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Choida V, Bray TJP, van Vucht N, Abbasi MA, Bainbridge AP, Parry T, Mallett S, Ciurtin C, Hall-Craggs MA. A simple, clinically usable whole-body MRI system of joint assessment in adolescents and young people with juvenile idiopathic arthritis. Rheumatology (Oxford) 2024; 63:SI219-SI227. [PMID: 38426363 PMCID: PMC11381680 DOI: 10.1093/rheumatology/keae117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 12/11/2023] [Accepted: 02/01/2024] [Indexed: 03/02/2024] Open
Abstract
OBJECTIVES To introduce and evaluate a simple method for assessing joint inflammation and structural damage on whole-body MRI (WBMRI) in juvenile idiopathic arthritis (JIA), which is usable in clinical practice. METHODS The proposed system utilizes post-contrast Dixon WBMRI scans. Joints are assessed for synovitis (grade 0-2) and structural damage (present/absent) at 81 sites. The synovitis grading is based on features including above-normal intensity synovial enhancement, synovial hypertrophy, joint effusion, subarticular bone marrow oedema and peri-articular soft tissue oedema.This system was evaluated in a prospective study of 60 young people (47 patients with JIA and 13 controls with non-inflammatory musculoskeletal pain) who underwent a WBMRI. Three readers (blinded to diagnosis) independently reviewed all images and re-reviewed 20 individual scans. The intra- and inter-reader overall agreement (OA) and the intra- and inter-reader Gwet's agreement coefficients 2 (GAC2) were measured for the detection of a) participants with ≥1 joint with inflammation or structural damage and b) joint inflammation or structural damage for each joint. RESULTS The inter-reader OA for detecting patients with ≥1 joint with inflammation, defined as grade 2 synovitis (G2), and ≥1 joint with structural damage were 80% and 73%, respectively. The intra-reader OA for readers 1-3 was 80-90% and 75-90%, respectively. The inter-reader OA and GAC2 for joint inflammation (G2) at each joint were both ≥85% for all joints but were lower if grade 1 synovitis was included as positive. CONCLUSION The intra- and inter-reader agreements of this WBMRI assessment system are adequate for assessing objective joint inflammation and damage in JIA.
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Affiliation(s)
- Varvara Choida
- Centre for Medical Imaging, University College London, London, UK
- Division of Medicine, Centre for Adolescent Rheumatology, University College London, UK
- Department of Rheumatology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Timothy J P Bray
- Centre for Medical Imaging, University College London, London, UK
- Department of Imaging, University College London Hospitals NHS Foundation Trust, London, UK
| | - Niels van Vucht
- Department of Imaging, University College London Hospitals NHS Foundation Trust, London, UK
| | - Maaz Ali Abbasi
- Department of Imaging, University College London Hospitals NHS Foundation Trust, London, UK
| | - Alan P Bainbridge
- Centre for Medical Imaging, University College London, London, UK
- Department of Medical Physics, University College Hospitals Trust, London, UK
| | - Thomas Parry
- Centre for Medical Imaging, University College London, London, UK
| | - Sue Mallett
- Centre for Medical Imaging, University College London, London, UK
| | - Coziana Ciurtin
- Division of Medicine, Centre for Adolescent Rheumatology, University College London, UK
- Department of Rheumatology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Margaret A Hall-Craggs
- Centre for Medical Imaging, University College London, London, UK
- Department of Imaging, University College London Hospitals NHS Foundation Trust, London, UK
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Tarsia M, Zajc Avramovič M, Gazikalović A, Ključevšek D, Avčin T. A clinical perspective on imaging in juvenile idiopathic arthritis. Pediatr Radiol 2024; 54:490-504. [PMID: 38015293 PMCID: PMC10984900 DOI: 10.1007/s00247-023-05815-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 11/09/2023] [Accepted: 11/10/2023] [Indexed: 11/29/2023]
Abstract
In recent years, imaging has become increasingly important to confirm diagnosis, monitor disease activity, and predict disease course and outcome in children with juvenile idiopathic arthritis (JIA). Over the past few decades, great efforts have been made to improve the quality of diagnostic imaging and to reach a consensus on which methods and scoring systems to use. However, there are still some critical issues, and the diagnosis, course, and management of JIA are closely related to clinical assessment. This review discusses the main indications for conventional radiography (XR), musculoskeletal ultrasound (US), and magnetic resonance imaging (MRI), while trying to maintain a clinical perspective. The diagnostic-therapeutic timing at which one or the other method should be used, depending on the disease/patient phenotype, will be assessed, considering the main advantages and disadvantages of each imaging modality according to the currently available literature. Some brief clinical case scenarios on the most frequently and severely involved joints in JIA are also presented.
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Affiliation(s)
- Maria Tarsia
- Clinical Paediatrics, Department of Molecular Medicine and Development, University of Siena, Siena, Italy
| | - Mojca Zajc Avramovič
- Department of Allergology, Rheumatology and Clinical Immunology, University Children's Hospital, University Medical Centre Ljubljana, Bohoričeva 20 SI-1525, 1000, Ljubljana, Slovenia
- Department of Pediatrics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Ana Gazikalović
- Department of Radiology, University Children's Hospital, University Medical Centre Ljubljana, Bohoričeva ulica 20, 1000, Ljubljana, Slovenia
| | - Damjana Ključevšek
- Department of Radiology, University Children's Hospital, University Medical Centre Ljubljana, Bohoričeva ulica 20, 1000, Ljubljana, Slovenia
| | - Tadej Avčin
- Department of Allergology, Rheumatology and Clinical Immunology, University Children's Hospital, University Medical Centre Ljubljana, Bohoričeva 20 SI-1525, 1000, Ljubljana, Slovenia.
- Department of Pediatrics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
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Otero MF, Tahoces PG, Mera A, Dalstra M, Verna C, Pedersen TK, Herlin T, Mira J. Quantification of temporomandibular joint space in patients with juvenile idiopathic arthritis assessed by cone beam computerized tomography. Orthod Craniofac Res 2024; 27:203-210. [PMID: 37525623 DOI: 10.1111/ocr.12702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 07/17/2023] [Accepted: 07/18/2023] [Indexed: 08/02/2023]
Abstract
OBJECTIVE To describe a method to calculate the total intra-articular volume (inter-osseous space) of the temporomandibular joint (TMJ) determined by cone-beam computed tomography (CBCT). This could be used as a marker of tissue proliferation and different degrees of soft tissue hyperplasia in juvenile idiopathic arthritis (JIA) patients. MATERIALS AND METHODS Axial single-slice CBCT images of cross-sections of the TMJs of 11 JIA patients and 11 controls were employed. From the top of the glenoid fossa, in the caudal direction, an average of 26 slices were defined in each joint (N = 44). The interosseous space was manually delimited from each slice by using dedicated software that includes a graphic interface. TMJ volumes were calculated by adding the areas measured in each slice. Two volumes were defined: Ve-i and Vi , where Ve-i is the inter-osseous space, volume defined by the borders of the fossa and Vi is the internal volume defined by the condyle. An intra-articular volume filling index (IF) was defined as Ve-i /Vi , which represents the filling of the space. RESULTS The measured space of the intra-articular volume, corresponding to the intra-articular soft tissue and synovial fluid, was more than twice as large in the JIA group as in the control group. CONCLUSION The presented method, based on CBCT, is feasible for assessing inter-osseus joint volume of the TMJ and delimits a threshold of intra-articular changes related to intra-articular soft tissue proliferation, based on differences in volumes. Intra-articular soft tissue is found to be enlarged in JIA patients.
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Affiliation(s)
- María Florinda Otero
- Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Pablo G Tahoces
- Departamento de Electrónica e Computación, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - Antonio Mera
- Rheumatology Service, Hospital Clínico Universitario, Santiago de Compostela, Spain
| | - Michel Dalstra
- Section of Orthodontics, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
| | - Carlalberta Verna
- Department of Orthodontics and Pediatric Dentistry, University Center for Dental Medicine, Basel, Switzerland
| | - Thomas Klit Pedersen
- Section of Orthodontics, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
- Department of Oral and Maxillofacial Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Troels Herlin
- Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
| | - Jorge Mira
- Departamento de Física Aplicada and Instituto de Materiais (iMATUS), Universidade de Santiago de Compostela, Santiago de Compostela, Spain
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Bullock CH, McAlpine SM, Roberts SE, Derfalvi B. MicroRNA-27a-3p enhances the inflammatory phenotype of Juvenile Idiopathic Arthritis fibroblast-like synoviocytes. Pediatr Rheumatol Online J 2023; 21:53. [PMID: 37277817 DOI: 10.1186/s12969-023-00833-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 05/25/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND Juvenile Idiopathic Arthritis (JIA) is the most prevalent chronic pediatric rheumatic disorder. In joints of JIA patients, aggressive phenotypic changes in fibroblast-like synoviocytes (FLS) of the synovial lining play a key role in inflammation. MicroRNAs are dysregulated in rheumatoid arthritis and JIA, including miR-27a-3p. However, it is not understood if miR-27a-3p, enriched in JIA synovial fluid (SF) and leukocytes, alters FLS function. METHODS Primary JIA FLS cells were transfected with a miR-27a-3p mimic or a negative control microRNA (miR-NC) and stimulated with pooled JIA SF or inflammatory cytokines. Viability and apoptosis were analyzed by flow cytometry. Proliferation was evaluated using a 3H-thymidine incorporation assay. Cytokine production was assessed by qPCR and ELISA. Expression of TGF-β pathway genes was determined using a qPCR array. RESULTS MiR-27a-3p was constitutively expressed in FLS. Overexpression of miR-27a-3p caused increased interleukin-8 secretion in resting FLS, and interleukin-6 was elevated in SF-activated FLS compared to miR-NC. Furthermore, stimulation with pro-inflammatory cytokines augmented FLS proliferation in miR-27a-3p-transfected FLS relative to miR-NC. Expression of multiple TGF-β pathway genes was modulated by overexpression of miR-27a-3p. CONCLUSIONS MiR-27a-3p significantly contributes to FLS proliferation and cytokine production, making it a potential candidate for epigenetic therapy that targets FLS in arthritis.
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Affiliation(s)
- Claire H Bullock
- Dalhousie Medical School, Faculty of Medicine, Dalhousie University, Halifax, Canada
| | - Sarah M McAlpine
- Division of Immunology, Dept. of Pediatrics, Dalhousie University, IWK Health, 8 East Research 5850/5980 University Ave Halifax, NS, B3K 6R8, Halifax, Canada.
| | - Sarah E Roberts
- Division of Immunology, Dept. of Pediatrics, Dalhousie University, IWK Health, 8 East Research 5850/5980 University Ave Halifax, NS, B3K 6R8, Halifax, Canada
| | - Beata Derfalvi
- Division of Immunology, Dept. of Pediatrics, Dalhousie University, IWK Health, 8 East Research 5850/5980 University Ave Halifax, NS, B3K 6R8, Halifax, Canada.
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Foot and Ankle Conventional Radiography in Juvenile Idiopathic Arthritis: Does It Still Matter? J Belg Soc Radiol 2022; 106:87. [PMID: 36213368 PMCID: PMC9503895 DOI: 10.5334/jbsr.2729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 08/27/2022] [Indexed: 11/24/2022] Open
Abstract
Objectives: The aim of this study was to evaluate the residual value of Conventional Radiography in children with arthralgia clinically suspected of Juvenile Idiopathic Arthritis (JIA). Materials and Methods: Three hundred seventy-two patients aged 1–18 years suspected of JIA were retrospectively reviewed. All patients had foot and ankle plain films performed in standard two projections: ankle in antero-posterior and lateral, and foot in antero-posterior and oblique. The cohort was divided into two groups: patients with confirmed JIA and non-JIA control group of children with foot and ankle arthralgia without diagnosis of inflammatory connective tissue disease. Radiographic findings in both groups were compared. Results: In 40% of JIA and 70% of non-JIA patients radiographs were normal. All radiographic findings were significantly more common in JIA than in non-JIA group (p = 0.000). Soft tissue swelling was the most frequent abnormality found in JIA patients (31, 51%) and only in 2.41% of non-JIA patients (p = 0.000). Osteoporosis and joint space narrowing were also significantly more common in JIA group (p = 0.000). The majority of imaging findings in non-JIA group were non-inflammatory abnormalities. Conclusion: Conventional radiography is an important tool in differential diagnosis of arthralgia of unknown etiology, as soft tissue swelling, osteoporosis and joint space narrowing are significantly more common in JIA patients as compared with patients without the diagnosis of inflammatory connective tissue disease. However, in case of high clinical suspicion of JIA and normal radiography, we recommend subsequent ultrasound (US) and/or MRI to allow early treatment.
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Proof-of-Concept Study of the Use of Accelerometry to Quantify Knee Joint Movement and Assist with the Diagnosis of Juvenile Idiopathic Arthritis. TECHNOLOGIES 2022. [DOI: 10.3390/technologies10040076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Abstract
Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease in childhood. Seven children and young people (CYP) with a diagnosis of JIA and suspected active arthritis of a single knee joint were recruited for this proof-of-concept study. The presence of active arthritis was confirmed by clinical examination. Four tri-axial accelerometers were integrated individually in elastic bands and placed above and below each knee. Participants performed ten periodic flexion-extensions of each knee joint while lying down, followed by walking ten meters in a straight path. The contralateral (non-inflamed) knee joint acted as a control. Accelerometry data were concordant with the results of clinical examination in six out of the seven patients recruited. There was a significant difference between the accelerometry measured range of movement (ROM, p-value = 0.032) of the knees with active arthritis and the healthy contralateral knees during flexion-extension. No statistically significant difference was identified between the ROM of the knee joints with active arthritis and healthy knee joints during the walking test. The study demonstrated that accelerometry may help in differentiating between healthy knee joints and those with active arthritis; however, further research is required to confirm these findings.
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Whittingslow DC, Zia J, Gharehbaghi S, Gergely T, Ponder LA, Prahalad S, Inan OT. Knee Acoustic Emissions as a Digital Biomarker of Disease Status in Juvenile Idiopathic Arthritis. Front Digit Health 2020; 2:571839. [PMID: 34713044 PMCID: PMC8521909 DOI: 10.3389/fdgth.2020.571839] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 10/22/2020] [Indexed: 12/14/2022] Open
Abstract
In this paper, we quantify the joint acoustic emissions (JAEs) from the knees of children with juvenile idiopathic arthritis (JIA) and support their use as a novel biomarker of the disease. JIA is the most common rheumatic disease of childhood; it has a highly variable presentation, and few reliable biomarkers which makes diagnosis and personalization of care difficult. The knee is the most commonly affected joint with hallmark synovitis and inflammation that can extend to damage the underlying cartilage and bone. During movement of the knee, internal friction creates JAEs that can be non-invasively measured. We hypothesize that these JAEs contain clinically relevant information that could be used for the diagnosis and personalization of treatment of JIA. In this study, we record and compare the JAEs from 25 patients with JIA-10 of whom were recorded a second time 3-6 months later-and 18 healthy age- and sex-matched controls. We compute signal features from each of those record cycles of flexion/extension and train a logistic regression classification model. The model classified each cycle as having JIA or being healthy with 84.4% accuracy using leave-one-subject-out cross validation (LOSO-CV). When assessing the full JAE recording of a subject (which contained at least 8 cycles of flexion/extension), a majority vote of the cycle labels accurately classified the subjects as having JIA or being healthy 100% of the time. Using the output probabilities of a JIA class as a basis for a joint health score and test it on the follow-up patient recordings. In all 10 of our 6-week follow-up recordings, the score accurately tracked with successful treatment of the condition. Our proposed JAE-based classification model of JIA presents a compelling case for incorporating this novel joint health assessment technique into the clinical work-up and monitoring of JIA.
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Affiliation(s)
- Daniel C. Whittingslow
- Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Emory University, Atlanta, GA, United States,Emory University School of Medicine, Atlanta, GA, United States,*Correspondence: Daniel C. Whittingslow
| | - Jonathan Zia
- Emory University School of Medicine, Atlanta, GA, United States,Department of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA, United States
| | - Sevda Gharehbaghi
- Department of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA, United States
| | - Talia Gergely
- Emory University School of Medicine, Atlanta, GA, United States
| | - Lori A. Ponder
- Emory University School of Medicine, Atlanta, GA, United States
| | | | - Omer T. Inan
- Department of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA, United States
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Mitra S, Samui PP, Samanta M, Mondal RK, Hazra A, Mandal K, Sabui TK. Ultrasound detected changes in joint cartilage thickness in juvenile idiopathic arthritis. Int J Rheum Dis 2019; 22:1263-1270. [PMID: 31117159 DOI: 10.1111/1756-185x.13584] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 02/14/2019] [Accepted: 03/25/2019] [Indexed: 11/29/2022]
Abstract
AIM The purpose of this study was to investigate the changes in joint cartilage thickness in different subtypes of juvenile idiopathic arthritis (JIA) using ultrasound, comparing them with healthy children and to evaluate the relationship with disease duration and inflammatory markers. METHODS We conducted a cross-sectional study comprising of 27 cases of JIA and 54 age- and sex-matched healthy children. Bilateral wrist, knee and ankle joint cartilage thicknesses were measured by ultrasound as per European League Against Rheumatism standard guidelines and compared them between JIA subtypes as well as between cases and control. RESULTS Descriptive analysis of the whole cohort revealed the mean age of the study population was 8.3 ± 3.2 years with mean cartilage thicknesses at the wrist, knee and ankle being 1.40 ± 0.89 mm, 1.57 ± 0.78 mm and 1.41 ± 0.85 mm, respectively. The median cartilage thicknesses of wrist, knee and ankle joints of JIA cases (n = 27) and healthy controls (n = 54) were 1.01, 1.35, 1.05 and 1.95, 2.00, 1.95, respectively. The joint cartilage thickness was significantly reduced in JIA in comparison to the healthy cohort (P < 0.01). Diseased boys suffered greater cartilage damage in knee joints compared to girls; the polyarticular variety of cases had thinner knee cartilage in comparison to the oligoarticular subtype. Further, it was found that joint cartilage destruction is independent of inflammatory markers and disease duration. CONCLUSION Significant cartilage thinning in addition was found in JIA children, particularly in the polyarticular subtype, and more in boys than girls, which is independent of disease duration and inflammatory markers, using ultrasound as a primary investigative tool.
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Affiliation(s)
- Sonali Mitra
- Department of Pediatrics, NRS Medical College, Kolkata, India
| | | | - Moumita Samanta
- Department of Pediatrics, NRS Medical College, Kolkata, India
| | | | - Avijit Hazra
- Department of Pharmacology, IPGME&R SSKM Hospital, Kolkata, India
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Cron RQ, Weiser P, Beukelman T. Juvenile Idiopathic Arthritis. Clin Immunol 2019. [DOI: 10.1016/b978-0-7020-6896-6.00053-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Mitchell PD, Viswanath A, Obi N, Littlewood A, Latimer M. A prospective study of screening for musculoskeletal pathology in the child with a limp or pseudoparalysis using erythrocyte sedimentation rate, C-reactive protein and MRI. J Child Orthop 2018; 12:398-405. [PMID: 30154932 PMCID: PMC6090194 DOI: 10.1302/1863-2548.12.180004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE To determine if the detection of musculoskeletal pathology in children with a limp or acute limb disuse can be optimized by screening with blood tests for raised inflammatory markers, followed by MRI. METHODS This was a prospective observational study. Entry criteria were children (0 to 16 years of age) presenting to our emergency department with a non-traumatic limp or pseudoparalysis of a limb, and no abnormality on plain radiographs. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) blood tests were performed. Children with ESR > 10 mm/hr or CRP > 10 mg/L underwent a MRI scan. When the location of the pathology causing the limp was clinically unclear, screening images (Cor t1 and Short Tau Inversion Recovery) of both lower limbs from pelvis to ankles ('legogram') was undertaken. Data was gathered prospectively from 100 consecutive children meeting the study criteria. RESULTS In all, 75% of children had a positive finding on their MRI. A total of 64% of cases had an infective cause for their symptoms (osteomyelitis, septic arthritis, pyomyositis, fasciitis, cellulitis or discitis). A further 11% had positive findings on MRI from non-infective causes (juvenile idiopathic arthritis, cancer or undisplaced fracture). The remaining 25% had either a normal scan or effusion due to transient synovitis. ESR was a more sensitive marker than CRP in infection, since ESR was raised in 97%, but CRP in only 70%. CONCLUSION In our opinion MRI imaging of all children with a limp and either raised ESR or CRP is a sensitive method to minimize the chance of missing important pathology in this group, and is an effective use of MRI resources. We advocate the use of both blood tests in conjunction. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- P. D. Mitchell
- Department of Orthopaedic Surgery, Peterborough City Hospital, Bretton Gate, Peterborough, UK, Correspondence should be sent to P. D. Mitchell, Department of Orthopaedic Surgery, Peterborough City Hospital, Bretton Gate, Peterborough PE3 9GZ, UK. E-mail:
| | - A. Viswanath
- Department of Orthopaedic Surgery, Peterborough City Hospital, Bretton Gate, Peterborough, UK
| | - N. Obi
- Department of Orthopaedic Surgery, Peterborough City Hospital, Bretton Gate, Peterborough, UK
| | - A. Littlewood
- Department of Radiology, Peterborough City Hospital, Bretton Gate, Peterborough, UK
| | - M. Latimer
- Department of Orthopaedic Surgery, Peterborough City Hospital, Bretton Gate, Peterborough, UK
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Shelmerdine SC, Di Paolo PL, Tanturri de Horatio L, Malattia C, Magni-Manzoni S, Rosendahl K. Imaging of the hip in juvenile idiopathic arthritis. Pediatr Radiol 2018; 48:811-817. [PMID: 29766251 DOI: 10.1007/s00247-017-4022-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 10/19/2017] [Indexed: 11/30/2022]
Abstract
Hip involvement is common and estimated to occur in approximately 35-63% of children with juvenile idiopathic arthritis (JIA). It is more prevalent in the aggressive systemic subtypes, with irreversible changes occurring as early as within 5 years of diagnosis. Whilst clinical parameters and joint examination can be useful for assessing disease severity, subclinical disease is known to exist and delayed treatment may herald a lifetime of disability and pain. Early recognition of JIA changes is therefore crucial in determining treatment options. Validated scoring systems in the radiologic assessment of the hip for clinical drug trials may inform treatment outcomes, although robust tools for analysis are still lacking. This review article details the modalities utilised for imaging the hip in children with JIA with particular efforts focused upon reliability and validity in their assessment of joint disease. We conclude with a short literature review on the potential future techniques being developed for hip joint imaging in JIA.
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Affiliation(s)
- Susan Cheng Shelmerdine
- Department of Clinical Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK.
| | - Pier Luigi Di Paolo
- Department of Radiology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | - Clara Malattia
- Istituto Giannina Gaslini, Pediatria II, Reumatologia, Largo Gaslini, Genoa, 5, 16147, Italy.,Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (DINOGMI), University of Genova, Genoa, Italy
| | - Silvia Magni-Manzoni
- Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (DINOGMI), University of Genova, Genoa, Italy.,Pediatric Rheumatology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Karen Rosendahl
- Department of Radiology, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, K1, University of Bergen, Bergen, Norway
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Avenarius DFM, Nusman C, Malattia C, de Horatio LT, Rosendahl K, Maas M, Müller LSO. Current status of wrist imaging in juvenile idiopathic arthritis. Pediatr Radiol 2018; 48:801-810. [PMID: 29766247 DOI: 10.1007/s00247-017-4063-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 11/19/2017] [Accepted: 12/18/2017] [Indexed: 10/17/2022]
Abstract
Wrist involvement occurs in about one-quarter of patients diagnosed with juvenile idiopathic arthritis (JIA), increasing to 40% 5 years after diagnosis. The imaging appearances, both for active inflammation and permanent change, differ from those seen in adult rheumatoid arthritis; therefore, a child-specific approach is crucial for correct assessment. In this review article, we provide an update on the current status for imaging wrist JIA, with a focus on evidence-based practice.
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Affiliation(s)
| | - Charlotte Nusman
- Department of Paediatric Haematology, Rheumatology, Immunology, and Infectious Disease, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands.,Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Clara Malattia
- Department of Paediatrics, University of Genoa, Genova, Italy
| | | | - Karen Rosendahl
- Department of Radiology, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, K1, University of Bergen, Bergen, Norway
| | - Mario Maas
- Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Lil-Sofie Ording Müller
- Department of Radiology and Intervention Unit for Paediatric Radiology, Oslo University, Oslo, Norway
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13
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Dimitriou C, Boitsios G, Badot V, Lê PQ, Goffin L, Simoni P. Imaging of Juvenile Idiopathic Arthritis. Radiol Clin North Am 2017; 55:1071-1083. [DOI: 10.1016/j.rcl.2017.04.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Ultrasound imaging of synovial inflammation in juvenile idiopathic arthritis. Pediatr Radiol 2017; 47:1160-1170. [PMID: 28779188 DOI: 10.1007/s00247-017-3934-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 06/05/2017] [Accepted: 06/23/2017] [Indexed: 01/17/2023]
Abstract
Juvenile idiopathic arthritis (JIA) is the most common rheumatic entity of childhood. The hallmark feature of all subtypes is joint inflammation. Imaging is used to evaluate the extent and severity of inflammation, degree of joint damage and response to treatment, which in turn impacts patient management. Ultrasound has become a useful adjunct to clinical examination because it shows promise in evaluating clinical and subclinical inflammation (synovitis, enthesitis) as well as cartilage and bone erosive changes. However more collaborative research is needed to help define the normal appearance of the growing skeleton, clarify the significance of subclinical findings and develop useful definitions, imaging protocols and scoring systems of disease.
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