Bildgebung in der Kinderrheumatologie

Zusammenfassung

Die juvenile idiopathische Arthritis (JIA) ist die zweithäufigste entzündlich-rheumatische Gelenkerkrankung im Kindesalter. Basierend auf klinischen Kriterien werden oligo- und polyartikuläre Verläufe unterschieden, die unterschiedliche Therapieansätze in Bezug auf die Aggressivität der Behandlung haben. Unter Verwendung bildgebender Verfahren in Primärdiagnostik und Verlaufskontrollen der JIA können silente Arthritiden nachgewiesen werden, die sich dem klinischen Fassungsvermögen des (Kinder-)Rheumatologen entziehen. Dies gilt insbesondere auch für die häufig betroffenen Kiefergelenke, deren Inflammation in fast 50 Prozent der Fälle nur mittels Bildgebung sichtbar gemacht werden kann. Hinzu kommt noch eine mögliche silente Progression der Erkrankung, die sich den aktuell gültigen Remissionskriterien entzieht. In diesen Fällen kann das Fehlen von Symptomen zu einer Deeskalation der Therapie verleiten. Bleibende Gelenkschäden mit allen Auswirkungen auf das Outcome der Erkrankung bis ins Erwachsenenalter können die Folge sein. In dieser Übersichtsarbeit sollen die Möglichkeiten der bildgebenden Diagnostik ergänzend zur klinischen Untersuchung in der Kinderrheumatologie dargestellt werden.

Summary

Juvenile idiopathic arthritis (JIA) is a frequent cause for joint inflammation in children. Based upon clinical criteria, the disease is divided into oligo- and polyarticular JIA, which have different therapeutic approaches regarding aggressiveness of the treatment strategy. The application of imaging techniques for the primary diagnostics and follow-up examinations in JIA patients may discover silent arthritides, being inconceivable to the clinical examination comprehension of the (Pediatric) Rheumatologist so far. The latter is especially true for the frequent involvement of the temporomandibular joints, showing in up 50 % of the patients a symptomless inflammation on imaging. JIA may also have a silently progressive disease course, undetectable by only applying the current remission criteria, misleading to treatment de-escalation. In those cases the lack of symptoms may cause abiding joint damage, having a negative impact on the long-term outcome into adulthood. The scope of imaging as an additional tool next to the clinical examination will be presented in the following review.

Schlüsselwörter

Juvenile idiopathische Arthritis - MRT - Ultraschall

Keywords

Juvenile idiopathic arthritis - MRI - ultrasound

• Literatur

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