Differences in MRI findings between subgroups of recent-onset childhood arthritis

Abstract

BackgroundMRI is sensitive for joint inflammation, but its ability to separate subgroups of arthritis in children has been questioned. Infectious arthritis (IA), postinfectious arthritis (PA), transient arthritis (TA) and juvenile idiopathic arthritis (JIA) are subgroups that may need early, different treatment.ObjectiveTo determine whether MRI findings differ in IA, PA/TA and JIA in recent-onset childhood arthritis.Materials and methodsFifty-nine children from a prospective study of incidence of arthritis (n = 216) were, based on clinical and biochemical criteria, examined by MRI. Joint fluid, synovium, bone marrow, soft tissue and cartilage were scored retrospectively and analysed by Pearson chi-square test and logistic regression analysis.ResultsFifty-nine children had MRI of one station. IA was suggested by bone marrow oedema (OR 7.46, P = 0.011) and absence of T1-weighted and T2-weighted low signal intensity synovial tissue (OR 0.06, P = 0.015). Furthermore, soft-tissue oedema and reduced contrast enhancement in the epiphyses were more frequent in children with IA. JIA correlated positively with low signal intensity synovial tissue (OR 13.30, P < 0.001) and negatively with soft-tissue oedema (OR 0.20, P = 0.018). No significant positive determinants were found for PA/TA, but bone marrow oedema, soft-tissue oedema, irregular thickened synovium and low signal intensity synovial tissue was less frequent than in IA/JIA.ConclusionIn children with high clinical suspicion of recent onset arthritis, there was a significant difference in the distribution of specific MRI features among the diagnostic groups.

Contrast-enhanced MRI features in the early diagnosis of Juvenile Idiopathic Arthritis

“…In the current study, we showed that MRI might be helpful in aiding the differentiation JIA from other causes of knee pain/symptoms in clinically suspected non-infectious arthritis. Our results are in line with another study assessing differences in MRI findings between subgroups of recent-onset childhood arthritis [ 24 ], and supports the notion that physical examination could be supported by more sensitive tools such as MRI.…”

The rationale for early aggressive treatment in juvenile idiopathic arthritis

“…While osteopenia was the most common finding, joint space narrowing and erosions were also observed [22,23]. Other studies using MRI demonstrated irregular synovial thickening and low-intensity synovial tissue, not only in recent-onset JIA, but also in joints prior to the onset of clinical symptoms [24,25]. In addition, localized growth disturbances have been reported in 10-48% of children within the first 2-3 years after diagnosis [16,22].…”

Inflammatory Conditions of the Hip

“…Kirkhus et al found nonenhancing low signal intensity synovial tissue and irregular thickness of the synovium to be more frequent in JIA than in infectious arthritis. 24 Nistala et al found that the erythrocyte sedimentation rate (ESR) was predictive of active hip arthritis on MRI. 11 They showed that a highly elevated ESR is specific for hip inflammation, but that hip arthritis on MRI may be present with a normal ESR.…”