Juvenile Idiopathic Arthritis of the Axial Joints: A Systematic Review of the Diagnostic Accuracy and Predictive Value of Conventional MRI

Abstract

There is fair (grade B) evidence that MRI is an accurate diagnostic method for evaluating early and intermediate changes in the TMJ in JIA and insufficient evidence to indicate MRI is an accurate diagnostic method for detecting JIA in the spinal (grade I) and sacroiliac (grade I) joints.

Magnetic Resonance Imaging of Temporomandibular Joints of Children

“…15 However, for early and intermediate TMJ changes in JIA, there is only level II evidence that MRI is accurate for disease detection, with low observer agreement seen for individual MRI signs. 4 Moreover, there is a radiologic overlap in MRI findings between normal pediatric TMJs and TMJs of mild JIA. In this study, synovial enhancement, a finding typically associated with synovitis in JIA, was seen in more than half the non-arthritic TMJs.…”

“…2,3 Characteristic MRI findings indicating TMJ involvement are synovial hypertrophy, synovitis, and joint effusion. 4,5 Late changes include erosions, subchondral cyst formation, condylar volume loss, and abnormal disc morphology. 4,5 In contrast, MRI findings of the healthy pediatric TMJ are not well reported.…”

“…4,5 Late changes include erosions, subchondral cyst formation, condylar volume loss, and abnormal disc morphology. 4,5 In contrast, MRI findings of the healthy pediatric TMJ are not well reported. The purpose of this study was to describe the MRI findings of TMJs in healthy children and better elucidate the spectrum of normal and abnormal findings in an attempt to intervene at the most appropriate time for pathologic TMJs.…”

Clinical craniofacial examination of patients with juvenile idiopathic arthritis

“…Based on the current literature, MRI is considered the golden standard in detection of early TMJ arthritis in patients with JIA. 29 In contrast, routine MRI is of less clinical value in patients with TMJ arthritis-related signs and symptoms, since only a limited association is shown between orofacial symptoms and TMJ MRI findings. 20,[30][31][32][33] Supporting this, Arabshahi et al 31 found no association between clinical improvements in maximal mouth-opening capacity and resolution of MRI effusion at follow-up after TMJ arthritis treatment with intra-articular steroid injections.…”

Clinical and MRI outcome of cervical spine lesions in children with juvenile idiopathic arthritis treated with anti-TNFα drugs early in disease course

“…In general, MRI is the method of choice in evaluation of cervical spine arthritis and is most useful in detecting synovitis with hypertrophic, enhanced synovia and pannus formation, joint effusion, erosions, bone marrow edema and possible neural structure compressions [10, 11]. The diagnostic accuracy and predictive value of conventional MRI in JIA patients with axial joint involvement have been poorly investigated [12]. The role of MRI in detecting early changes in cervical spine in JIA was first evaluated in a Turkish study showing higher sensitivity of MRI compared to radiography for detection of erosions in children [13].…”