods N ，Jaremko JL ，Åström G ，Avenarius D ，Becce F ，Bielecki DK ，Boesen M ，Dalili D ，Giraudo C ，Hermann KG ，Humphries P ，Isaac A ，Jurik AG ，Klauser AS ，Kvist O ，Laloo F ，Maas M ，Mester A ，Oei E ，Offiah AC ，Omoumi P ，Papakonstantinou O ，Plagou A ，Shelmerdine S ，Simoni P ，Sudoł-Szopińska I ，Tanturri de Horatio L ，Teh J ，Jans L ，Rosendahl K ... -  《-》

Imaging in juvenile idiopathic arthritis (JIA): an update with particular emphasis on MRI.

Damasio MB ，de Horatio LT ，Boavida P ，Lambot-Juhan K ，Rosendahl K ，Tomà P ，Muller LO ... -  《-》