2
Imaging in the diagnosis and management of axial spondyloarthritis in children

https://doi.org/10.1016/j.berh.2020.101596Get rights and content

Abstract

Imaging is often used at the time of diagnosis to exclude conditions other than arthritis, to confirm the physical examination if equivocal, and to assess the degree of inflammation and baseline damage. Plain radiography is helpful in the evaluation of damage from chronic inflammation, while ultrasound and magnetic resonance imaging (MRI) are helpful in the assessment of early disease and active inflammation. Multiple studies have shown that tenderness on physical examination of the sacroiliac joint is often discordant with imaging results, so MRI is increasingly relied upon to assess for objective evidence of inflammation. There are no widely accepted, validated tools for the pediatric population using ultrasound or MRI assessment of the peripheral joints. Validated tools exist for objective assessment of pediatric hip disease on radiographs and axial disease on MRI, but not on other imaging modalities. The utility of these scoring systems in clinical care and clinical trials remains untested.

Section snippets

Clinical manifestations

Juvenile spondyloarthritis (JSpA) is a heterogeneous group of conditions, including enthesitis-related arthritis (ERA), psoriatic arthritis (PsA), inflammatory bowel disease-associated arthropathy, juvenile ankylosing spondylitis, and reactive arthritis. These conditions are manifested by a combination of peripheral arthritis, axial (sacroiliac or spine) arthritis, inflammation at tendon insertions on the bone (enthesitis), acute symptomatic eye inflammation, psoriasis, bowel inflammation, and

Evaluation of the peripheral skeleton

Radiographs are most helpful at presentation of JSpA to exclude other diagnoses that are being considered which may include infection, trauma, malignancy, chronic nonbacterial osteomyelitis, and avascular necrosis. Radiographs of the hips can be helpful diagnostically to also evaluate for Legg–Calve–Perthes disease, slipped capital femoral epiphyses, osteonecrosis of the femoral epiphyses from systemic disease, chondrolysis of the hip, and femoral acetabular impingement. If the diagnosis of

Summary

Imaging is helpful at diagnosis to exclude conditions other than arthritis, to confirm the physical examination if equivocal, and to assess the degree of inflammation and baseline damage. Radiography is helpful in the evaluation of chronic inflammation while ultrasound and MRI are helpful in the assessment of early disease and active inflammation. Signs of chronic joint inflammation on radiographs include joint space narrowing secondary to cartilage destruction, osteopenia, subchondral cystic

Funding

No funding.

Declaration of competing interest

Nancy has no conflicts of interest. Pamela has done consulting for Lilly and Pfizer.

References (67)

  • M.A. D'Agostino et al.

    Imaging evaluation of the entheses: ultrasonography, MRI, and scoring of evaluation

    Rheum Dis Clin N Am

    (2016)
  • W.P. Maksymowych

    Controversies in conventional radiography in spondyloarthritis

    Best Pract Res Clin Rheumatol

    (2012)
  • H.E. Daldrup-Link et al.

    MR imaging of pediatric arthritis

    Magn Reson Imag Clin N Am

    (2009)
  • S. Gmuca et al.

    Multicenter inception cohort of enthesitis-related arthritis: variation in disease characteristics and treatment approaches

    Arthritis Res Ther

    (2017)
  • P.F. Weiss et al.

    Detection of enthesitis in children with enthesitis-related arthritis: dolorimetry compared to ultrasonography

    Arthritis Rheum

    (2014)
  • S. Jousse-Joulin et al.

    Ultrasonography for detecting enthesitis in juvenile idiopathic arthritis

    Arthritis Care Res

    (2011)
  • M. Bollow et al.

    Use of contrast-enhanced MR imaging to detect sacroiliitis in children

    Skeletal Radiol

    (1998)
  • M.L. Stoll et al.

    Spondyloarthritis in a pediatric population: risk factors for sacroiliitis

    J Rheumatol

    (2010)
  • I. Pagnini et al.

    Early predictors of juvenile sacroiliitis in enthesitis-related arthritis

    J Rheumatol

    (2010)
  • P.F. Weiss et al.

    Sacroiliitis at diagnosis of juvenile spondyloarthritis assessed by radiography, magnetic resonance imaging, and clinical examination

    (2015)
  • C.M. Nusman et al.

    Imaging in juvenile idiopathic arthritis - international initiatives and ongoing work

    Pediatr Radiol

    (2018)
  • I. Sudol-Szopinska et al.

    Imaging of juvenile idiopathic arthritis. Part I: clinical classifications and radiographs

    J Ultrason

    (2016)
  • A.C. Brower

    Use of the radiograph to measure the course of rheumatoid arthritis. The gold standard versus fool's gold

    Arthritis Rheum

    (1990)
  • P. Mandl et al.

    EULAR recommendations for the use of imaging in the diagnosis and management of spondyloarthritis in clinical practice

    Ann Rheum Dis

    (2015)
  • N. Herregods et al.

    Diagnostic value of MRI features of sacroiliitis in juvenile spondyloarthritis

    Clin Radiol

    (2015)
  • P.F. Weiss et al.

    Detection of inflammatory sacroiliitis in children with magnetic resonance imaging: is gadolinium contrast enhancement necessary?

    Arthritis Rheum

    (2015)
  • I.F. Macrae et al.

    Grading of films for sacro-iliitis in population studies

    Ann Rheum Dis

    (1971)
  • P.F. Weiss et al.

    Radiographs in screening for sacroiliitis in children: what is the value?

    Arthritis Res Ther

    (2018)
  • E.W. St Clair et al.

    Combination of infliximab and methotrexate therapy for early rheumatoid arthritis: a randomized, controlled trial

    Arthritis Rheum

    (2004)
  • A. Ravelli et al.

    Adapted versions of the Sharp/van der Heijde score are reliable and valid for assessment of radiographic progression in juvenile idiopathic arthritis

    Arthritis Rheum

    (2007)
  • F. Rossi et al.

    Use of the Sharp and Larsen scoring methods in the assessment of radiographic progression in juvenile idiopathic arthritis

    Arthritis Rheum

    (2006)
  • M. Bertamino et al.

    Development and initial validation of a radiographic scoring system for the hip in juvenile idiopathic arthritis

    J Rheumatol

    (2010)
  • S.C. Shelmerdine et al.

    A novel radiographic scoring system for growth abnormalities and structural change in children with juvenile idiopathic arthritis of the hip

    Pediatr Radiol

    (2018)
  • H.S. Goie The et al.

    Evaluation of diagnostic criteria for ankylosing spondylitis: a comparison of the Rome, New York and modified New York criteria in patients with a positive clinical history screening test for ankylosing spondylitis

    Br J Rheumatol

    (1985)
  • N.A. Chauvin et al.

    Ultrasound imaging of synovial inflammation in juvenile idiopathic arthritis

    Pediatr Radiol

    (2017)
  • J. Roth et al.

    Preliminary definitions for the sonographic features of synovitis in children

    Arthritis Care Res

    (2017)
  • S. Magni-Manzoni et al.

    Advances and challenges in imaging in juvenile idiopathic arthritis

    Nat Rev Rheumatol

    (2012)
  • P. Collado et al.

    Amendment of the OMERACT ultrasound definitions of joints' features in healthy children when using the Doppler technique

    Pediatr Rheumatol Online J

    (2018)
  • T.V. Ting et al.

    Novel ultrasound image acquisition protocol and scoring system for the pediatric knee

    Arthritis Care Res

    (2019)
  • N.A. Chauvin et al.

    Ultrasound of the joints and entheses in healthy children

    Pediatr Radiol

    (2015)
  • L. Gossec et al.

    European League against Rheumatism (EULAR) recommendations for the management of psoriatic arthritis with pharmacological therapies: 2015 update

    Ann Rheum Dis

    (2016)
  • L. Gossec et al.

    Management of psoriatic arthritis in 2016: a comparison of EULAR and GRAPPA recommendations

    Nat Rev Rheumatol

    (2016)
  • R.J. Wakefield et al.

    Musculoskeletal ultrasound including definitions for ultrasonographic pathology

    J Rheumatol

    (2005)
  • Cited by (0)

    View full text