Imaging assessment of children presenting with suspected or known juvenile idiopathic arthritis: ESSR-ESPR points to con
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PAEDIATRIC
Imaging assessment of children presenting with suspected or known juvenile idiopathic arthritis: ESSR-ESPR points to consider Robert Hemke 1 & Nele Herregods 2 & Jacob L. Jaremko 3 & Gunnar Åström 4 & Derk Avenarius 5 & Fabio Becce 6 & Dennis K. Bielecki 7 & Mikael Boesen 8 & Danoob Dalili 9 & Chiara Giraudo 10 & Kay-Geert Hermann 11 & Paul Humphries 12 & Amanda Isaac 13 & Anne Grethe Jurik 14 & Andrea S. Klauser 15 & Ola Kvist 16 & Frederiek Laloo 2 & Mario Maas 1 & Adam Mester 17 & Edwin Oei 18 & Amaka C. Offiah 19 & Patrick Omoumi 6 & Olympia Papakonstantinou 20 & Athena Plagou 21 & Susan Shelmerdine 12 & Paolo Simoni 22 & Iwona Sudoł-Szopińska 23 & Laura Tanturri de Horatio 24 & James Teh 25 & Lennart Jans 2 & Karen Rosendahl 5 Received: 20 November 2019 / Revised: 8 February 2020 / Accepted: 12 March 2020 # The Author(s) 2020
Abstract
Juvenile idiopathic arthritis (JIA) is the most common paediatric rheumatic disease. It represents a group of heterogenous inflammatory disorders with unknown origin and is a diagnosis of exclusion in which imaging plays an important role. JIA is defined as arthritis of one or more joints that begins before the age of 16 years, persists for more than 6 weeks and is of unknown aetiology and pathophysiology. The clinical goal is early suppression of inflammation to prevent irreversible joint damage which has shifted the emphasis from detecting established joint damage to proactively detecting inflammatory change. This drives the need for imaging techniques that are more sensitive than conventional radiography in the evaluation of inflammatory processes as well as early osteochondral change. Physical examination has limited reliability, even if performed by an experienced clinician, emphasising the importance of imaging to aid in clinical decision-making. On behalf of the European Society of Musculoskeletal Radiology (ESSR) arthritis subcommittee and the European Society of Paediatric Radiology (ESPR) musculoskeletal imaging taskforce, based on literature review and/or expert opinion, we discuss paediatric-specific imaging characteristics of the most commonly involved, in literature best documented and clinically important joints in JIA, namely the temporomandibular joints (TMJs), spine, sacroiliac (SI) joints, wrists, hips and knees, followed by a clinically applicable point to consider for each joint. We will also touch upon controversies in the current literature that remain to be resolved with ongoing research. Key Points
• Juvenile idiopathic arthritis (JIA) is the most common chronic paediatric rheumatic disease and, in JIA imaging, is increasingly important to aid in clinical decision-making. • Conventional radiographs have a lower sensitivity and specificity for detection of disease activity and early destructive change, as compared to MRI or ultrasound. Nonetheless, radiography remains important, particularly in narrowing the differential diagnosis and evaluating growth disturbances. • Mainly in peripheral joints, ultrasound can be helpful for assessment of i
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