Conventional radiography in juvenile idiopathic arthritis: Joint recommendations from the French societies for rheumatology, radiology and paediatric rheumatology

Abstract

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.

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

“…Atlanto-axial diastases may be normal in paediatric patients; therefore, dynamic radiographic views must be interpreted with caution. Radiography is not sensitive for detecting early joint changes [55]. [32] Collado et al [33] Roth et al [34] Ording Muller et al [35] Avenarius et al [36] Hip NA Rohrschneider et al [37] Robben [38] NA Knee NA Collado et al [33] Roth et al [34] Keshava et al [39] Spannow et al [40] Hemke et al [41] Concerning the cervical joints, there are no published studies on the use of US in JIA.…”

“…Radiography remains important, particularly in narrowing the differential diagnosis and in establishing a baseline for follow-up. It can provide information on growth disturbances [55,86]. Because of the availability of more effective treatment options and the relatively large amount of epiphyseal cartilage in knees of growing children, bone erosions in knee joints in JIA patients are relatively rare.…”

“…Atlanto-axial diastases may be normal in paediatric patients; therefore, dynamic radiographic views must be interpreted with caution. Radiography is not sensitive for detecting early joint changes [ 55 ].…”

“…Wrist involvement in JIA occurs in about 25% of patients, increasing to 40% after 5 years of disease [ 69 ]. In JIA, early involvement of the wrist, distal small joint arthritis and a symmetric arthritis are poor prognostic factors [ 55 ]. Since early recognition and proper treatment can improve clinical outcome [ 70 ], imaging plays an important role in JIA patients with hand and wrist involvement.…”

“…The Poznanski index is a useful measure of late change [ 47 ]; particularly in younger children, bone damage can appear as squaring or deformity of the carpal bones and epiphyses rather than as true erosive change [ 71 ]. Conventional radiography is superior to MRI in this regard [ 55 , 72 ].…”