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