Juvenile chronic arthritis: Imaging of the knees and hips before and after intraarticular steroid injection

Abstract

Intraarticular steroid therapy in juvenile chronic arthritis (JCA) is performed because of high local efficacy with few side effects. Imaging is used for initial evaluation and for monitoring of treatment response. The aim of this study was to compare imaging findings in diseased hips and knees before and after therapy. A prospective study was performed on 10 patients (15 joints) scheduled for intraarticular therapy. Pretherapeutic assessment included clinical work-up, radiographs, ultrasound (US), and magnetic resonance imaging (MRI) of affected joints. Following therapy, clinical and sonographic examinations were performed at 1 week and 1 month. MRI was repeated at 1 month. MRI and US demonstrated pannus formation and effusion, but differentiation was less distinct on US. Popliteal cysts and lymph nodes were visible in both modalities. MRI additionally revealed articular cartilage loss and subchondral cysts, not shown by US. Epiphyseal overgrowth and osteopenia were best seen radiographically. At present MRI is the best tool to assess the inflammatory changes of the joints in JCA. Initial staging of the joints may be done with plain films and MRI. US is useful to assess effusion and pannus and may be used to monitor treatment response.

Immunolocalization of lymphatic vessels in human fetal knee joint tissues

“…We have now shown that as in adult arthritic joints [3], developing human joints also have a prominent lymphatic network. It is recognized that cartilage degradation products are cleared by the lymphatic system in arthritis, and this can lead to autoantigen production and perpetuation of inflammatory arthritis in mice [10][11][12].…”

Lipoma arborescens: diagnóstico e imagem

“…É desencadeado por lesão e conseqüente reação inflamatória inespecí-fica da sinóvia, com infiltração moderada de células mononucleares e fibroblastos (8,11,12) . Não há relatos da presença de célu-las malignas nos tecidos gordurosos e sinovial de pacientes com LA (5,13) .…”

Role of musculoskeletal ultrasound in juvenile idiopathic arthritis

“…One study demonstrated a positive correlation between capsule distention of the hip as measured by MSK-US and increased intracapsular pressure and severe synovitis revealed on arthroscopy [34]. Another study using MRI and US to monitor the response of ten JCA patients to intra-articular steroid (IAS) injections of the knees and hips concluded that US was as sensitive as MRI in detecting pannus and/or effusion before IAS injection, although US distinction between the two entities was less clear compared with MRI [35]. El-Miedany et al compared x-ray, US and MRI findings in the knees of 38 patients with clinically active JIA and also in ten healthy control patients.…”