Juvenile idiopathic arthritis
Citation, DOI and article data
Juvenile idiopathic arthritis (JIA), also known as juvenile rheumatoid arthritis, is the most common chronic arthritic disease of childhood and corresponds to a group of different subtypes.
The estimated incidence is ~13 per 100,000 per annum 3. By definition, symptoms must start before 16 years of age. Females are more affected with F:M = 2:1.
Oligoarticular or polyarticular arthritis of a duration of six weeks or longer must be present to diagnose JIA.
Patients may present with an acute onset of symptoms or a more gradual onset. Symptoms are often worse in the morning but typically persist to some extent throughout the day.
In patients with systemic onset (also known as Still disease), intermittent spiking fevers are typically noted, which helps distinguish JIA from other diseases such as infection, other inflammatory diseases and malignancy. Migratory salmon colored light pink rash involving the trunk and/or extremities and hepatosplenomegaly are also frequently observed in patients with systemic onset.
A proportion of patients have serum rheumatoid factor 9.
There are several subtypes of JIA 7,8:
- affected ≤4 joints in the first six months of illness
- peak age: 1-6 years
- mainly affects medium and large joints
polyarticular JIA (pJIA)
- ≥5 joints are affected
- peak age: 1-4 years; 7-10 years
- mainly affects small and medium joints
systemic onset JIA (Still's disease, not to be confused with adult onset Still's disease)
- see above
- arthritis may present weeks to months after the onset of systemic symptoms
Imaging shows a varied spectrum of involvement, based on the severity and duration of the disease. There is usually a predilection for large joints rather than small joints.
Cervical spine radiographs may demonstrate:
- atlantoaxial subluxation
- odontoid erosions
- ankylosis, especially of the facet joints
Hips: can be common (reported range ~ 35-63% 15) especially with enthesitis-related arthritis and polyarticular subtypes 14
MRI may show synovial hypertrophy, joint effusions and rice bodies 10, as well as osseous and cartilaginous erosions. Active synovitis is characterized by enhancement on T1-weighted gadolinium contrast studies.
- 1. Sheybani EF, Khanna G, White AJ et-al. Imaging of juvenile idiopathic arthritis: a multimodality approach. Radiographics. 2013;33 (5): 1253-73. doi:10.1148/rg.335125178 - Pubmed citation
- 2. Resnick D. Diagnosis of bone and joint disorders. W.B. Saunders Company. ISBN:0721650686. Read it at Google Books - Find it at Amazon
- 3. Gylys-Morin VM, Graham TB, Blebea JS et-al. Knee in early juvenile rheumatoid arthritis: MR imaging findings. Radiology. 2001;220 (3): 696-706. doi:10.1148/radiol.2203000461 - Pubmed citation
- 4. Williams RA, Ansell BM. Radiological findings in seropositive juvenile chronic arthritis (juvenile rheumatoid arthritis) with particular reference to progression. Ann. Rheum. Dis. 1985;44 (10): 685-93. Free text at pubmed - Pubmed citation
- 5. Sofka CM, Bogner E. Imaging of juvenile rheumatoid arthritis. HSS J. 2008;4 (1): 71-3. doi:10.1007/s11420-007-9065-0 - Free text at pubmed - Pubmed citation
- 6. Doria AS, Kiss MH, Lotito AP et-al. Juvenile rheumatoid arthritis of the knee: evaluation with contrast-enhanced color Doppler ultrasound. Pediatr Radiol. 2001;31 (7): 524-31. Pubmed citation
- 7. Schwartz MW. The 5 Minute Pediatric Consult. LWW. ISBN:145111656X. Read it at Google Books - Find it at Amazon
- 8. Marcdante K, Kliegman RM. Nelson essentials of pediatrics. Saunders. ISBN:B00JBSPWVO. Read it at Google Books - Find it at Amazon
- 9. Ingegnoli F, Castelli R, Gualtierotti R. Rheumatoid factors: clinical applications. (2013) Disease markers. 35 (6): 727-34. doi:10.1155/2013/726598 - Pubmed
- 10. C Chung, B D Coley, L C Martin. Rice bodies in juvenile rheumatoid arthritis. (2013) AJR. American journal of roentgenology. 170 (3): 698-700. doi:10.2214/ajr.170.3.9490956 - Pubmed
- 11. Marteau P, Adamsbaum C, Rossi-Semerano L, De Bandt M, Lemelle I, Deslandre C, Tran TA, Lohse A, Solau-Gervais E, Sordet C, Pillet P, Bader-Meunier B, Wipff J, Gaujoux-Viala C, Breton S, Devauchelle-Pensec V. Conventional radiography in juvenile idiopathic arthritis: Joint recommendations from the French societies for rheumatology, radiology and paediatric rheumatology. (2018) European radiology. 28 (9): 3963-3976. doi:10.1007/s00330-018-5304-7 - Pubmed
- 12. Nusman CM, de Horatio LT, Hemke R, van Gulik EC, Ording Müller LS, Malattia C, Avenarius D, Toma P, Roth J, Tzaribachev N, Magni-Manzoni S, Maas M, Doria AS, Rosendahl K. Imaging in juvenile idiopathic arthritis - international initiatives and ongoing work. (2018) Pediatric radiology. 48 (6): 828-834. doi:10.1007/s00247-017-4054-z - Pubmed
- 13. Davidson J. Juvenile idiopathic arthritis: a clinical overview. (2000) European journal of radiology. 33 (2): 128-34. doi:10.1016/s0720-048x(99)00161-8 - Pubmed
- 14. Rostom S, Amine B, Bensabbah R, Abouqal R, Hajjaj-Hassouni N. Hip involvement in juvenile idiopathic arthritis. (2008) Clinical rheumatology. 27 (6): 791-4. doi:10.1007/s10067-008-0853-9 - Pubmed
- 15. Shelmerdine SC, Di Paolo PL, Tanturri de Horatio L, Malattia C, Magni-Manzoni S, Rosendahl K. Imaging of the hip in juvenile idiopathic arthritis. (2018) Pediatric radiology. 48 (6): 811-817. doi:10.1007/s00247-017-4022-7 - Pubmed
- 16. Sanaz Javadi, J. Herman Kan, Robert C. Orth, Marietta DeGuzman. Wrist and Ankle MRI of Patients With Juvenile Idiopathic Arthritis: Identification of Unsuspected Multicompartmental Tenosynovitis and Arthritis. (2014) American Journal of Roentgenology. doi:10.2214/AJR.13.10671