Joints In Juvenile Idiopathic Arthritis Research Articles

Time to Reconsider Management of the Temporomandibular Joint in Juvenile Idiopathic Arthritis

The temporomandibular joints are often affected by juvenile idiopathic arthritis, but few evidence-based management strategies exist. Intra-articular steroid injection (IASI) is a common intervention and is associated with pain reduction and improved mandibular function. Emerging evidence, however, suggests that IASI may actually impair rather than improve mandibular growth. It is therefore time to reconsider this practice.

Juvenile idiopathic arthritis: magnetic resonance imaging of the clinically unaffected knee

BackgroundSynovial thickening detected on magnetic resonance imaging (MRI) is present in a significant number of children with clinically inactive juvenile idiopathic arthritis (JIA).ObjectiveTo evaluate patient characteristics and disease activity parameters in a cohort of children with clinically inactive JIA, both with and without synovial thickening, in order to clarify the observed discrepancy between clinical and MRI assessments.Materials and methodsWe prospectively enrolled 52 clinically inactive JIA patients (median age 13.3 years, 63.5% girls) who underwent MRI of the knee as major target joint in JIA. Children were divided into two groups based on MRI outcome: group 1, with synovial thickening on MRI; and group 2, with no synovial thickening on MRI. We used the Juvenile Arthritis MRI Scoring system to evaluate synovial thickness. We compared patient characteristics and disease activity parameters between the groups.ResultsSynovial thickening on MRI was present in 18 clinically inactive patients (group 1, 34.6%). The age was significantly lower for the patients in group 1 (median 10.7 versus 14.4, P=0.008). No significant differences were observed in any of the other patient characteristics nor the disease activity parameters tested.ConclusionSynovial thickening on MRI was present in nearly 35% of the children with clinically inactive JIA. Children with synovial thickening on MRI were significantly younger than those without. This might indicate that younger patients are at risk of subclinical disease activity and under-treatment, although the exact clinical relevance of synovial thickening on MRI has not been determined.

Power Color Doppler and Spectral Doppler Ultrasonography to Evaluate Response to Intra-articular Steroid Injection in Knee Joints in Juvenile Idiopathic Arthritis.

To evaluate the role of ultrasonographic indices (Color Fraction and Resistive Index) in assessing the effect of intra-articular steroid (IAS) injection on synovial inflammation in knee joints of Juvenile Idiopathic Arthritis (JIA) patients and to determine the correlation between these ultrasonographic indices and clinical and laboratory parameters in JIA patients after IAS. Twenty seven patients of JIA and equal number of age and sex matched healthy controls were enrolled. Thirty six knee joints were injected with IAS. Duration of morning stiffness, swelling score, tenderness score, range of motion, visual analogue scale for pain, Physician global assessment of disease activity, Patient/Parent assessment of general well being, Juvenile Arthritis Disease Activity Score, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), synovial thickness, synovial effusion, Color fraction (CF) and Resistive index (RI) were measured at base line and at one and two months of follow-up. At baseline, a significant difference was found in ESR, CRP, CF and RI values between cases and controls. A significant decrease in various clinical, core set variables and ultrasonographic parameters was observed at each follow-up. Synovial thickness, synovial effusion and CF decreased by 51.78%, 64.67% and 49.35% respectively and range of motion and RI increased by 166% and 31.94% respectively at second follow-up. Both CF and RI showed a significant correlation with active joint count. Both CF and RI had a high inter and intra-class correlation. Power Color Doppler and Spectral Doppler ultrasonographic indices (CF and RI) may have a role in assessment of the response to IAS injection of inflamed knee joints.

MR Imaging of the Temporomandibular Joint in Juvenile Idiopathic Arthritis: Technique and Findings.

The term juvenile idiopathic arthritis (JIA) encompasses a group of arthritides of unknown cause that begin before 16 years of age and last for at least 6 weeks. Temporomandibular joint (TMJ) involvement has been described in up to 87% of children with JIA and has been associated with all JIA subtypes. TMJ involvement is difficult to detect clinically. In one study, 71% of JIA patients with active TMJ synovitis were asymptomatic and 63% had normal physical examination results. Moreover, the main growth center of the mandible is located in the condyle, separated from the joint space by only a thin layer of fibrocartilage. This makes mandibular growth vulnerable to arthritic changes, eventually resulting in facial asymmetry and retrognathia. Therefore, early detection and treatment of TMJ arthritis are paramount to preserving motility and preventing deformity. As clinical symptoms and physical examination results are not good markers of TMJ involvement, imaging plays a key role in diagnosis and treatment monitoring. Magnetic resonance imaging is the technique of choice for the study of TMJ arthritis. It has the advantages of displaying both soft tissue and bone, is the most sensitive technique for detecting acute synovitis, and is the only one able to demonstrate bone marrow edema. In addition, it allows the assessment of changes to the joint over time and evaluation of the effectiveness of therapeutic interventions. ©RSNA, 2017.

Delineating the Application of Ultrasound in Detecting Synovial Abnormalities of the Subtalar Joint in Juvenile Idiopathic Arthritis.

To investigate the frequency of ultrasound (US)-detectable involvement of the subtalar joint (STJ), to compare clinical versus US assessment of the STJ, and to compare different scanning approaches to the STJ in juvenile idiopathic arthritis (JIA). Clinical and US assessments were performed independently in 50 ankles with clinically active JIA. US abnormalities of the STJ were investigated using a lateral, medial, and posterior scanning approach and scored semiquantitatively. Agreement was tested using kappa statistics. A control group of 10 healthy subjects was examined. Clinical and US evaluations detected synovitis in 24 of 50 (48.0%) and 27 of 50 (54.0%) of STJs, respectively. US detected synovitis in 10 of 26 STJs (38.5%) recorded as normal on clinical evaluation, but was negative in 7 of 24 STJs (29.2%) diagnosed as having involvement on clinical examination. Agreement between clinical and US assessments was fair (κ = 0.32). US abnormalities were more frequently detectable using the lateral scanning approach. All patients with US abnormalities in the medial and/or posterior side of the STJ had also US abnormalities on the lateral scanning approach, but the reverse was not true. Intra- and interobserver agreements for the lateral scanning approach were satisfactory for both detecting involvement and scoring US abnormalities. None of the 17 STJs of healthy controls showed US abnormalities. US may increase the precision of the evaluation of the STJ in JIA. The observed high frequency of STJ involvement on US suggests to include this joint in US scanning protocols devised for children with JIA. Synovitis is more frequently detected using the lateral scanning approach.

Leflunomide is associated with a higher flare rate compared to methotrexate in the treatment of chronic uveitis in juvenile idiopathic arthritis

Objectives: Chronic anterior uveitis is a serious complication of juvenile idiopathic arthritis (JIA); disease flares are highly associated with loss of vision. Leflunomide (LEF) is used successfully for JIA joint disease but its effectiveness in uveitis has not been determined. The aim of this study was to determine whether LEF improves flare rates of uveitis in JIA patients compared to preceding methotrexate (MTX) therapy.Method: A single-centre retrospective study of consecutive children with JIA and chronic anterior uveitis was performed. All children initially received MTX and were then switched to LEF. Demographic, clinical, and laboratory data, dose and duration of MTX and LEF therapy, concomitant medications and rate of anterior uveitis flares, as determined by an expert ophthalmologist, were obtained. Flare rates were compared using a generalized linear mixed model with a negative binomial distribution.Results: A total of 15 children were included (80% females, all antinuclear antibody positive). The median duration of MTX therapy was 51 (range 26–167) months; LEF was given for a median of 12 (range 4–47) months. Anti-tumour necrosis factor (anti-TNF-α) co-medication was given to four children while on MTX. By contrast, LEF was combined with anti-TNF-α treatment in six children. On MTX, JIA patients showed a uveitis flare rate of 0.0247 flares/month, while LEF treatment was associated with a significantly higher flare rate of 0.0607 flares/month (p = 0.008).Conclusions: Children with JIA had significantly more uveitis flares on LEF compared to MTX despite receiving anti-TNF-α co-medication more frequently. Therefore, LEF may need to be considered less effective in controlling chronic anterior uveitis.

The joints in juvenile idiopathic arthritis.

Juvenile idiopathic arthritis is the most common rheumatic entity in childhood. Imaging has become an important supplement to the clinical assessment of children with JIA. Radiographs still play an important role in the workup, and long-term follow-up in children with JIA, but are not sensitive to findings in the early disease stage. Both ultrasound and MRI are more sensitive to inflammatory changes than clinical assessment alone. However, the differentiation between normal findings and pathology can be challenging, particularly in early disease. The objective of this review is to discuss the role of imaging in JIA, describe the typical findings on different modalities and highlight the challenges we face regarding the reliability and accuracy of the different methods for imaging the joints in children with JIA.Key Points• Imaging is an important supplement to the clinical examination in JIA.• Ultrasound is more sensitive for detecting synovitis than clinical examination alone.• MRI can depict all relevant structures in joint inflammation.• The differentiation between normal variants and pathology is difficult in children.

Frequency of joint involvement in juvenile idiopathic arthritis during a 5-year follow-up of newly diagnosed patients: implications for MR imaging as outcome measure.

To assess the sequence and type of active joints in a cohort of newly diagnosed juvenile idiopathic arthritis (JIA) patients with full access to current treatment at first visit and during a follow-up period of 5-years, in order to identify an index joint/group of joints for magnetic resonance imaging in JIA. Patient charts of all consecutive newly diagnosed JIA patients with a follow-up duration of at least 5 years were analyzed. Patients were derived from two tertiary pediatric rheumatology centers. Patient characteristics and data concerning the presence of joints with arthritis and the use of medication were recorded. Findings from 95 JIA patients [39 (41 %) oligoarticular and 56 (59 %) polyarticular] were analyzed. At first visit, distribution of active joints among patients was as follows: knee (n = 70, 74 %), ankle (n = 55, 58 %), elbow (n = 23, 24 %), wrist (n = 23, 24 %), metacarpophalangeal (MCP) (n = 20, 21 %), proximal interphalangeal (PIP) (n = 13, 14 %), hip (n = 6, 6 %), shoulder (n = 5, 5 %), and distal interphalangeal (DIP) (n = 4, 4 %) joints. After a follow-up period of 5 years, the cumulative percentage of patients with specific joint involvement changed into: knee (n = 88, 93 %), ankle (n = 79, 83 %), elbow (n = 43, 45 %), wrist (n = 38, 40 %), MCP (n = 36, 38 %), PIP (n = 29, 31 %), shoulder (n = 20, 21 %), hip (n = 17, 19 %), and DIP (n = 9, 10 %) joints. Despite changes in treatment strategies over the years, the knee remains the most commonly involved joint at onset and during follow-up in JIA, followed by the ankle, elbow, and wrist. For the evaluation of outcome with MRI, the knee appears the most appropriate joint in JIA.

PReS-FINAL-2069: T cells secreting granulocyte-macrophage colony stimulating factor (GM-CSF) within the inflammed joint originate from an "EX-Th17" population

Since 2003, the established paradigm of T cell immunology has defined interleukin (IL)-17 as a dominant Th17 cell derived cytokine driving autoimmune disease. Recent murine studies have challenged this, identifying GM-CSF as a Th17 related cytokine necessary and sufficient for the induction of autoimmunity. The origin of GM-CSF+ T cells and their relationship with IL-17 secreting cells is unclear in human autoimmune disease. Trials of biologic agents targeting the GM-CSF pathway show promise in rheumatoid arthritis, so it is important to establish if GM-CSF contributes to the inflammatory environment of the arthritic joint in Juvenile Idiopathic Arthritis (JIA).

INDICES OF MATRIX METALLOPROTEINASES (MMP-2, MMP-9, TIMP-1) WITH JUVENILE ARTHRITIS IN CHILDREN

One of the perspectives of modern rheumatology is the study of matrix metalloproteinases (MMP) in juvenile arthritis--enzymes that play a key role in the process of joint destruction. To analyse the content of matrix MMP-2 and MMP-9 and their tissue inhibitor (TIMP-1) in blood serum and synovial fluid in various embodiments of juvenile arthritis in children. The study involved 82 children with juvenile arthritis, and 20 healthy children. The level of MMP-2, MMP-9 and TIMP-1 were determined in serum and synovial fluid by ELISA. It was found out that with any form of arthritis serum concentrations of MMP-2, MMP-9 and TIMP-1 was significantly higher than control values, but the level of MMP-2 in a subset of enthesitis-related arthritis, didn't differ from the control. Studied parameters in the synovial fluid were much higher than the serum level. With the development of uveitis TIMP-1 in blood serum was lower than in the absence of eye damage. On treatment of patients significant changes in the studied enzymes weren't established. On a good response to therapy the level of MMP-9 in serum decreased, on the lack of effectiveness - increased. The analysis results confirm the involvement of MMP-2, MMP-9 and TIMP-1 in the processes of inflammatory changes of the joints in juvenile idiopathic arthritis (JIA) and reactive arthritis, regardless the patients' sex or age.

SAT0452 Distribution Pattern of MRI Abnormalities Within the Knee and Wrist of Juvenile Idiopathic Arthritis Patients; MRI made Easy

BackgroundMRI plays an increasingly important role in the assessment and monitoring of disease activity in juvenile idiopathic arthritis (JIA). Awareness of the incidence and distribution pattern of MRI abnormalities in...

THU0318 A prospective comparative study of three methods of assessment of the knee joint in juvenile idiopathic arthritis: Clinical examination, ultrasound and MRI. (a newly developed knee mri scoring system)

BackgroundJuvenile Idiopathic Arthritis (JIA) is the main cause of chronic arthritis in children, and it can lead to joint damage and disability. Detecting early articular involvement in JIA is therefore...

AB0703 Temporomandibular joint involvement in children with juvenile idiopathic arthritis

BackgroundJuvenile idiopathic arthritis (JIA) is the most common autoimmune heterogenic diseases group of unknown etiology with7 subtypes. There are markedly high prevalence of temporomandibular joint (TMJ) involvement- 17 - 87%...

Evaluation of the association between Hispanic ethnicity and disease activity and severity in a large cohort of patients with juvenile idiopathic arthritis

To examine the association between ethnicity and disease activity in patients with juvenile idiopathic arthritis (JIA), and to determine the association of ethnicity with disease severity and disability in this population. CARRAnet, a US database containing information (collected between May 2010 and June 2011) on almost 3,000 subjects with JIA, was used. Demographic variables were compared between Hispanic patients and non-Hispanic patients. Mann-Whitney and chi-square tests were used to compare indicators of disease activity, as well as imaging evidence of joint damage, and Childhood Health Assessment Questionnaire (CHAQ) scores between ethnicities. Two linear regression models were used to determine the association of ethnicity with number of active joints in JIA, and the association between ethnicity and disability (CHAQ scores). A total of 2,704 patients with JIA (277 Hispanic; 2,427 non-Hispanic) were included. Income and health insurance coverage were higher in non-Hispanics. RF-positive polyarticular JIA, positive RF and anti-CCP, as well as use of systemic steroids were more frequent in Hispanics. Imaging evidence of joint damage was present in 32 % of the Hispanic patients compared to 24 % of the non-Hispanic patients (p = 0.008). In multivariate linear regression analyses, the number of active joints was significantly higher in Hispanics than in non-Hispanics (p = 0.03), as well as CHAQ scores (p = 0.003), after adjusting for confounders. Hispanic patients with JIA had higher disease activity than non-Hispanic patients, as well as higher disease severity and disability. Since ethnicity influences disease activity, severity, and disability, different management and treatment plans should be planned accordingly.

Coexpression of chemokine receptors CCR5, CXCR3, and CCR4 and ligands for P‐ and E‐selectin on T lymphocytes of patients with juvenile idiopathic arthritis

To investigate P- and E-selectin ligand coexpression with chemokine receptors (CKRs) on T cells in the synovial fluid (SF) and blood of children with juvenile idiopathic arthritis (JIA). Sixteen patients with polyarticular or persistent oligoarticular JIA (ages 5.3-15.1 years) were studied. SF and venous blood were collected, and immunostaining for the expression of CCR4, CCR5, CXCR3, and P- or E-selectin ligands was performed. Compared to blood, SF was greatly enriched for CD4+ T cells bearing CCR5, CCR4, CXCR3, and both P- and E-selectin ligand. Twenty-five percent of the CD4+ T cells in SF expressed both CCR5 and CCR4, some also coexpressing CXCR3. Such cells were rare in blood. Half of the few CCR5+ T cells in blood coexpressed P- or E-selectin ligand, a phenotype that was enriched up to 50-fold in SF. A minority of CCR4+ and CXCR3+ cells in blood (∼25%) coexpressed selectin ligand; these were enriched 4-8-fold in SF. Most CCR4-expressing CD4+ T cells expressed both E-selectin ligand and cutaneous lymphocyte antigen. CCR4-, CCR5-, CXCR3-, and selectin ligand-expressing CD4+ T cells preferentially accumulate in the joints of children with JIA. The marked enrichment of CCR5+ T cells coexpressing P-selectin and/or E-selectin ligand in CD4+ SF T cells suggests that the few such cells in blood selectively migrate to inflamed joints via endothelial P- and E-selectin- and CCR5-activating chemokines. The predominance of CCR4-expressing CD4+ T cells coexpressing E-selectin ligand suggests that such cells migrate not only to areas of cutaneous inflammation, as previously reported, but also to the joints in JIA. Combined targeting of CCR5- and E-selectin-dependent mechanisms may be a relevant treatment strategy.

Re: More about Scoliosis Imaging for Radiologists

HomeRadioGraphicsVol. 31, No. 4 Previous Letters to the EditorRe: More about Scoliosis Imaging for RadiologistsFerris M. Hall Ferris M. Hall Author AffiliationsDepartment of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA 02215e-mail: [email protected]Ferris M. Hall Published Online:Jul 8 2011https://doi.org/10.1148/Radiographics.31.4.105243MoreSectionsFull textPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In Reference1 Kim H, Kim HS, Moon ESet al.. Scoliosis imaging: what radiologists should know. RadioGraphics 2010;30(7):1823–1842. Link, Google ScholarArticle HistoryPublished online: July 8 2011Published in print: July 2011 FiguresReferencesRelatedDetailsCited ByCerebrospinal fluid velocity changes of idiopathic scoliosis: a preliminary study on 3-T PC-MRI and 3D-SPACE-VFAM dataO.Algin, U.Koc, N.Yalcin2022 | Child's Nervous System, Vol. 38, No. 2Recommended Articles Pelvic Evaluation in Thoracolumbar Corrective Spine Surgery: How I Do ItRadiology2016Volume: 278Issue: 3pp. 646-656Diffusion-weighted MRI Is Superior to PET/CT in Predicting Survival of Patients Undergoing 90Y Radioembolization of Hepatic MetastasesRadiology2018Volume: 288Issue: 3pp. 764-773Convolutional Neural Networks for Automatic Risser Stage AssessmentRadiology: Artificial Intelligence2020Volume: 2Issue: 3Can Dynamic MRI Depict Change in Thoracic Function after Operation for Thoracic Insufficiency Syndrome?Radiology2019Volume: 292Issue: 1pp. 214-215MR Imaging of the Temporomandibular Joint in Juvenile Idiopathic Arthritis: Technique and FindingsRadioGraphics2017Volume: 37Issue: 2pp. 595-612See More RSNA Education Exhibits 3D EOS: A New Way to Image Pediatric ScoliosisDigital Posters2019Screwed Aorta: Imaging and Diagnostic Pitfalls of Delaed Iatrogenic Aortic Injury Caused by a Thoracic Spince Pedicle Screws—Lessons LearnedDigital Posters2020Pre-Surgical Radiographic Evaluation of Adult Spinal Deformity: A Current ReviewDigital Posters2019 RSNA Case Collection Chiari 1 malformation RSNA Case Collection2020Poland SyndromeRSNA Case Collection2022Poland SyndromeRSNA Case Collection2020 Vol. 31, No. 4 Metrics Altmetric Score PDF download

Synovial fluid proteins differentiate between the subtypes of juvenile idiopathic arthritis

Juvenile idiopathic arthritis (JIA) is a heterogeneous group of inflammatory diseases, and no clinically useful prognostic markers to predict disease outcome in children with JIA are currently available. Synovial fluid likely reflects the proteins present in the inflamed synovium. The purpose of this study was to delineate the synovial fluid proteome and determine whether protein expression differs in the different subtypes of JIA. Synovial fluid samples obtained from children with oligoarticular JIA, polyarticular JIA, or systemic JIA were compared. Two-dimensional gel electrophoresis for protein separation and matrix-assisted laser desorption ionization-time-of-flight mass spectrometry and quadripole time-of-flight mass spectrometry for protein identification were used for this study. Synovial fluid cells were analyzed by polymerase chain reaction (PCR) for the presence of haptoglobin messenger RNA (mRNA). The synovial fluid proteome of the samples was delineated. The majority of proteins showed overexpression in JIA synovial fluid as compared with noninflammatory control samples. There were 24 statistically significantly differentially expressed spots (>2-fold change; P < 0.05) between the subtypes of JIA. PCR analysis revealed haptoglobin mRNA, suggesting that haptoglobin is locally produced in an inflamed joint in JIA. Despite the similar histologic appearance of inflamed joints in patients with different subtypes of JIA, there are differences in protein expression according to the subtype of JIA. Haptoglobin is differentially expressed between the subtypes of JIA and is locally produced in an inflamed joint in JIA. Haptoglobin and other differentially expressed proteins may be potential biomarkers in JIA.

Invited Commentary

Invited Commentary

The temporomandibular joint in juvenile idiopathic arthritis: frequently used and frequently arthritic

Recent recognition of the markedly high prevalence of temporomandibular joint (TMJ) arthritis in children with juvenile idiopathic arthritis (JIA) coupled with the significant morbidity associated with TMJ damage has prompted increased interest in both the clinical and pathological aspects of TMJ arthritis. This review focuses on the prevalence of TMJ arthritis in JIA, the imaging modalities used to detect TMJ arthritis, and the treatment of TMJ arthritis in children with JIA.

Evidence-Based Outcomes of Studies Addressing Diagnostic Accuracy of MRI of Juvenile Idiopathic Arthritis

Our objective was to semiquantitatively evaluate the diagnostic accuracy of MRI for evaluation of synovium and cartilage of peripheral joints in juvenile idiopathic arthritis (JIA) according to the levels of evidence and recommendations of the Canadian Task Force on Periodic Health Examination guidelines. Articles were screened using MEDLINE, EMBASE, DARE, and the Cochrane Library. Two independent reviewers assessed whether the currently available MRI techniques are accurate for diagnosis of synovial hypertrophy and cartilage degeneration in children with JIA. Overall, there is fair (grade B) strength of evidence that MRI is an accurate diagnostic method for evaluating synovium and cartilage and for assessing clinical responsiveness to treatment in peripheral joints in JIA.