Juvenile spondyloarthropathies: clinical manifestations and medical imaging

Abstract

The spondyloarthropathies comprise four distinct entities--ankylosing spondylitis, psoriatic arthritis, the arthritis associated with inflammatory bowel disease, and Reiter's syndrome and other related forms of reactive arthritis. Although these are distinct diseases, they have a number of clinical, radiologic, and genetic characteristics in common which permit them to be classified under the unifying term "spondyloarthropathy". They are diseases of young adults, and when they present in patients under 16 years of age we refer to them as the "juvenile" spondyloarthropathies. They must be distinguished from juvenile rheumatoid arthritis, which is a totally separate entity; however the distinction may not always be obvious. Involvement of peripheral and sacroiliac joints commonly occurs in the juvenile spondyloarthropathies. The peripheral arthritis may be erosive and associated with bone apposition at the joint margins. Axial involvement is usually a late finding. Dactylitis and tenosynovitis are frequently present early on. Enthesitis, a highly specific feature, occurs much more often in the juvenile spondyloarthropathies than in the adult forms and it may be the only presenting feature. The plain radiograph is the primary and most important imaging modality for the assessment of these diseases. However, an expanding role of magnetic resonance imaging is evident.

MRI in Juvenile Idiopathic Arthritis and Juvenile Dermatomyositis

“…86 Work in adult ankylosing spondyloarthropathy 87,88 and psoriatic arthropathy 89 has recognized the importance of identifying enthesitis and extra-articular features on MRI in supporting the diagnosis and guiding therapy, 87 although Eshed et al used an example of enthesitis in a 15-year old boy with ERA, and showed that these features are found in children as well as adults. 92 Imaging uses different techniques, such as dynamic contrast-enhanced imaging and diffusion-weighted imaging, which may work better with the younger patient 87,90 No such work has been published on JIA, but clinicians recognize the importance of enthesitis as a justification for earlier introduction of anti-TNF or other biologics in place of traditional therapies such as methotrexate. 91 Dactilitis, along with inflammation of the joints and associated tendon sheaths giving a "sausage" toe/finger, is typical in PsA.…”

Magnetresonanztomographie bei Spondylarthropathien

“…Die plantare Fasziitis stellt sich in der T 1 -Sequenz in einer Verdickung der plantaren Faszie dar. In STIR-Sequenzen finden sich Signalvermehrungen innerhalb der Faszie [25]. Diese kann in eine Fibroostitis calcanea übergehen und zu Defektbildungen am Tuber calcanei am Insertionsort der Fascia plantaris und einer begleitenden Osteitis calcanea führen [26].…”

Evaluation of MR imaging guided steroid injection of the sacroiliac joints for the treatment of children with refractory enthesitis-related arthritis

“…Next to symptomatic relief, the prevention of joint destruction is a primary treatment goal that requires control of sacroiliac inflammation [1,3]. Widely available drug therapy may provide symptomatic relief, but may not result in a substantial reduction of inflammatory activity and joint destruction is thought to progress [4][5][6].…”

“…Uncontrolled inflammatory arthropathy of the juvenile sacroiliac joints is a hallmark feature of the enthesitisrelated arthritis, which can lead to early and irreversible joint damage [1,2].…”