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Tsujioka Y, Nishimura G, Sugimoto H, Nozaki T, Kono T, Jinzaki M. Imaging findings of juvenile idiopathic arthritis and autoinflammatory diseases in children. Jpn J Radiol 2023; 41:1186-1207. [PMID: 37329408 PMCID: PMC10613601 DOI: 10.1007/s11604-023-01447-6] [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: 02/05/2023] [Accepted: 05/10/2023] [Indexed: 06/19/2023]
Abstract
Juvenile idiopathic arthritis (JIA) is a collective term for pediatric inflammatory arthritis of unknown etiology, which presents diverse clinical and imaging findings. The pathogenesis is complex; however, most cases stem from an autoimmune mechanism. Herein we provide a short review of imaging findings of JIA. Imaging assessment begins with plain radiography demonstrating joint swelling, periarticular osteopenia, and juxtaarticular bone erosion. Bone erosion occurs later in JIA. Instead, aberrant epimetaphyseal growth often gives the first clue to the diagnosis. US and MRI can demonstrate the details of the synovium, cartilage, and subchondral bone. JIA is subdivided into oligoarthritis, polyarthritis (rheumatoid factor-negative and positive), psoriatic arthritis, enthesitis-related arthritis, and systemic JIA. Awareness of the different clinical characteristics, pathogenic background, and prognosis of each subtype facilitates a more advanced, imaging-based diagnosis. Unlike the other types, systemic JIA is an autoinflammatory disease accompanied by inflammatory cytokinemia and systemic symptoms stemming from aberrant activation of the innate immunity. Other autoinflammatory diseases, both monogenic (e.g., NOMID/CINCA) and multifactorial (e.g., CRMO), are also discussed.
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Affiliation(s)
- Yuko Tsujioka
- Department of Radiology, Keio University School of Medicine, 35, Shinanomachi, Shinjuku-Ku, Tokyo, 160-0016, Japan.
- Department of Radiology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan.
| | - Gen Nishimura
- Department of Radiology, Musashino-Yowakai Hospital, Tokyo, Japan
| | | | - Taiki Nozaki
- Department of Radiology, Keio University School of Medicine, 35, Shinanomachi, Shinjuku-Ku, Tokyo, 160-0016, Japan
- Department of Radiology, St. Luke's International Hospital, Tokyo, Japan
| | - Tatsuo Kono
- Department of Radiology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Masahiro Jinzaki
- Department of Radiology, Keio University School of Medicine, 35, Shinanomachi, Shinjuku-Ku, Tokyo, 160-0016, Japan
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2
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Weaver JS, Omar I, Epstein K, Brown A, Chadwick N, Taljanovic MS. High-resolution ultrasound in the evaluation of musculoskeletal infections. J Ultrason 2023; 23:e272-e284. [PMID: 38020512 PMCID: PMC10668941 DOI: 10.15557/jou.2023.0034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 07/31/2023] [Indexed: 12/01/2023] Open
Abstract
Soft tissue and osseous musculoskeletal infections are common but can be difficult to diagnose clinically. Signs, symptoms, and physical examination findings may be nonspecific, and laboratory values can be inconclusive. The extent of disease may also be underestimated on physical examination. Soft tissue infections most commonly occur secondary to direct inoculation from broken skin and less frequently due to the seeding of the soft tissues from hematogenous spread, while osseous infections are more commonly due to hematogenous seeding. Infections may also be iatrogenic, following surgery or other procedural interventions. High-resolution ultrasound is an extremely useful imaging modality in the evaluation of musculoskeletal soft tissue and joint infections, and can occasionally be used to evaluate osseous infections as well. Ultrasound can aid in the early diagnosis of musculoskeletal infections, allowing for prompt treatment, decreased risk of complications, and treatment optimization. Ultrasound is sensitive and specific in evaluating soft tissue edema and hyperemia; soft tissue abscesses; joint, bursal and tendon sheath effusions/synovitis; and subperiosteal abscesses. This article describes the typical high-resolution grayscale as well as color and power Doppler ultrasound imaging findings of soft tissue infections including cellulitis, fasciitis, necrotizing deep soft tissue infection, pyomyositis, soft tissue abscess, infectious bursitis, and infectious tenosynovitis. Ultrasound findings of septic arthritis as well as osteomyelitis, such as subperiosteal spread of infection (subperiosteal abscess). are also reviewed. In addition, the use of ultrasound to guide fluid and tissue sampling is discussed.
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Affiliation(s)
- Jennifer S. Weaver
- Department of Radiology, University of Texas Health San Antonio, San Antonio, USA
| | - Imran Omar
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Katherine Epstein
- Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, USA
| | | | - Nicholson Chadwick
- Department of Radiology, Vanderbilt University Medical Center, Nashville, USA
| | - Mihra S. Taljanovic
- Department of Radiology, University of New Mexico, Albuquerque, New Mexico, USA
- Departments of Medical Imaging and Orthopedic Surgery, Banner University Medical Center, Tucson, Arizona, USA
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3
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The AIUM Practice Parameter for the Performance of the Musculoskeletal Ultrasound Examination. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:E23-E35. [PMID: 37130137 DOI: 10.1002/jum.16228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 03/17/2023] [Indexed: 05/03/2023]
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4
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Giraudo C, Fichera G, Ganguly S, Arumugam M, Cecchin D, Rennie WJ. Ankle and Foot: Focus on Inflammatory Disease. Semin Musculoskelet Radiol 2023; 27:327-336. [PMID: 37230132 DOI: 10.1055/s-0043-1766097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The ankle and foot have numerous bones and complex joints that can be affected by several types of inflammatory arthritis with different patterns and various radiologic signs, depending on the phase of the disease. Involvement of these joints is most frequently seen in peripheral spondyloarthritis and rheumatoid arthritis in adults and juvenile idiopathic arthritis in children. Although radiographs are a mainstay in the diagnostic process, ultrasonography and especially magnetic resonance imaging allow early diagnosis and are crucial diagnostic tools. Some diseases have typical features based on target populations (e.g., adults versus children, men versus women), but others may have overlapping imaging characteristics. We highlight key diagnostic features and describe appropriate investigations to guide clinicians toward the correct diagnosis and provide support during disease monitoring.
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Affiliation(s)
- Chiara Giraudo
- Nuclear Medicine Unit, Department of Medicine - DIMED, University of Padova, Padova, Italy
| | - Giulia Fichera
- Pediatric Radiology Unit, University Hospital of Padova, Padova, Italy
| | - Sujata Ganguly
- Department of Rheumatology, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Moorthy Arumugam
- Department of Rheumatology, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Diego Cecchin
- Nuclear Medicine Unit, Department of Medicine - DIMED, University of Padova, Padova, Italy
| | - Winston J Rennie
- Department of Radiology, Leicester Royal Infirmary, Leicester, United Kingdom
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5
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Gupta A, Bagri N, Spalkit S, Jana M. Technical and Interpretive Pitfalls in Pediatric Musculoskeletal Ultrasound. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023. [PMID: 36851863 DOI: 10.1002/jum.16206] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 02/04/2023] [Accepted: 02/12/2023] [Indexed: 06/18/2023]
Abstract
The use of musculoskeletal (MSK) ultrasound (US) in pediatric rheumatology has expanded rapidly with various diagnostic and therapeutic indications. Unlike magnetic resonance imaging (MRI), US allows real-time dynamic assessment, evaluation of multiple joints in a single session and comparison with contralateral limb. However, a long learning curve and lack of experience with MSK US in pediatric patients still precludes its routine use at many imaging centers. It is prudent for pediatric radiologists to be aware of normal US appearances of the growing MSK structures to avoid their misinterpretation as pathology. The normal MSK US findings in children which can be confused with pathology and create diagnostic difficulty can arise due to variable states of maturation of bones, cartilage and tendons, complex anatomical locations, accessory structures, and artifacts. Herein, we describe the various technical and interpretive challenges encountered with MSK US in pediatric patients.
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Affiliation(s)
- Amit Gupta
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Narendra Bagri
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Stanzin Spalkit
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Manisha Jana
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
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Poboży T, Konarski W, Piotrowska-Lis K, Domańska J, Poboży K, Kielar M. Basic Differences and Most Common Findings in Ultrasound Examinations of Musculoskeletal System in Children: A Narrative Literature Review. Healthcare (Basel) 2022; 10:healthcare10102010. [PMID: 36292459 PMCID: PMC9602487 DOI: 10.3390/healthcare10102010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 10/03/2022] [Accepted: 10/04/2022] [Indexed: 11/04/2022] Open
Abstract
We present basic differences in the musculoskeletal ultrasound examinations between adults and children. Examiners who deal with adults on a daily basis have shared concerns about examining children. Such concerns may arise from the different approach to child ultrasounds, but they also come from differences in anatomical characteristics according to developmental age. We discuss the presence of growth plates, as well as non-mineralized parts of the bones. We also refer to the pathologies most often found in ultrasounds in early developmental stages. In the PubMed database, the set of keywords: "msk ultrasound in children", "pediatric msk sonoanatomy", "coxitis fugax", "pediatric Baker's cyst", "Baker's cyst ultrasonography", "bone septic necrosis in ultrasonography", "ultrasonography in juvenile idiopathic arthritis", and "ultrasonography in juvenile spondyloarthropathies", was used to identify a total of 1657 results, from which 54 was selected to be included in the article. We discuss the problem of osteochondritis dissecans, Osgood-Schlatter disease, examples of ligament injuries (especially in relation to the knee and ankle joints), exfoliation of growth cartilages, osteochondroma, exudates and inflammations affecting joints, and Baker's cysts. In this way, we have collected useful information about the most common diseases of the musculoskeletal system in children.
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Affiliation(s)
- Tomasz Poboży
- Department of Orthopedic Surgery, Ciechanów Hospital, 06-400 Ciechanów, Poland
- Correspondence:
| | - Wojciech Konarski
- Department of Orthopedic Surgery, Ciechanów Hospital, 06-400 Ciechanów, Poland
| | | | - Julia Domańska
- Central Clinical Hospital of the Ministry of Interior and Administration in Warsaw, 02-507 Warsaw, Poland
| | - Kamil Poboży
- Faculty of Medicine, Medical University of Warsaw, 01-938 Warsaw, Poland
| | - Maciej Kielar
- Surgery Clinic of Medical Department, Lazarski High School, 02-662 Warsaw, Poland
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Jafari K, Woodward GA. Fever and Knee Effusion in the Pediatric Patient. Pediatr Emerg Care 2022; 38:555-561. [PMID: 36173430 DOI: 10.1097/pec.0000000000002839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT The pediatric patient with fever and knee effusion is always a cause for clinical concern. A thorough history and physical examination is required to guide appropriate diagnostic evaluation and management. Although pediatric knee effusions are common in the setting of trauma, the presence of fever should prompt consideration of infectious, rheumatologic, vasculitic, and malignant etiologies. This review covers the key components of the history, physical examination, diagnostic strategies, common etiologies, and initial management of the pediatric patient with fever and knee effusion.
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Affiliation(s)
- Kaileen Jafari
- From the Senior Fellow (PEM faculty as of February 2022), Division of Emergency Medicine, University of Washington Department of Pediatrics, Seattle Children's Hospital
| | - George A Woodward
- Chief, Division of Emergency Medicine, Professor, University of Washington Department of Pediatrics, Seattle Children's Hospital, Seattle, WA
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Lassoued Ferjani H, Maatallah K, Miri S, Triki W, Nessib DB, Kaffel D, Hamdi W. Enthesitis-related arthritis: monitoring and specific tools. J Pediatr (Rio J) 2022; 98:223-229. [PMID: 34597529 PMCID: PMC9432174 DOI: 10.1016/j.jped.2021.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 07/31/2021] [Accepted: 08/02/2021] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVES In this article, the authors aimed to review the different tools used in the monitoring of enthesitis-related arthritis. SOURCES The authors performed a literature review on PubMed, Google Scholar, and Scopus databases. The dataset included the original research and the reviews including patients with enthesitis-related arthritis or juvenile spondylarthritis up to October 2020. SUMMARY OF FINDING Enthesitis-related arthritis is a category of juvenile idiopathic arthritis. It is characterized by the presence of enthesitis, peripheral arthritis, as well as axial involvement. The only validated tool for disease activity measurement in juvenile idiopathic arthritis is the Disease Activity Score: It has proven its reliability and sensitivity. Nevertheless, due to an absence of validated evaluation tools, the extent of functional impairment, as well as the children and parents' perception of the disease, could not be objectively perceived. Despite the great progress in the field of imaging modalities, the role they play in the evaluation of disease activity is still controversial. This is partially due to the lack of validated scoring systems. CONCLUSIONS Further work is still required to standardize the monitoring strategy and validate the outcome measures in enthesitis-related arthritis.
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Affiliation(s)
- Hanène Lassoued Ferjani
- Kassab Orthopedics Institute, Rheumatology Department, Ksar Saïd, Tunisia; University Tunis el Manar, Faculty of Medicine, Tunis, Tunisia; Research Unit UR17SP04, 2010, Ksar Said, 2010 Tunis, Tunisia.
| | - Kaouther Maatallah
- Kassab Orthopedics Institute, Rheumatology Department, Ksar Saïd, Tunisia; University Tunis el Manar, Faculty of Medicine, Tunis, Tunisia; Research Unit UR17SP04, 2010, Ksar Said, 2010 Tunis, Tunisia
| | - Sirine Miri
- Kassab Orthopedics Institute, Rheumatology Department, Ksar Saïd, Tunisia
| | - Wafa Triki
- Kassab Orthopedics Institute, Rheumatology Department, Ksar Saïd, Tunisia; University Tunis el Manar, Faculty of Medicine, Tunis, Tunisia; Research Unit UR17SP04, 2010, Ksar Said, 2010 Tunis, Tunisia
| | - Dorra Ben Nessib
- Kassab Orthopedics Institute, Rheumatology Department, Ksar Saïd, Tunisia; University Tunis el Manar, Faculty of Medicine, Tunis, Tunisia; Research Unit UR17SP04, 2010, Ksar Said, 2010 Tunis, Tunisia
| | - Dhia Kaffel
- Kassab Orthopedics Institute, Rheumatology Department, Ksar Saïd, Tunisia; University Tunis el Manar, Faculty of Medicine, Tunis, Tunisia; Research Unit UR17SP04, 2010, Ksar Said, 2010 Tunis, Tunisia
| | - Wafa Hamdi
- Kassab Orthopedics Institute, Rheumatology Department, Ksar Saïd, Tunisia; University Tunis el Manar, Faculty of Medicine, Tunis, Tunisia; Research Unit UR17SP04, 2010, Ksar Said, 2010 Tunis, Tunisia
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9
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Shet NS, Iyer RS, Chan SS, Baldwin K, Chandra T, Chen J, Cooper ML, Creech CB, Gill AE, Levin TL, Moore MM, Nadel HR, Saidinejad M, Schooler GR, Squires JH, Swenson DW, Rigsby CK. ACR Appropriateness Criteria® Osteomyelitis or Septic Arthritis-Child (Excluding Axial Skeleton). J Am Coll Radiol 2022; 19:S121-S136. [PMID: 35550797 DOI: 10.1016/j.jacr.2022.02.017] [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: 02/16/2022] [Accepted: 02/19/2022] [Indexed: 10/18/2022]
Abstract
Imaging plays an integral role in the evaluation of suspected musculoskeletal infections in children, not only in the accurate identification of infection such as osteomyelitis or septic arthritis, but also in guiding management. Various diagnostic modalities serve different purposes in the assessment of suspected pediatric musculoskeletal infections. The purpose of this document is to provide imaging guidance in the most frequently encountered clinical scenarios in which osteomyelitis and/or septic arthritis are suspected, outside of the axial skeleton. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion.
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Affiliation(s)
- Narendra S Shet
- Children's National Hospital, Washington, District of Columbia.
| | - Ramesh S Iyer
- Panel Chair, Seattle Children's Hospital, Seattle, Washington; and Chair, SPCC (CoPLL)
| | - Sherwin S Chan
- Panel Vice-Chair, Vice Chair of Radiology, Children's Mercy Hospital, Kansas City, Missouri
| | - Keith Baldwin
- Associate Professor, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; American Academy of Orthopaedic Surgeons
| | - Tushar Chandra
- Magnetic Resonance Medical Director, Chief of Research, Chief of Medical Education, Co-director of 3D and Advanced Imaging Lab, Nemours Children's Hospital, Orlando, Florida
| | - Jimmy Chen
- University of Florida College of Medicine Jacksonville, Jacksonville, Florida; American Academy of Pediatrics
| | - Matthew L Cooper
- Pediatric Radiology Division Chief, Radiology Medical Director, Riley Hospital for Children, Indianapolis, Indiana
| | - C Buddy Creech
- Vanderbilt University Medical Center, Nashville, Tennessee; Infectious Diseases Society of America; and President, Pediatric Infectious Diseases Society
| | - Anne E Gill
- Children's Healthcare of Atlanta and Emory University, Atlanta, Georgia
| | - Terry L Levin
- The Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York; Chair ACR Pediatric Practice Parameters
| | - Michael M Moore
- Co-director, Division of Radiology Innovation and Value Enhancement (DRIVE), Penn State Health Children's Hospital, Hershey, Pennsylvania
| | - Helen R Nadel
- Lucile Packard Children's Hospital at Stanford, Stanford, California; Member Committee on Practice Parameters-Pediatric ACR; and Alternate to Senate Stanford University School of Medicine
| | - Mohsen Saidinejad
- UCLA Medical Center, Los Angeles, California; American College of Emergency Physicians; and Director, Institute for Health Services and Outcomes Research-The Lundquist Institute for Biomedical Innovation at Harbor UCLA
| | | | - Judy H Squires
- Chief of Ultrasound; Associate Program Director for Diagnostic Radiology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - David W Swenson
- Alpert Medical School of Brown University, Providence, Rhode Island
| | - Cynthia K Rigsby
- Specialty Chair, Department of Medical Imaging, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
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Qing-Qi R, Ya-Wen L, Huan C, Yu Z, Yun-Fei A, Xue-Mei T, Xiao-Dong Z, Zhi-Yong Z. Retrospective study of 98 patients with X-linked agammaglobulinemia complicated with arthritis. Clin Rheumatol 2022; 41:1889-1897. [PMID: 35171366 DOI: 10.1007/s10067-022-06095-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 01/19/2022] [Accepted: 01/30/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE We preformed this retrospective study of clinical manifestation, imaging feature, and mutations to describe joint involvement in X-linked agammaglobulinemia (XLA) patients, aimed to provide recommendation for physicians. METHODS A total number of 98 XLA patients who have been diagnosed between January 2000 and February 2020 were enrolled and grouped based on whether they developed arthritis and analyzed for the clinical, imaging, and gene mutation data using the t test or the Mann-Whitney test. RESULTS Forty-five out of 98 patients (45.9%) had joint involvement, 40.8% had symptom prior to the diagnosis of XLA, and 54.1% had no articular symptom. Patients with joint involvement had a higher median diagnostic age of XLA and initial IgG level than patients without it, while their intravenous immunoglobulin was lower (p < 0.05). Knee, hip, and ankle were the most frequent joint, and oligoarthritis (≦ 4 joints) was more common than polyarthritis (88.9% vs 11.1%). Red and tenderness were the most frequent clinical symptoms (80%) with 24.4% reporting limited activity and 8.9% reporting deformity. Imaging data collected from 32 patients indicated that joint effusion (53.3%), synovitis (15.5%), and swollen soft tissue (15.5%) were the most common feature. Seventeen patients were treated by antibiotics plus intravenous immunoglobulin (IVIG) with an effective rate of 70.6%, and 28 patients only received IVIG with an effective rate of 67.9%. In comparison to patients without arthritis who have higher frequency nonsense and frameshift mutation, patients with arthritis had a higher incidence of missense mutation (p < 0.05). CONCLUSION High prevalence of arthritis among X-linked agammaglobulinemia patients and subsequent progression through IVIG replacement therapy highlight the importance of timely diagnosis and better management of these patients. Our finding indicated a potential correlation between genotype and phenotype, and further research on the mechanism of arthritis in XLA patients could increase physicians' awareness and improve patients' prognosis. Key Points • This study described the feature of arthritis in XLA patients and indicated a potential correlation between this complication and genotype.
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Affiliation(s)
- Ran Qing-Qi
- Department of Rheumatology and Immunology, Children's Hospital of Chongqing Medical University, Chongqing, 400015, China
| | - Li Ya-Wen
- Department of Rheumatology and Immunology, Children's Hospital of Chongqing Medical University, Chongqing, 400015, China
| | - Chen Huan
- Department of Rheumatology and Immunology, Children's Hospital of Chongqing Medical University, Chongqing, 400015, China
| | - Zhang Yu
- Department of Rheumatology and Immunology, Children's Hospital of Chongqing Medical University, Chongqing, 400015, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, 40015, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, 40015, China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, 40015, China.,Chongqing Key Laboratory of Child Infection and Immunity, Chongqing, 40015, China
| | - An Yun-Fei
- Department of Rheumatology and Immunology, Children's Hospital of Chongqing Medical University, Chongqing, 400015, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, 40015, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, 40015, China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, 40015, China.,Chongqing Key Laboratory of Child Infection and Immunity, Chongqing, 40015, China
| | - Tang Xue-Mei
- Department of Rheumatology and Immunology, Children's Hospital of Chongqing Medical University, Chongqing, 400015, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, 40015, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, 40015, China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, 40015, China.,Chongqing Key Laboratory of Child Infection and Immunity, Chongqing, 40015, China
| | - Zhao Xiao-Dong
- National Clinical Research Center for Child Health and Disorders, Chongqing, 40015, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, 40015, China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, 40015, China.,Chongqing Key Laboratory of Child Infection and Immunity, Chongqing, 40015, China.,The Second Affiliated Hospital, Chongqing Medical University, Chongqing, 400010, China
| | - Zhang Zhi-Yong
- Department of Rheumatology and Immunology, Children's Hospital of Chongqing Medical University, Chongqing, 400015, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, 40015, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, 40015, China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, 40015, China.,Chongqing Key Laboratory of Child Infection and Immunity, Chongqing, 40015, China
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El-Sobky T, Mahmoud S. Acute osteoarticular infections in children are frequently forgotten multidiscipline emergencies: beyond the technical skills. EFORT Open Rev 2021; 6:584-592. [PMID: 34377550 PMCID: PMC8335954 DOI: 10.1302/2058-5241.6.200155] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Acute osteoarticular infections (AOI) should be treated as top emergencies. The first few days following the inception of infection are ultra-critical to long-term prognosis.A comprehensive road map for management of childhood AOI is still lacking despite recent advances in microbiology and imaging (magnetic resonance imaging). The many faces of childhood AOI warrant a multidiscipline approach to management.Laboratory and imaging findings of are still debatable and should not overshadow or delay a management plan based on the experienced physician's clinical judgment.Ample evidence-based practice supports the use of a few days of intravenous antibiotic administration followed by oral therapy until correlative clinical and basic laboratory (acute phase reactants) results improve.The growing body of evidence on 'high-risk' children/neonates of AOI warrants continual clinical extra-vigilance in identifying these patient subsets.Open drainage and debridement remain the mainstay of treatment of septic hips, whereas for other joints the use of alternative surgical techniques should be individualized or on case-by-case basis.Because the consequences of misdiagnosis of AOI are usually grave and permanent, proactive treatment/overtreatment is justified in the event of unconfirmed but suspicious diagnosis. Cite this article: EFORT Open Rev 2021;6:584-592. DOI: 10.1302/2058-5241.6.200155.
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Affiliation(s)
- Tamer El-Sobky
- Division of Paediatric Orthopaedics, Department of Orthopaedic Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Shady Mahmoud
- Division of Paediatric Orthopaedics, Department of Orthopaedic Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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12
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Kandemirli SG, Cicek F, Erdemli Gursel B, Bilgin C, Kilic SS, Yazici Z. Superb Microvascular Imaging in Assessment of Synovitis and Tenosynovitis in Juvenile Idiopathic Arthritis. Ultrasound Q 2021; 37:56-62. [PMID: 33661799 DOI: 10.1097/ruq.0000000000000516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
ABSTRACT The aim of this study is to evaluate the diagnostic utility of superb microvascular imaging (SMI) in assessment of synovitis/tenosynovitis in juvenile idiopathic arthritis in comparison to power Doppler ultrasound. Thirty juvenile idiopathic arthritis cases with active clinical findings and ultrasound features of effusion and/or tenosynovitis were further imaged with power Doppler and SMI. For classification of synovial inflammation, a semiquantitative scale (4 points) adopted by Outcome Measures in Rheumatology was used.A total of 35 knee, 2 hip, 2 ankle, 2 wrist, 2 elbow joints, and 6 flexor hallucis longus/tibialis posterior tenosynovitis were assessed. In knee joint, power Doppler and SMI scales were the same for 23 (65.7%) joints, SMI upgraded scale from 0 to 2 in single joint (2.9%); 1 to 2 (14.3%) in 5 joints; and 2 to 3 (17.1%) in 6 joints. For other joints, power Doppler and SMI scales were the same for 5 (62.5%) joints. Superb microvascular imaging upgraded scale from 1 to 2 (25%) in 2 joints and 1 to 3 (12.5%) in a single joint. For flexor hallucis longus/tibialis posterior tenosynovitis, power Doppler and SMI scales were the same for two cases (33.3%). Superb microvascular imaging upgraded scale from 0 to 2 in two cases (33.3%); and 2 to 3 (33.3%) in 2 cases. There was no case of SMI scale downgraded compared with power Doppler scale.Superb microvascular imaging is a feasible technique in the assessment of synovial inflammation and tenosynovitis in juvenile idiopathic arthritis. Superb microvascular imaging has higher sensitivity compared with power Doppler ultrasound in depiction of increased vascularity.
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Affiliation(s)
| | - Fatih Cicek
- Department of Pediatrics, Uludag University Faculty of Medicine, Bursa, Turkey
| | | | | | - Sara Sebnem Kilic
- Department of Pediatrics, Uludag University Faculty of Medicine, Bursa, Turkey
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Evaluation of suspected musculoskeletal infection in children over 2 years of age using only fluid-sensitive sequences at MRI. Eur Radiol 2019; 29:5682-5690. [DOI: 10.1007/s00330-019-06143-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 02/09/2019] [Accepted: 03/08/2019] [Indexed: 12/17/2022]
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Bartoloni A, Aparisi Gómez MP, Cirillo M, Allen G, Battista G, Guglielmi G, Tomà P, Bazzocchi A. Imaging of the limping child. Eur J Radiol 2018; 109:155-170. [PMID: 30527299 DOI: 10.1016/j.ejrad.2018.10.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 09/28/2018] [Accepted: 10/20/2018] [Indexed: 01/09/2023]
Abstract
Limping is a challenging symptom in the pediatric patient as the diagnosis can range from traumatic, malformative, infectious/inflammatory and neoplastic diseases. In this paper, we propose a schematic imaging algorithm to the limping child in three different age groups (Toddler: 1-3years, child: 4-10 years; adolescent: 11-16 years) based on presence of signs of infection, any specific localization of pain, and history of trauma. In this setting, the most common imaging pitfalls are also summarised. Finally, a literature review of the main differential causes of limping in the pediatric patient is reported.
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Affiliation(s)
- Alessandra Bartoloni
- Department of Imaging, IRCCS Bambino Gesù Children's Hospital, Piazza Sant' Onofrio 4, 00165 Roma, Italy
| | - Maria Pilar Aparisi Gómez
- Department of Radiology, Auckland City Hospital, 2 Park Road, Grafton, 1023 Auckland, New Zealand; Department of Radiology, Hospital Nueve de Octubre, Calle Valle de la Ballestera, 59, 46015 Valencia, Spain
| | - Marco Cirillo
- Department of Imaging, IRCCS Bambino Gesù Children's Hospital, Piazza Sant' Onofrio 4, 00165 Roma, Italy
| | - Georgina Allen
- Department of Radiology, St Lukes Radiology Oxford Ltd, Oxford, UK
| | - Giuseppe Battista
- Department of Specialized, Diagnostic, and Experimental Medicine, University of Bologna, Sant'Orsola-Malpighi Hospital, Via Massarenti 9, 40138 Bologna, Italy
| | - Giuseppe Guglielmi
- Department of Radiology, University of Foggia, Viale Luigi Pinto 1, 71100 Foggia, Italy; Department of Radiology, Scientific Institute "Casa Sollievo della Sofferenza" Hospital, Viale Cappuccini 1, 71013 San Giovanni Rotondo, Foggia, Italy
| | - Paolo Tomà
- Department of Imaging, IRCCS Bambino Gesù Children's Hospital, Piazza Sant' Onofrio 4, 00165 Roma, Italy
| | - Alberto Bazzocchi
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Via G. C. Pupilli 1, 40136 Bologna, Italy.
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Nguyen JC, Rebsamen SL, Tuite MJ, Davis JM, Rosas HG. Imaging of Kingella kingae musculoskeletal infections in children: a series of 5 cases. Emerg Radiol 2018; 25:615-620. [PMID: 29909593 DOI: 10.1007/s10140-018-1617-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 06/08/2018] [Indexed: 02/06/2023]
Abstract
PURPOSE Kingella kingae musculoskeletal infections continue to be under-diagnosed and there remains a paucity of literature on its imaging features. The purpose of this manuscript is to review the imaging, clinical, and laboratory findings of microbiology-proven K. kingae infections. MATERIALS AND METHODS A retrospective review of musculoskeletal infections between January 1, 2013 and Dec 31, 2016 yielded 134 patients from whom 5 patients had confirmed K. kingae infections (3 boys and 2 girls, mean age of 16 months, range 9-38 months). Picture archiving and communication system and electronic medical records were reviewed. RESULTS At presentation, none of the patients had a fever and not all patients had abnormal inflammatory markers. Three patients had septic arthritis (2 knee and 1 sternomanubrial joints), one had epiphyseal osteomyelitis, and one had lumbar spondylodiscitis. The case of epiphyseal osteomyelitis of the distal humerus also had elbow joint involvement. A combination of radiography (n = 4), ultrasound (n = 2), and magnetic resonance (MR) imaging (n = 5) were performed. Prominent synovial thickening was observed for both knee and elbow joints and extensive regional myositis for all except for the patient with sternomanubrial joint infection. The diagnosis of K. kingae infection resulted in a change in the antibiotic regimen in 80% of the patients. CONCLUSION Disproportionate synovial thickening, prominent peri-articular myositis, and/or characteristic sites of involvement demonstrating imaging features of infection or inflammation in a young child with mild infectious symptoms and elevated inflammatory markers should invoke the possibility of an underlying K. kingae infection.
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Affiliation(s)
- Jie C Nguyen
- Department of Radiology, 3NW39, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA.
| | - Susan L Rebsamen
- Department of Radiology, CSC, MC 3252, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI, 53792-3252, USA
| | - Michael J Tuite
- Department of Radiology, CSC, MC 3252, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI, 53792-3252, USA
| | - J Muse Davis
- Department of Infectious Diseases, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI, 53792-3252, USA
| | - Humberto G Rosas
- Department of Radiology, CSC, MC 3252, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI, 53792-3252, USA
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Nguyen JC, Markhardt BK, Merrow AC, Dwek JR. Imaging of Pediatric Growth Plate Disturbances. Radiographics 2018; 37:1791-1812. [PMID: 29019753 DOI: 10.1148/rg.2017170029] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The growth plates, or physes, are visible on virtually all images obtained in skeletally immature children. The proper function of these growth plates depends on an intricate balance between chondrocyte proliferation, which requires nourishment from the epiphyseal vessels, and chondrocyte death, which requires the integrity of the metaphyseal vessels. Therefore, injury to the growth plate (ie, direct insult) or vascular compromise on either side of the growth plate (ie, indirect insult) can cause growth plate dysfunction. Direct growth plate insults occur most commonly with Salter-Harris fractures, and injuries that allow the transphyseal communication of vessels are at a higher risk for subsequent transphyseal bone bridge formation. Indirect insults lead to different sequelae that are based on whether the epiphyseal blood supply or metaphyseal blood supply is compromised. Epiphyseal osteonecrosis can result in slowed longitudinal bone growth, with possible growth plate closure, and is often accompanied by an abnormal secondary ossification center. In contrast, the disruption of metaphyseal blood supply alters endochondral ossification and allows the persistence of chondrocytes within the metaphysis, which appear as focal or diffuse growth plate widening. Imaging remains critical for detecting acute injuries and identifying subsequent growth disturbances. Depending on the imaging findings and patient factors, these growth disturbances may be amenable to conservative or surgical treatment. Therefore, an understanding of the anatomy and physiologic features of the normal growth plate and the associated pathophysiologic conditions can increase diagnostic accuracy, enable radiologists to anticipate future growth disturbances, and ensure optimal imaging, with the ultimate goal of timely and appropriate intervention. ©RSNA, 2017.
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Affiliation(s)
- Jie C Nguyen
- From the Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (J.C.N., B.K.M.); Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (A.C.M.); and Department of Radiology, University of California at San Diego, Rady Children's Hospital and Health Center, San Diego, Calif (J.R.D.)
| | - B Keegan Markhardt
- From the Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (J.C.N., B.K.M.); Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (A.C.M.); and Department of Radiology, University of California at San Diego, Rady Children's Hospital and Health Center, San Diego, Calif (J.R.D.)
| | - Arnold C Merrow
- From the Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (J.C.N., B.K.M.); Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (A.C.M.); and Department of Radiology, University of California at San Diego, Rady Children's Hospital and Health Center, San Diego, Calif (J.R.D.)
| | - Jerry R Dwek
- From the Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (J.C.N., B.K.M.); Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (A.C.M.); and Department of Radiology, University of California at San Diego, Rady Children's Hospital and Health Center, San Diego, Calif (J.R.D.)
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