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Imaging assessment of children presenting with suspected or known juvenile idiopathic arthritis: ESSR-ESPR points to consider.

  • Hemke, Robert1
  • Herregods, Nele2
  • Jaremko, Jacob L3
  • Åström, Gunnar4
  • Avenarius, Derk5
  • Becce, Fabio6
  • Bielecki, Dennis K7
  • Boesen, Mikael8
  • Dalili, Danoob9
  • Giraudo, Chiara10
  • Hermann, Kay-Geert11
  • Humphries, Paul12
  • Isaac, Amanda13
  • Jurik, Anne Grethe14
  • Klauser, Andrea S15
  • Kvist, Ola16
  • Laloo, Frederiek2
  • Maas, Mario17
  • Mester, Adam18
  • Oei, Edwin19
  • And 11 more
  • 1 Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam Movement Sciences, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. [email protected] , (Netherlands)
  • 2 Department of Radiology and Medical Imaging, Ghent University Hospital, Ghent, Belgium. , (Belgium)
  • 3 Department of Radiology and Diagnostic Imaging, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada. , (Canada)
  • 4 Department of Radiology, Uppsala University, Uppsala, Sweden. , (Sweden)
  • 5 Department of Radiology, University Hospital of North Norway, Tromsø, Norway. , (Norway)
  • 6 Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, Lausanne, Switzerland. , (Switzerland)
  • 7 Department of Diagnostic Imaging, Kings College Hospital, London, UK.
  • 8 Department of Radiology, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark. , (Denmark)
  • 9 Department of Radiology, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK.
  • 10 Radiology Institute, Department of Medicine - DIMED, Padova University, Padua, Italy. , (Italy)
  • 11 Department of Radiology, University Hospital Charité, Berlin, Germany. , (Germany)
  • 12 Department of Radiology, Great Ormond Street Hospital, London, UK.
  • 13 Department of Radiology, Guy's & St Thomas Hospitals, London, UK.
  • 14 Department of Radiology, Aarhus University Hospital, Aarhus, Denmark. , (Denmark)
  • 15 Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria. , (Austria)
  • 16 Department of Paediatric Radiology, Karolinska University Hospital, Stockholm, Sweden. , (Sweden)
  • 17 Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam Movement Sciences, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. , (Netherlands)
  • 18 Department of Radiology, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary. , (Hungary)
  • 19 Department of Radiology and Nuclear Medicine, Erasmus University Medical Center (Erasmus MC), Rotterdam, The Netherlands. , (Netherlands)
  • 20 Academic Unit of Child Health, University of Sheffield, Western Bank, Sheffield, UK.
  • 21 Department of Radiology, "Attikon" Hospital, National University of Athens, Athens, Greece. , (Greece)
  • 22 Private Radiological Institution, Athens, Greece. , (Greece)
  • 23 Department of Radiology, Reine Fabiola Children's University Hospital of Bruxelles, University of Bruxelles, Brussels, Belgium. , (Belgium)
  • 24 Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation and Department of Medical Imaging, Medical University of Warsaw, Warsaw, Poland. , (Poland)
  • 25 Department of Diagnostic Imaging, Bambino Gesù Children's Hospital, Rome, Italy. , (Italy)
  • 26 Department of Radiology, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, UK.
Published Article
European Radiology
Publication Date
Oct 01, 2020
DOI: 10.1007/s00330-020-06807-8
PMID: 32399709


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 inflammation and guiding joint injections. In JIA, MRI is the most validated technique. MRI should be considered as the modality of choice to assess the axial skeleton or where the clinical presentation overlaps with JIA.

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