Juvenile chronic arthritis: diagnosis and management of tibio-talar and sub-talar disease.
The aim of this study was to compare clinical evaluation of the site of hindfoot synovitis with contrast-enhanced magnetic resonance imaging (MRI) findings in children with juvenile chronic arthritis (JCA), and to evaluate the efficacy of selective guided intra-articular steroid injections. Thirteen symptomatic ankles of 11 consecutive JCA patients were examined clinically and with contrast-enhanced MRI. Pannus was demonstrated on MRI in both tibio-talar and sub-talar joints in 10 ankles, in the tibio-talar joint only in one ankle and in neither joint in two ankles. Correlation of clinical and MRI findings was good for the tibio-talar joint with concordance in 11/13 cases. Correlation was poor for the sub-talar joints. Of the 10 sub-talar joints shown to have pannus on MRI, only two were thought to have had definite clinical evidence of synovitis. Guided intra-articular steroid injection resulted in at least 6 months remission in 6/9 ankles compared with 1/10 ankles which had had previous unguided injections. We therefore recommend the use of image guidance for intra-articular triamcinolone hexacetonide injection in children with hindfoot synovitis.
Remedios
D
D
Department of Clinical Radiology, Northwick Park Hospital, Harrow, London.
Martin
K
K
Kaplan
G
G
Mitchell
R
R
Woo
P
P
Rooney
M
M
D000293:Adolescent; D000843:Ankle Joint / Q000187:drug effects / Q000473:pathology*; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D001171:Arthritis, Juvenile / Q000175:diagnosis* / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007270:Injections, Intra-Articular / Q000379:methods; D008279:Magnetic Resonance Imaging; D008297:Male; D013380:Subtalar Joint / Q000187:drug effects / Q000473:pathology*; D013585:Synovitis / Q000188:drug therapy / Q000473:pathology*; D014222:Triamcinolone Acetonide / Q000627:therapeutic use*
D000893:Anti-Inflammatory Agents; D014222:Triamcinolone Acetonide