Ankle Magnetic Resonance Imaging in Juvenile Idiopathic Arthritis Versus Non-Juvenile Idiopathic Arthritis Patients with Arthralgia

Abstract

This retrospective case–control study aimed to evaluate whether Magnetic Resonance Imaging (MRI) enables differentiation of ankle arthritis in Juvenile Idiopathic Afrthritis JIA from ankle arthralgia of unknown aetiology in patients clinically suspected of JIA. Forty-four children, at ages 5–16, who underwent MRI of the ankle from January 2016 to March 2021 for clinically suspected active ankle arthritis in the course of JIA were included. MRI findings in both groups—patients with the final diagnosis of JIA and without final diagnosis of JIA—were compared and scored. The sum of the scores of 22 ankle lesions in an individual patient (active, destructive and developmental), so-called the MRI summarized score, was calculated and tested in terms of the most optimal diagnosis of JIA. Interobserver agreement was calculated. Inflammatory features were seen on MRI in 38 out of all the included patients (86%). The most common lesions in both groups were effusion in the tibio-talar joint (68% in JIA and 64% in the arthralgia group) and effusion in subtalar joint (64% in JIA vs. 59% in the arthralgia group). In general, more lesions were identified in the JIA group than in non-JIA. However, only tenosynovitis was significantly more common in the JIA vs. non-JIA group (p = 0.031). The MRI summarized score did not allow for discrimination between ankle arthritis in JIA from non-JIA patients; the best levels of sensitivity (32%), specificity (91%), positive predictive value PPV (78%) and negative predictive value NPV (57%) were achieved only at the cut-off point of 10.

Evaluating the Diagnostic Performance of Systemic Immune-Inflammation Index in Childhood Inflammatory Arthritis: A Focus on Differentiating Juvenile Idiopathic Arthritis from Reactive Arthritis

“…In pediatric settings, the spectrum of potential arthritis diagnoses can be relatively broad, primarily including infectious and inflammatory causes and, to a lesser extent, oncological diseases [34][35][36][37]. With respect to inflammatory causes, distinguishing between JIA and other types of arthritis can prove to be a challenge, mainly because of the lack of specific antibodies in several JIA subtypes [35,38]. Over time, research has focused on investigating potential markers to assist clinicians in discriminating arthritis patients more accurately [13,39].…”

Magnetic resonance imaging of the musculoskeletal system in the diagnosis of rheumatic diseases in the pediatric population

“…Attempts have been made to create a similar MRI summarized score for the ankle that enables discrimination between ankle arthritis in JIA from non-JIA patients with clinically suspected arthritis. The findings of Ostrowska et al [ 48 ] confirm that MRI diagnosis of JIA remains a challenge, and with the exception of tendinitis, other MRI features are nonspecific for JIA, and thus the scoring system has proven inadequate.…”

Ankle and Foot: Focus on Inflammatory Disease

“…38 Ostrowska et al reported that MRI showed tenosynovitis was significantly more present in children diagnosed with JIA (p ¼ 0.031). 44 Tenosynovitis, which usually occurs in at least 50% of the patients, mainly affects the tibialis posterior, peroneus longus, and brevis. 44 Effusion and synovitis can be reliably distinguished on MRI only with gadolinium, but the potential harm caused by deposits in the brain is still unknown.…”

“…44 Tenosynovitis, which usually occurs in at least 50% of the patients, mainly affects the tibialis posterior, peroneus longus, and brevis. 44 Effusion and synovitis can be reliably distinguished on MRI only with gadolinium, but the potential harm caused by deposits in the brain is still unknown. Thus, Panwar et al suggested using the term "effusion/synovial thickening" that does not necessarily require the use of contrast.…”

“…45 Enthesitis is another feature frequently seen in EOA, PsA, and undifferentiated arthritis. 44 This mainly includes the insertion of the plantar fascia and the Achilles tendon. 46 Clinically, the Juvenile Arthritis Foot Disability Index was developed in Sweden to assess disability due to foot involvement and has demonstrated good reliability.…”