Imaging approaches for evaluating peripheral joint abnormalities in juvenile idiopathic arthritis.
OBJECTIVE
To assess the usefulness of imaging studies for peripheral joint assessment in children with juvenile idiopathic arthritis (JIA), based on a systematic literature review.


METHODS
We used PubMed to identify relevant articles published between 2000 and 2011.


RESULTS
Plain radiography is still the reference imaging study for monitoring joint destruction in patients with JIA, and the results correlate well with the clinical findings. Radiographs should be obtained routinely during follow-up and in therapeutic trials. Available scoring methods have been validated in children, but no recommendations are available on the intervals between radiographic assessments. Ultrasonography and magnetic resonance imaging (MRI) can detect inflammatory changes that precede bone destruction. Ultrasonography features in JIA are still being studied. Ultrasonography can detect clinically silent synovitis, which has major implications for determining the JIA subtype. MRI is the only imaging study capable of showing bone marrow edema, which predicts joint destruction.


CONCLUSIONS
Although radiography remains the reference standard imaging study for assessing peripheral joint destruction in JIA, ultrasonography and MRI allow the early detection of predestructive changes, the presence of which affects treatment decisions. Much more work is needed to determine the optimal imaging protocols, the best interval between imaging evaluations during follow-up, and the therapeutic implications of imaging study findings.
Unit of Radiology and Laboratory of Medical Imaging Processing (LaTIM), Université de Bretagne Occidentale, Faculté de Médecine et des Sciences de la Santé, Brest, France.
Sylvain
S
Breton
Sandrine
S
Jousse-Joulin
Elisabeth
E
Finel
Thierry
T
Marhadour
Danielle
D
Colin
Loic
L
de Parscau
Valérie
V
Devauchelle-Pensec
D001171:Arthritis, Juvenile / Q000175:diagnosis*; D002648:Child; D003952:Diagnostic Imaging; D005260:Female; D006801:Humans; D007592:Joint Diseases / Q000175:diagnosis*; D007596:Joints / Q000473:pathology*; D008297:Male; D013585:Synovitis / Q000175:diagnosis