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Arthritis und Rheuma 2011; 31(03): 195-197
DOI: 10.1055/s-0037-1618064
Kinder-rheumatologie: Übersichtsbeitrag
Schattauer GmbH

Bildgebung in der Kinderrheumatologie

Das Konzept der silenten ArthritisImaging in pediatric rheumatologythe concept of silent arthritis
N. Tzaribachev
1   Dept. für Kinderrheumatologie, Klinikum Bad Bramstedt
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Publication History

Publication Date:
21 December 2017 (online)

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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

  • 1 Gesellschaft für Kinder- und Jugendrheumatologie. www.gkjr.de
    Google Scholar
  • 2 Petty RE, Southwood TR, Manners P. et al. International League of Associations for Rheumatology. International League of Associations for Rheumatology classification of juvenile idiopathic arthritis: second revision, Edmonton, 2001. J Rheumatol 2004; 31 (02) 390-392.
    Google Scholar
  • 3 Beukelman T. et al. Arthritis Care & Research. 2011; 63 (04) 465-482.
    PubMedGoogle Scholar
  • 4 Ringold S, Torgerson TR, Egbert MA, Wallace CA. Intraarticular corticosteroid injections of the temporomandibular joint in juvenile idiopathic arthritis. J Rheumatol 2008; 35: 1-6.
    Google Scholar
  • 5 Twilt M, Mobers SM, Arends LR. et al. Temporomandibular involvement in juvenile idiopathic arthritis. J Rheumatol 2004; 31 (07) 1418-1422.
    Google Scholar
  • 6 Arabshahi B, Dewitt EM, Cahill AM. et al. Utility of corticosteroid injection for temporomandibular arthritis in children with juvenile idiopathic arthritis. Arthritis Rheum 2005; 52 (11) 3563-3569.
    CrossrefPubMedGoogle Scholar
  • 7 Twilt M, Schulten AJ, Verschure F. et al. Long-term followup of temporomandibular joint involvement in juvenile idiopathic arthritis. Arthritis Rheum 2008; 59 (04) 546-552.
    CrossrefPubMedGoogle Scholar
  • 8 Weiss PF, Arabshahi B, Johnson A. et al. High prevalence of temporomandibular joint arthritis at disease onset in children with juvenile idiopathic arthritis, as detected by magnetic resonance imaging but not by ultrasound. Arthritis Rheum 2008; 58 (04) 1189-1196.
    CrossrefPubMedGoogle Scholar
  • 9 Müller L, Kellenberger CJ, Cannizzaro E. et al. Early diagnosis of temporomandibular joint involvement in juvenile idiopathic arthritis: a pilot study comparing clinical examination and ultrasound to magnetic resonance imaging. Rheumatology (Oxford) 2009; 48 (06) 680-685.
    CrossrefPubMedGoogle Scholar
  • 10 Küseler A, Pedersen TK, Gelineck J, Herlin T. A 2 year followup study of enhanced magnetic resonance imaging and clinical examination of the temporomandibular joint in children with juvenile idiopathic arthritis. J Rheumatol 2005; 32 (01) 162-169.
    Google Scholar
  • 11 Tzaribachev N, Weber D, Horger M. Juvenile idiopathische Arthritis – der leise Zerstörer kindlicher Kiefergelenke. Z Rheumatol 2010; 69: 124-129.
    CrossrefPubMedGoogle Scholar
  • 12 Saurenmann RK, Schroeder S, Müller L. et al. Efficacy of Intraarticular corticosteroid injection into the temporomandibular joint in children with juvenile idiopathic arthritis. EULAR 2009 SAT0521.
    PubMedGoogle Scholar
  • 13 Parra DA, Chan M, Krishnamurthy G. et al. Use and accuracy of US guidance for image-guided injections of the temporomandibular joints in children with arthritis. Pediatr Radiol 2010; 40 (09) 1498-1504.
    CrossrefPubMedGoogle Scholar
  • 14 Fritz J, Thomas C, Tzaribachev N. et al. MRI-guided injection procedures of the temporomandibular joints in children and adults: technique, accuracy, and safety. AJR Am J Roentgenol 2009; 193 (04) 1148-1154.
    CrossrefPubMedGoogle Scholar
  • 15 Fritz J, Pereira PL, Lewin JS. Temporomandibular joint injections: interventional MR imaging demonstrates anatomical landmark approach to be inaccurate when compared to direct visualization of the injectant. Pediatr Radiol 2010; 40 (12) 1964-1965.
    CrossrefPubMedGoogle Scholar
  • 16 Rooney ME, McAllister C, Burns JF. Ankle disease in juvenile idiopathic arthritis: ultrasound findings in clinically swollen ankles. J Rheumatol 2009; 36 (08) 1725-1729.
    CrossrefPubMedGoogle Scholar
  • 17 Pascoli L, Wright S, McAllister C, Rooney M. Prospective evaluation of clinical and ultrasound findings in ankle disease in juvenile idiopathic arthritis: importance of ankle ultrasound. J Rheumatol 2010; 37 (11) 2409-2414.
    CrossrefPubMedGoogle Scholar
  • 18 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.
    CrossrefPubMedGoogle Scholar
  • 19 Haslam KE, McCann LJ, Wyatt S, Wakefield RJ. The detection of subclinical synovitis by ultrasound in oligoarticular juvenile idiopathic arthritis: a pilot study. Rheumatology (Oxford) 2010; 49 (01) 123-127.
    CrossrefPubMedGoogle Scholar
  • 20 Rooney ME, McAllister C, Burns JF. Ankle disease in juvenile idiopathic arthritis: ultrasound findings in clinically swollen ankles. J Rheumatol 2009; 36 (08) 1725-1729.
    CrossrefPubMedGoogle Scholar
  • 21 Tzaribachev N. EULAR. 2011 OP0069.
    PubMedGoogle Scholar
  • 22 Magni-Manzoni S. ACR. 2011 .
    PubMedGoogle Scholar