Commentary on "Inter- and intrareader variability in the interpretation of two radiographic classification systems for juvenile rheumatoid arthritis".

Abstract

Published online: 2 August 2003 Springer-Verlag 2003 In this issue of Pediatric Radiology there is an interesting article by Doria et al. [1], which discusses the difficulties of using conventional radiographs for the detection and monitoring of arthritic changes in the paediatric skeleton. Inadvertently, the authors have also highlighted the need for further discussion of nomenclature in childhood arthritis. Pediatric Radiology rightly prides itself on having a worldwide readership. Unfortunately, for radiologists with an interest in childhood arthritis who practice on opposite sides of the Atlantic, imaging of the same disease process is hampered by confusion of nomenclature and classification of their patients. In North America the American College of Rheumatology has formulated criteria to describe childhood arthritis under the term ’juvenile rheumatoid arthritis’ (JRA) [2]. The European League Against Rheumatism (EULAR) has alternative criteria which define childhood arthritides in Europe and use the term ’juvenile chronic arthritis’ (JCA) [3]. Importantly, these two classifications have slightly different subgrouping of the arthritides. In particular, JCA includes the spondyloarthropathies, psoriatic arthropathy and those arthropathies associated with inflammatory bowel disease; these subcategories are not included in JRA. In an effort to bring uniformity to the diagnosis, to aid research and to improve management protocols, the Paediatric Standing Committee of the International League of Associations for Rheumatism (ILAR) has tried to establish a new classification [4]. This new classification uses the label ’juvenile idiopathic arthritis’ (JIA). The term JIA indicates onset before 16 years of age of a disease characterised primarily by arthritis, persisting for at least 6 weeks and currently with no known cause. The different subcategories of JIA are systemic onset, polyarticular (rheumatoid factor positive and negative) oligoarthritis, psoriatic, enthesitis and other arthritides. While there still remains some controversy about the term JIA and further work is needed on disease classification, it is hoped this ’new disease’ will bring world-wide uniformity and improve patient management. While interesting to the radiologist, this new classification has not altered our understanding of the primary pathological process in childhood arthritis or the radiological features. In their study, Doria et al. [1] rightly comment that there is significant intraand interobserver variability when using a scoring system based on conventional radiographs. Other recent studies have also shown that conventional radiographs have a limited role in Pediatr Radiol (2003) 33: 671–672 DOI 10.1007/s00247-003-0957-y COMMENTARY