BackgroundJuvenile idiopathic arthritis (JIA) can cause structural damage. However, data on conventional radiography (CR) in JIA are scant.ObjectiveTo provide pragmatic guidelines on CR in each non-systemic JIA subtype.MethodsA multidisciplinary task force of 16 French experts (rheumatologists, paediatricians, radiologists and one patient representative) formulated research questions on CR assessments in each non-systemic JIA subtype. A systematic literature review was conducted to identify studies providing detailed information on structural joint damage. Recommendations, based on the evidence found, were evaluated using two Delphi rounds and a review by an independent committee.Results74 original articles were included. The task force developed four principles and 31 recommendations with grades ranging from B to D. The experts felt strongly that patients should be selected for CR based on the risk of structural damage, with routine CR of the hands and feet in rheumatoid factor-positive polyarticular JIA but not in oligoarticular non-extensive JIA.ConclusionThese first pragmatic recommendations on CR in JIA rely chiefly on expert opinion, given the dearth of scientific evidence. CR deserves to be viewed as a valuable tool in many situations in patients with JIA.Key Points• CR is a valuable imaging technique in selected indications.• CR is routinely recommended for peripheral joints, when damage risk is high.• CR is recommended according to the damage risk, depending on JIA subtype.• CR is not the first-line technique for imaging of the axial skeleton.Electronic supplementary materialThe online version of this article (10.1007/s00330-018-5304-7) contains supplementary material, which is available to authorized users.

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BackgroundJuvenile idiopathic arthritis (JIA) may lead to structural damage. Yet radiographic assessment is seldom considered in studies.ObjectivesTo provide pragmatic guidelines concerning conventional radiography (CR) in each subtype of JIA (exclusion of systemic JIA).MethodsA multidisciplinary task force of 15 French experts (rheumatologists, pediatricians, radiologists) plus one patient's representative, was convened. Following the GRADE1 method, they formulated a series of research questions concerning CR assessment, at diagnosis and follow-up of each subtype of JIA. Systemic JIA was ruled out. A systematic literature review was conducted, considering articles in which structural damage was detailed (erosion, joint space narrowing, bone deformities). A series of recommendations was elaborated, following evidence-based data, and expert opinion. It underwent an evaluation from an independant committee (including patient's representative), and a final round of Delphi-voting process from the whole expert group.ResultsOf 646 publications identified, 73 original articles were included. The task force produced 4 principles and 31 recommendations. Level of evidence ranked from B to D, level of agreement was high. The experts insisted on weighing indication of CR considering structural risk. The importance of assessing structural progression, the need for constant attention to radioprotection were asserted. Systematic CR of hands and feet are thus recommended in polyarthritis JIA rheumatoid factor positive, and in polyarticular JIA with pejorative prognostic factors. Systematic CR are not recommended in oligoarticular JIA. CR is not the prime imaging technique of the axial skeleton.ConclusionsThese are the first pragmatic recommendations upon CR in JIA. They mostly rely on experts' opinion, due to lack of evidence-based data. CR is still relevant in many situations in JIA, but should not be overlooked, while non-irradiating imagine techniques are developing.References Brożek JL, Akl EA, Compalati E, Kreis J, Terracciano L, Fiocchi A, et al. Grading quality of evidence and strength of recommendations in clinical practice guidelines part 3 of 3. The GRADE approach to developing recommendations. Allergy. 2011 May;66(5):588–95. AcknowledgementsDr Bouchra Amine, Pr Nathalie Boutry, Pr Rolando Cimaz, Pr Bernard Combe, Dr Véronique Despert, M William Fahy and Mrs Céline Obert (association KOURIR), Dr Laurence Goumy, Pr Michael Hofer, Dr Laëtitia Houx, Dr Sylvie Jean, Dr Valérie Merzoug, Pr Michel Panuel, Pr Samira Rostom, Pr Jean Sibilia; the French Society for Rheumatology, the French Society for Radiology, The French Society for Pediatric and antenatal Imaging.Disclosure of InterestNone declared

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