Download PDF
Semin Musculoskelet Radiol 2021; 25(01): 068-081
DOI: 10.1055/s-0041-1726014
Review Article

Conventional Radiography and Ultrasound Imaging of Rheumatic Diseases Affecting the Pediatric Population

Grzegorz Pracoń
1   Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
,
Maria Pilar Aparisi Gómez
2   Department of Radiology, Auckland City Hospital, Auckland, New Zealand
3   Department of Radiology, Hospital Vithas Nueve de Octubre, Valencia, Spain
,
Paolo Simoni
4   “Reine Fabiola” Children's University Hospital, Paediatric Imaging Department, Bruxelles, Belgium
,
Piotr Gietka
5   Clinics of Pediatric Rheumatology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
,
Iwona Sudoł-Szopińska
1   Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
› Author Affiliations
› Further Information
Also available at
    Permissions and Reprints

Abstract

Juvenile idiopathic arthritis is the most frequent rheumatic disease in the pediatric population, followed by systemic lupus erythematosus, juvenile scleroderma syndromes, juvenile dermatomyositis, chronic recurrent multifocal osteomyelitis, and juvenile vasculopathies. The imaging approach to inflammatory connective tissue diseases in childhood has not changed dramatically over the last decade, with radiographs still the leading method for bony pathology assessment, disease monitoring, and evaluation of growth disturbances. Ultrasonography is commonly used for early detection of alterations within the intra- and periarticular soft tissues, assessing their advancement and also disease monitoring. It offers several advantages in young patients including nonionizing radiation exposure, short examination time, and high resolution, allowing a detailed evaluation of the musculoskeletal system for the features of arthritis, tenosynovitis, enthesitis, bursitis, myositis, as well as pathologies of the skin, subdermis, vessels, and fasciae. In this pictorial essay we discuss radiographic and ultrasound inflammatory features of autoimmune pediatric inflammatory arthropathies: juvenile idiopathic arthritis, lupus erythematosus, juvenile scleroderma, juvenile dermatomyositis and polymyositis.

Keywords

juvenile idiopathic arthritis - systemic lupus erythematosus - juvenile scleroderma syndromes - juvenile dermatomyositis


Publication History

Article published online:
21 May 2021

© 2021. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Jurik AG, Klicman RF, Simoni P, Robinson P, Teh J. SAPHO and CRMO: the value of imaging. Semin Musculoskelet Radiol 2018; 22 (02) 207-224
    Thieme ConnectPubMedSearch in Google Scholar
  • 2 Sudoł-Szopińska I, Jacques T, Gietka P, Cotten A. Imaging in dermatomyositis in adults and children. J Ultrason 2020; 20 (80) e36-e42
    CrossrefPubMedSearch in Google Scholar
  • 3 Znajdek M, Gazda A, Gietka P, Wysmołek M, Sudoł-Szopińska I. Juvenile spondyloarthritis and chronic recurrent multifocal osteomyelitis overlap syndrome in a 16-year-old adolescent. A case report and literature review. J Ultrason 2019; 19 (77) 152-157
    CrossrefPubMedSearch in Google Scholar
  • 4 Sudoł-Szopińska I, Jans L, Jurik AG, Hemke R, Eshed I, Boutry N. Imaging features of the juvenile inflammatory arthropathies. Semin Musculoskelet Radiol 2018; 22 (02) 147-165
    Thieme ConnectPubMedSearch in Google Scholar
  • 5 Basra HAS, Humphries PD. Juvenile idiopathic arthritis: what is the utility of ultrasound?. Br J Radiol 2017; 90 (1073): 20160920
    CrossrefPubMedSearch in Google Scholar
  • 6 Ravelli A, Martini A. Juvenile idiopathic arthritis. Lancet 2007; 369 (9563): 767-778
    CrossrefPubMedSearch in Google Scholar
  • 7 Dalvi SR, Moser DW, Samuels J. Ultrasound and treatment algorithms of RA and JIA. Rheum Dis Clin North Am 2013; 39 (03) 669-688
    CrossrefPubMedSearch in Google Scholar
  • 8 Avenarius DFM, Nusman C, Malattia C. et al. Current status of wrist imaging in juvenile idiopathic arthritis. Pediatr Radiol 2018; 48 (06) 801-810
    CrossrefPubMedSearch in Google Scholar
  • 9 Barbuto L, Di Serafino M, Della Vecchia N. et al. Pediatric musculoskeletal ultrasound: a pictorial essay. J Ultrasound 2019; 22 (04) 491-502
    CrossrefPubMedSearch in Google Scholar
  • 10 Ravelli A, Ioseliani M, Norambuena X. et al. Adapted versions of the Sharp/van der Heijde score are reliable and valid for assessment of radiographic progression in juvenile idiopathic arthritis. Arthritis Rheum 2007; 56 (09) 3087-3095
    CrossrefPubMedSearch in Google Scholar
  • 11 Cellerini M, Salti S, Trapani S, D'Elia G, Falcini F, Villari N. Correlation between clinical and ultrasound assessment of the knee in children with mono-articular or pauci-articular juvenile rheumatoid arthritis. Pediatr Radiol 1999; 29 (02) 117-123
    CrossrefPubMedSearch in Google Scholar
  • 12 Sheybani EF, Khanna G, White AJ, Demertzis JL. Imaging of juvenile idiopathic arthritis: a multimodality approach. Radiographics 2013; 33 (05) 1253-1273
    CrossrefPubMedSearch in Google Scholar
  • 13 Magni-Manzoni S, Rossi F, Pistorio A. et al. Prognostic factors for radiographic progression, radiographic damage, and disability in juvenile idiopathic arthritis. Arthritis Rheum 2003; 48 (12) 3509-3517
    CrossrefPubMedSearch in Google Scholar
  • 14 Hemke R, Nusman CM, van der Heijde DM. et al. 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. Rheumatol Int 2015; 35 (02) 351-357
    CrossrefPubMedSearch in Google Scholar
  • 15 Kröger L, Piippo-Savolainen E, Tyrväinen E, Penttilä P, Kröger H. Osteochondral lesions in children with juvenile idiopathic arthritis. Pediatr Rheumatol Online J 2013; 11 (01) 18
    CrossrefPubMedSearch in Google Scholar
  • 16 Lang BA, Schneider R, Reilly BJ, Silverman ED, Laxer RM. Radiologic features of systemic onset juvenile rheumatoid arthritis. J Rheumatol 1995; 22 (01) 168-173
    PubMedSearch in Google Scholar
  • 17 Rossi F, Di Dia F, Galipò O. et al. Use of the Sharp and Larsen scoring methods in the assessment of radiographic progression in juvenile idiopathic arthritis. Arthritis Rheum 2006; 55 (05) 717-723
    CrossrefPubMedSearch in Google Scholar
  • 18 Ravelli A. The time has come to include assessment of radiographic progression in juvenile idiopathic arthritis clinical trials. J Rheumatol 2008; 35 (04) 553-557
    PubMedSearch in Google Scholar
  • 19 Burnham JM, Shults J, Weinstein R, Lewis JD, Leonard MB. Childhood onset arthritis is associated with an increased risk of fracture: a population based study using the General Practice Research Database. Ann Rheum Dis 2006; 65 (08) 1074-1079
    CrossrefPubMedSearch in Google Scholar
  • 20 Vicente G, Osman R. eds. Hand Bone Age: A Digital Atlas of Skeletal Maturity. Berlin, Germany: Springer; 2005
    Search in Google Scholar
  • 21 Saurenmann RK, Rose JB, Tyrrell P. et al. Epidemiology of juvenile idiopathic arthritis in a multiethnic cohort: ethnicity as a risk factor. Arthritis Rheum 2007; 56 (06) 1974-1984
    CrossrefPubMedSearch in Google Scholar
  • 22 Malattia C, Rinaldi M, Martini A. The role of imaging in juvenile idiopathic arthritis. Expert Rev Clin Immunol 2018; 14 (08) 681-694
    CrossrefPubMedSearch in Google Scholar
  • 23 Ostrowska M, Maśliński W, Prochorec-Sobieszek M, Nieciecki M, Sudoł-Szopińska I. Cartilage and bone damage in rheumatoid arthritis. Reumatologia 2018; 56 (02) 111-120
    CrossrefPubMedSearch in Google Scholar
  • 24 Sudoł-Szopińska I, Grochowska E, Gietka P. et al. Imaging of juvenile idiopathic arthritis. Part II: Ultrasonography and MRI. J Ultrason 2016; 16 (66) 237-251
    CrossrefPubMedSearch in Google Scholar
  • 25 Bruyn GA, Iagnocco A, Naredo E. et al; OMERACT Ultrasound Working Group. OMERACT definitions for ultrasonographic pathologies and elementary lesions of rheumatic disorders 15 years on. J Rheumatol 2019; 46 (10) 1388-1393
    CrossrefPubMedSearch in Google Scholar
  • 26 Smith MD. The normal synovium. Open Rheumatol J 2011; 5: 100-106
    CrossrefPubMedSearch in Google Scholar
  • 27 Brunner E, Ting T, Vega-Fernandez P. Musculoskeletal ultrasound in children: current state and future directions. Eur J Rheumatol 2020; 7 (Suppl. 01) S28-S37
    PubMedSearch in Google Scholar
  • 28 Sudoł-Szopińska I, Kwiatkowska B, Prochorec-Sobieszek M, Maśliński W. Enthesopathies and enthesitis. Part 1. Etiopathogenesis. J Ultrason 2015; 15 (60) 72-84
    CrossrefPubMedSearch in Google Scholar
  • 29 Sudoł-Szopińska I, Kwiatkowska B, Prochorec-Sobieszek M, Pracoń G, Walentowska-Janowicz M, Maśliński W. Enthesopathies and enthesitis. Part 2: Imaging studies. J Ultrason 2015; 15 (61) 196-207
    CrossrefPubMedSearch in Google Scholar
  • 30 Sudoł-Szopińska I, Kontny E, Zaniewicz-Kaniewska K, Prohorec-Sobieszek M, Saied F, Maśliński W. Role of inflammatory factors and adipose tissue in pathogenesis of rheumatoid arthritis and osteoarthritis. Part I: Rheumatoid adipose tissue. J Ultrason 2013; 13 (53) 192-201
    CrossrefPubMedSearch in Google Scholar
  • 31 Lanni S, Martini A, Malattia C. Heading toward a modern imaging approach in juvenile idiopathic arthritis. Curr Rheumatol Rep 2014; 16 (05) 416
    CrossrefPubMedSearch in Google Scholar
  • 32 Müller LS, Avenarius D, Damasio B. et al. The paediatric wrist revisited: redefining MR findings in healthy children. Ann Rheum Dis 2011; 70 (04) 605-610
    CrossrefPubMedSearch in Google Scholar
  • 33 Roth J, Jousse-Joulin S, Magni-Manzoni S. et al; Outcome Measures in Rheumatology Ultrasound Group. Definitions for the sonographic features of joints in healthy children. Arthritis Care Res (Hoboken) 2015; 67 (01) 136-142
    CrossrefPubMedSearch in Google Scholar
  • 34 Magni-Manzoni S, Epis O, Ravelli A. et al. Comparison of clinical versus ultrasound-determined synovitis in juvenile idiopathic arthritis. Arthritis Rheum 2009; 61 (11) 1497-1504
    CrossrefPubMedSearch in Google Scholar
  • 35 Ćwikła JB, Żbikowski P, Kwiatkowska B, Buscombe JR, Sudoł-Szopińska I. Radiosynovectomy in rheumatic diseases. J Ultrason 2014; 14 (58) 241-251
    CrossrefPubMedSearch in Google Scholar
  • 36 Laloo F, Herregods N, Jaremko JL, Verstraete K, Jans L. MRI of the sacroiliac joints in spondyloarthritis: the added value of intra-articular signal changes for a ‘positive MRI.’. Skeletal Radiol 2018; 47 (05) 683-693
    CrossrefPubMedSearch in Google Scholar
  • 37 Tucker LB, Menon S, Schaller JG, Isenberg DA. Adult- and childhood-onset systemic lupus erythematosus: a comparison of onset, clinical features, serology, and outcome. Br J Rheumatol 1995; 34 (09) 866-872
    CrossrefPubMedSearch in Google Scholar
  • 38 Levy DM, Kamphuis S. Systemic lupus erythematosus in children and adolescents. Pediatr Clin North Am 2012; 59 (02) 345-364
    CrossrefPubMedSearch in Google Scholar
  • 39 Brunner HI, Gladman DD, Ibañez D, Urowitz MD, Silverman ED. Difference in disease features between childhood-onset and adult-onset systemic lupus erythematosus. Arthritis Rheum 2008; 58 (02) 556-562
    CrossrefPubMedSearch in Google Scholar
  • 40 Hersh AO, von Scheven E, Yazdany J. et al. Differences in long-term disease activity and treatment of adult patients with childhood- and adult-onset systemic lupus erythematosus. Arthritis Rheum 2009; 61 (01) 13-20
    CrossrefPubMedSearch in Google Scholar
  • 41 Hoffman IE, Lauwerys BR, De Keyser F. et al. Juvenile-onset systemic lupus erythematosus: different clinical and serological pattern than adult-onset systemic lupus erythematosus. Ann Rheum Dis 2009; 68 (03) 412-415
    CrossrefPubMedSearch in Google Scholar
  • 42 das Chagas Medeiros MM, Bezerra MC, Braga FN. et al. Clinical and immunological aspects and outcome of a Brazilian cohort of 414 patients with systemic lupus erythematosus (SLE): comparison between childhood-onset, adult-onset, and late-onset SLE. Lupus 2016; 25 (04) 355-363
    CrossrefPubMedSearch in Google Scholar
  • 43 Lalani TA, Kanne JP, Hatfield GA, Chen P. Imaging findings in systemic lupus erythematosus. Radiographics 2004; 24 (04) 1069-1086
    CrossrefPubMedSearch in Google Scholar
  • 44 Hemke R, Herregods N, Jaremko JL. et al. Imaging assessment of children presenting with suspected or known juvenile idiopathic arthritis: ESSR-ESPR points to consider. Eur Radiol 2020; 30 (10) 5237-5249
    CrossrefPubMedSearch in Google Scholar
  • 45 Adrovic A, Şahin S, Barut K, Kasapçopur Ö. Juvenile scleroderma: a referral center experience. Arch Rheumatol 2018; 33 (03) 344-351
    CrossrefPubMedSearch in Google Scholar
  • 46 Osminina MK, Geppe NA, Shpitonkova OV. Articular involvement in juvenile localized scleroderma. MOJ Orthop Rheumatol 2018; 10 (02) 104-108
    PubMedSearch in Google Scholar
  • 47 Lo CY, Shyur SD, Chu SH. et al. Juvenile scleroderma: experience in one institution. Asian Pac J Allergy Immunol 2010; 28 (04) 279-286
    PubMedSearch in Google Scholar
  • 48 Adrovic A, Sahin S, Barut K, Kasapcopur O. Juvenile scleroderma—what has changed in the meantime?. Curr Rheumatol Rev 2018; 14 (03) 219-225
    CrossrefPubMedSearch in Google Scholar
  • 49 Zulian F, Culpo R, Sperotto F. et al. Consensus-based recommendations for the management of juvenile localised scleroderma. Ann Rheum Dis 2019; 78 (08) 1019-1024
    CrossrefPubMedSearch in Google Scholar
  • 50 Chapin R, Hant FN. Imaging of scleroderma. Rheum Dis Clin North Am 2013; 39 (03) 515-546
    CrossrefPubMedSearch in Google Scholar
  • 51 Marta I, Maria M, Emil M, Piotr G, Sudoł-Szopińska I. Ultrasonography, MRI and classic radiography of skin and MSK involvement in juvenile scleroderma. J Ultrason 2020; 20: e311-e317
    CrossrefPubMedSearch in Google Scholar
  • 52 Berko NS, Hay A, Sterba Y, Wahezi D, Levin TL. Efficacy of ultrasound elastography in detecting active myositis in children: can it replace MRI?. Pediatr Radiol 2015; 45 (10) 1522-1528
    CrossrefPubMedSearch in Google Scholar
  • 53 Davis WR, Halls JE, Offiah AC, Pilkington C, Owens CM, Rosendahl K. Assessment of active inflammation in juvenile dermatomyositis: a novel magnetic resonance imaging-based scoring system. Rheumatology (Oxford) 2011; 50 (12) 2237-2244
    CrossrefPubMedSearch in Google Scholar
  • 54 Leeuwenberg KE, Albayda J. Muscle ultrasound in inflammatory myopathies: a critical review. J Rheum Dis Treat 2019; 5: 69
    PubMedSearch in Google Scholar
  • 55 Bhansing KJ, Hoppenreijs EP, Janssen AJ. et al. Quantitative muscle ultrasound: a potential tool for assessment of disease activity in juvenile dermatomyositis. Scand J Rheumatol 2014; 43 (04) 339-341
    CrossrefPubMedSearch in Google Scholar
  • 56 Habers GE, Van Brussel M, Bhansing KJ. et al. Quantitative muscle ultrasonography in the follow-up of juvenile dermatomyositis. Muscle Nerve 2015; 52 (04) 540-546
    CrossrefPubMedSearch in Google Scholar
  • 57 Collison CH, Sinal SH, Jorizzo JL, Walker FO, Monu JU, Snyder J. Juvenile dermatomyositis and polymyositis: a follow-up study of long-term sequelae. South Med J 1998; 91 (01) 17-22
    CrossrefPubMedSearch in Google Scholar
  • 58 Song Y, Lee S, Yoo DH, Jang KS, Bae J. Strain sonoelastography of inflammatory myopathies: comparison with clinical examination, magnetic resonance imaging and pathologic findings. Br J Radiol 2016; 89 (1065): 20160283
    CrossrefPubMedSearch in Google Scholar
  • 59 Bachasson D, Dubois GJR, Allenbach Y, Benveniste O, Hogrel JY. Muscle shear wave elastography in inclusion body myositis: feasibility, reliability and relationships with muscle impairments. Ultrasound Med Biol 2018; 44 (07) 1423-1432
    CrossrefPubMedSearch in Google Scholar
  • 60 Mlosek RK, Migda B, Migda M. High-frequency ultrasound in the 21st century. J Ultrason 2020; 20: e233-e241
    CrossrefPubMedSearch in Google Scholar