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Appropriateness Criteria

Reference Study Type Patients/Events Study Objective(Purpose of Study) Study Results Study Quality
1. Chauvin NA, Doria AS. Ultrasound imaging of synovial inflammation in juvenile idiopathic arthritis. [Review]. Pediatric Radiology. 47(9):1160-1170, 2017 Aug. Review/Other-Dx NA No objective stated in abstract. No results stated in abstract. 4
2. Basra HAS, Humphries PD. Juvenile idiopathic arthritis: what is the utility of ultrasound?. [Review]. British Journal of Radiology. 90(1073):20160920, 2017 May. Review/Other-Dx N/A To review the normal appearances, highlight potential pitfalls and present the key pathological findings commonly seen in juvenile idiopathic arthritis (JIA). No results stated in the abstract. 4
3. Malattia C, Rinaldi M, Martini A. The role of imaging in juvenile idiopathic arthritis. [Review]. Expert Review of Clinical Immunology. 14(8):681-694, 2018 08. Review/Other-Dx N/A This review compiles an inventory of potential uses of imaging studies in the modern practice of pediatric rheumatology, together with a critical analysis of the major challenges that are still to be addressed. No results stated in the abstract. 4
4. 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. [Review]. European Radiology. 30(10):5237-5249, 2020 Oct. Review/Other-Dx N/A To  discuss paediatric-specific imaging characteristics of the most commonly involved and clinically important joints in juvenile idiopathic arthritis (JIA). No results stated in the abstract. 4
5. Sheybani EF, Khanna G, White AJ, Demertzis JL. Imaging of juvenile idiopathic arthritis: a multimodality approach. Radiographics. 33(5):1253-73, 2013 Sep-Oct. Review/Other-Dx N/A To review the most recently developed classification system for juvenile idiopathic arthritis (JIA) and describe a rational approach for imaging of this disease entity, with emphasis on magnetic resonance imaging (MRI) and ultrasound (US). No results stated in the abstract. 4
6. Collado P, Malattia C. Imaging in paediatric rheumatology: Is it time for imaging?. [Review]. Best Practice & Research in Clinical Rheumatology. 30(4):720-735, 2016 08. Review/Other-Dx N/A This review describes indications and limitations of these imaging techniques and suggests some advices for a rational use in the management of juvenile idiopathic arthritis (JIA) in clinical practice. No results stated in the abstract. 4
7. Tarsia M, Zajc Avramovic M, Gazikalovic A, Kljucevsek D, Avcin T. A clinical perspective on imaging in juvenile idiopathic arthritis. Pediatr Radiol 2023. Review/Other-Dx N/A To provide a concise overview of the clinical utility of different imaging modalities in patients with juvenile idiopathic arthritis (JIA). No results stated in the abstract. 4
8. Ording Muller LS, Boavida P, Avenarius D, et al. MRI of the wrist in juvenile idiopathic arthritis: erosions or normal variants? A prospective case-control study. Pediatric Radiology. 43(7):785-95, 2013 Jul. Review/Other-Dx 85 healthy children, 68 children with JIA To compare findings on magnetic resonance imaging (MRI) of the wrist in healthy children and those with juvenile idiopathic arthritis (JIA) to investigate markers for true disease. No significant difference in the number of bony depressions in the carpal bones was seen between healthy children and children with JIA at any age. Depressions are found in similar locations in the two groups, except for a few sites, where bony depressions were seen exclusively in the JIA group, particularly at the CMC joints. The wrist was significantly smaller in children with JIA (P < 0.001). 4
9. Herregods N, Maksymowych WP, Jans L, et al. Atlas of MRI findings of sacroiliitis in pediatric sacroiliac joints to accompany the updated preliminary OMERACT pediatric JAMRIS (Juvenile Idiopathic Arthritis MRI Score) scoring system: Part I: Active lesions. Seminars in Arthritis & Rheumatism. 51(5):1089-1098, 2021 10. Review/Other-Dx N/A This atlas demonstrates fundamental MRI disease features of active inflammation in a format that can serve as a reference for assessing SIJ arthritis according to the updated preliminary JAMRIS (Juvenile Idiopathic Arthritis MRI Score) scoring system proposed by the MRI in JIA working group of Outcome Measures in Rheumatology and Clinical Trials (OMERACT). No results stated in the abstract. 4
10. Herregods N, Maksymowych WP, Jans L, et al. Atlas of MRI findings of sacroiliitis in pediatric sacroiliac joints to accompany the updated preliminary OMERACT pediatric JAMRIS (Juvenile Idiopathic Arthritis MRI Score) scoring system: Part II: Structural damage lesions. Seminars in Arthritis & Rheumatism. 51(5):1099-1107, 2021 10. Review/Other-Dx N/A This atlas can serve as a reference for assessing structural lesions of SIJ arthritis according to the updated preliminary JAMRIS (Juvenile Idiopathic Arthritis MRI Score) scoring system proposed by the MRI in JIA working group of Outcome Measures in Rheumatology and Clinical Trials (OMERACT). No results stated in the abstract. 4
11. Kellenberger CJ, Junhasavasdikul T, Tolend M, Doria AS. Temporomandibular joint atlas for detection and grading of juvenile idiopathic arthritis involvement by magnetic resonance imaging. [Review]. Pediatric Radiology. 48(3):411-426, 2018 03. Review/Other-Dx N/A This atlas can serve as a reference for grading temporomandibular joint arthritis according to the scoring systems proposed by working groups of OMERACT (Outcome Measures in Rheumatology and Clinical Trials) and the EuroTMjoint research network. No results stated in the abstract. 4
12. Restrepo R, Lee EY, Babyn PS. Juvenile idiopathic arthritis: current practical imaging assessment with emphasis on magnetic resonance imaging. [Review]. Radiologic Clinics of North America. 51(4):703-19, 2013 Jul. Review/Other-Dx N/A This review focuses on the classification of juvenile idiopathic arthritis (JIA), the role of imaging with emphasis on magnetic resonance (MR) imaging at diagnosis, staging, and follow-up, including its challenges, and some future directions. No results stated in abstract. 4
13. Hemke R, van Rossum MA, van Veenendaal M, et al. Reliability and responsiveness of the Juvenile Arthritis MRI Scoring (JAMRIS) system for the knee. European Radiology. 23(4):1075-83, 2013 Apr. Review/Other-Dx 25 patients To assess the reliability and responsiveness of a new Juvenile Arthritis MRI Scoring (JAMRIS) system for evaluating disease activity of the knee. Inter-reader (ICCs 0.86-0.95) and intra-reader reliability (ICCs 0.92-1.00) for the scoring of JAMRIS features was good. Reliability of the actual scores and changes in scores over time was good for all items: ICCs 0.89-1.00, 0.87-1.00, respectively. Concerning therapy response, the mean synovial hypertrophy scores decreased significantly (mean 1.1 point; P < 0.001, SRM = -0.65). No change was observed with respect to bone marrow change, cartilage lesion and bone erosion scores. 4
14. Malattia C, Consolaro A, Pederzoli S, et al. MRI versus conventional measures of disease activity and structural damage in evaluating treatment efficacy in juvenile idiopathic arthritis. Annals of the Rheumatic Diseases. 72(3):363-8, 2013 Mar. Review/Other-Dx 40 patients To compare the American College of Rheumatology paediatric (ACRp) response criteria and conventional radiography with MRI findings in a cohort of patients with juvenile idiopathic arthritis. ACRp90 responders showed a significantly higher decrease in MRI synovitis score (median change -4) than non-responders (median change 0), ACRp30-50 responders (median change 0) and ACRp70 responders (median change -1) (p=0.0006, Kruskal-Wallis test). Non-responders showed significantly higher radiographic progression than ACRp90 responders (pB=0.016). The MRI synovitis score showed a greater responsiveness to change (SRM 1.69) compared with the majority of ACR core set of variables. MRI erosion scores were less responsive than conventional radiography in detecting destructive changes (RE <1). MRI follow-up revealed no signs of inflammation in four out of 24 wrists with clinically inactive disease. 4
15. Porter-Young FM, Offiah AC, Broadley P, et al. Inter- and intra-observer reliability of contrast-enhanced magnetic resonance imaging parameters in children with suspected juvenile idiopathic arthritis of the hip. Pediatric Radiology. 48(13):1891-1900, 2018 12. Observational-Dx 80 patients To assess inter- and intra-observer reliability of selected MRI parameters (effusion, marrow oedema and synovial thickness and enhancement) used in the diagnosis of juvenile idiopathic arthritis. Eighty patients were included. Interobserver reliability was moderate for effusion (?=0.5-0.7), marrow oedema (?=0.6), subjective synovial assessment (?=0.4-0.5) and synovial enhancement (?=0.1-0.5). Intra-observer reliability was highest for marrow oedema (?=0.6-0.8) and lowest for effusion (?=0.4-0.7). Intra-observer reliability for synovial enhancement (?= -0.7-0.8) and subjective synovial assessment (?=0.4-1.0) ranged from poor to excellent. For synovial thickness, intra- and interobserver Bland-Altman plots were well clustered around the mean suggesting good agreement. 3
16. Hemke R, Kuijpers TW, van den Berg JM, et al. The diagnostic accuracy of unenhanced MRI in the assessment of joint abnormalities in juvenile idiopathic arthritis. European Radiology. 23(7):1998-2004, 2013 Jul. Observational-Dx 73 patients To assess the diagnostic accuracy and reliability of magnetic resonance imaging (MRI) without contrast enhancement in the evaluation of juvenile idiopathic arthritis (JIA) knee joint abnormalities. Imaging findings from 73 patients were analysed. Agreement between Gd-enhanced (+Gd) and Gd-unenhanced (-Gd) MRI scores of bone marrow changes, cartilage lesions and bone erosions was good concerning sensitivity, specificity, negative predictive value and positive predictive value. Inter-observer agreement was good for both -Gd and +Gd scores (ICC = 0.91-1.00, 0.93-1.00, respectively). Regarding the assessment of synovial hypertrophy, specificity of -Gd was high (0.97), but the sensitivity of unenhanced MRI was only 0.62. Inter-reader agreement for +Gd MRI was ICC = 0.94; however, omitting post-Gd acquisitions increased inter-reader variation (ICC = 0.86). 1
17. Nusman CM, Hemke R, Benninga MA, et al. Contrast-enhanced MRI of the knee in children unaffected by clinical arthritis compared to clinically active juvenile idiopathic arthritis patients. European Radiology. 26(4):1141-8, 2016 Apr. Observational-Dx 25 children To evaluate enhancing synovial thickness upon contrast-enhanced magnetic resonance imaging (MRI) of the knee in children unaffected by clinical arthritis compared with clinically active juvenile idiopathic arthritis (JIA) patients. A secondary objective was optimization of the scoring method based on maximizing differences on MRI between these groups. Enhancing synovium (=2 mm) was present in 13 (52 %) unaffected children. Using the total JAMRIS score for synovial thickening, no significant difference was found between unaffected children and active JIA patients (p = 0.091). Additional weighting of synovial thickening at the JIA-specific locations enabled more sensitive discrimination (p = 0.011). 2
18. Nusman CM, Ording Muller LS, Hemke R, et al. Current Status of Efforts on Standardizing Magnetic Resonance Imaging of Juvenile Idiopathic Arthritis: Report from the OMERACT MRI in JIA Working Group and Health-e-Child. [Review]. Journal of Rheumatology. 43(1):239-44, 2016 Jan. Review/Other-Dx N/A To report on the progress of an ongoing research collaboration on magnetic resonance imaging (MRI) in juvenile idiopathic arthritis (JIA) and describe the proceedings of a meeting, held prior to Outcome Measures in Rheumatology (OMERACT) 12, bringing together the OMERACT MRI in JIA working group and the Health-e-Child radiology group. The goal of the meeting was to establish agreement on scoring definitions, locations, and scales for the assessment of MRI of patients with JIA for both large and small joints. The meeting resulted in preliminary statements on the MR imaging protocol of the JIA knee and wrist and determination of the starting point for development of MRI scoring systems based on previous studies. It was also considered important to be descriptive rather than explanatory in the assessment of MRI in JIA (e.g., "thickening" instead of "hypertrophy"). Further, the group agreed that well-designed calibration sessions were warranted before any future scoring exercises were conducted. 4
19. Nusman CM, Rosendahl K, Maas M. MRI Protocol for the Assessment of Juvenile Idiopathic Arthritis of the Wrist: Recommendations from the OMERACT MRI in JIA Working Group and Health-e-Child. J Rheumatol 2016;43:1257-8. Review/Other-Dx N/A To discuss the MRI Protocol for the Assessment of Juvenile Idiopathic Arthritis of the Wrist: Recommendations from the Outcome Measures in Rheumatoid Arthritis Clinical Trials (OMERACT) magnetic resonance imaging (MRI) in JIA Working Group and Health-e-Child. These are consensus-based recommendations on MRI acquisition protocols are to help facilitate comparison of MRI studies conducted in different centers across the world. No abstract available. 4
20. Barendregt AM, van Gulik EC, Lavini C, et al. Diffusion-weighted imaging for assessment of synovial inflammation in juvenile idiopathic arthritis: a promising imaging biomarker as an alternative to gadolinium-based contrast agents. European Radiology. 27(11):4889-4899, 2017 Nov. Observational-Dx 35 patients To compare dynamic-contrast-enhanced MRI (DCE) and diffusion-weighted imaging (DWI) in quantifying synovial inflammation in juvenile idiopathic arthritis (JIA). Thirty-five JIA patients (18 MRI active and 17 MRI inactive) were included. Median age was 13.1 years and 71% were female. ME, MIS, TTP, % TIC 5 and ADC were significantly different in MRI-active versus MRI-inactive JIA with median ADC 1.49 × 10-3mm2/s in MRI-active and 1.25 × 10-3mm2/s in MRI-inactive JIA, p = 0.001, 95% confidence interval of difference in medians =0.11-0.53 × 10-3mm2/s. ADC correlated to ME, MIS and TIC 5 shapes (r = 0.62, r = 0.45, r = -0.51, respectively, all p < 0.05). 3
21. Vo Chieu VD, Vo Chieu V, Dressler F, et al. Juvenile idiopathic arthritis of the knee: is contrast needed to score disease activity when using an augmented MRI protocol comprising PD-weighted sequences?. European Radiology. 33(5):3775-3784, 2023 May. Observational-Dx 27 patients To compare unenhanced versus enhanced knee joint magnetic resonance imaging (MRI) to assess disease activity of juvenile idiopathic arthritis (JIA). Inter-reader agreement determined by ICC for unenhanced and enhanced MRI scores for IPSG was moderate (0.65, 95% CI 0.51-0.76, and 0.62, 95% CI 0.48-0.75) and high for JAMRIS (0.83, 95% CI 0.75-0.89, and 0.82, 95% CI 0.74-0.89). Intra-reader agreement was good to very good for JAMRIS (0.85 95% CI 0.81-0.88, 0.87 95% CI 0.83-0.89 and 0.96 95% CI 0.92-0.98) and IPSG (0.76 95% CI 0.62-0.86, 0.86 95% CI 0.77-0.92 and 0.92 95% CI 0.86-0.96). Scores of unenhanced MRI correlated with contrast-enhanced MRI: JAMRIS (r = 0.97, R2 = 0.93, p < 0.01), modified IPSG (r = 0.95, R2 = 0.91, p < 0.01). When using JADAS10 as a reference standard, moderate accuracy for both unenhanced and enhanced MRI scores was noted: JAMRIS (AUC = 0.68, 95% CI 0.51-0.85, and AUC = 0.66, 95% 0.49-0.82), IPSG score (AUC = 0.68, 95% 0.50-0.86, and AUC = 0.61, 95% 0.41-0.81). 2
22. Marteau P, Adamsbaum C, Rossi-Semerano L, et al. Conventional radiography in juvenile idiopathic arthritis: Joint recommendations from the French societies for rheumatology, radiology and paediatric rheumatology. [Review]. European Radiology. 28(9):3963-3976, 2018 Sep. Review/Other-Dx 74 articles To provide pragmatic guidelines on conventional radiography (CR) in each non-systemic juvenile idiopathic arthritis (JIA) subtype. 74 original articles were included. The task force developed four principles and 31 recommendations with grades ranging from B to D. The experts felt strongly that patients should be selected for CR based on the risk of structural damage, with routine CR of the hands and feet in rheumatoid factor-positive polyarticular JIA but not in oligoarticular non-extensive JIA. 4
23. Pracon G, Aparisi Gomez MP, Simoni P, Gietka P, Sudol-Szopinska I. Conventional Radiography and Ultrasound Imaging of Rheumatic Diseases Affecting the Pediatric Population. Seminars in Musculoskeletal Radiology. 25(1):68-81, 2021 Feb. Review/Other-Dx N/A This pictorial essay is to discuss radiographic and ultrasound inflammatory features of autoimmune pediatric inflammatory arthropathies: juvenile idiopathic arthritis, lupus erythematosus, juvenile scleroderma, juvenile dermatomyositis and polymyositis. No results stated in the abstract. 4
24. Onel KB, Horton DB, Lovell DJ, et al. 2021 American College of Rheumatology Guideline for the Treatment of Juvenile Idiopathic Arthritis: Recommendations for Nonpharmacologic Therapies, Medication Monitoring, Immunizations, and Imaging. Arthritis Rheumatol 2022;74:570-85. Review/Other-Dx N/A To provide recommendations for the management of juvenile idiopathic arthritis (JIA) with a focus on nonpharmacologic therapies, medication monitoring, immunizations, and imaging, irrespective of JIA phenotype. Recommendations in this guideline include the use of physical therapy and occupational therapy interventions; a healthy, well-balanced, age-appropriate diet; specific laboratory monitoring for medications; widespread use of immunizations; and shared decision-making with patients/caregivers. Disease management for all patients with JIA is addressed with respect to nonpharmacologic therapies, medication monitoring, immunizations, and imaging. Evidence for all recommendations was graded as low or very low in quality. For that reason, more than half of the recommendations are conditional. 4
25. Rodriguez-Lozano AL, Giancane G, Pignataro R, et al. Agreement among musculoskeletal pediatric specialists in the assessment of radiographic joint damage in juvenile idiopathic arthritis. Arthritis care & research. 66(1):34-9, 2014 Jan. Observational-Dx 177 patients To evaluate agreement among musculoskeletal pediatric specialists in assessing radiographic joint damage in juvenile idiopathic arthritis (JIA). The pediatric radiologists tended to assign lower scores and to provide more frequently scores of 0 than did the other specialists. Weighted kappa for the 3 pairs of specialists ranged from 0.67-0.69, indicating substantial agreement. Absolute agreement ranged from 51.3-55.7%, depending on the pair of specialists examined. Both absolute and weighted kappa concordance between specialists' scores and the adapted SHS score were poorer for the pediatric radiologist than for the other specialists. 2
26. Borocco C, Anselmi F, Rossi-Semerano L. Contribution of Ultrasound in Current Practice for Managing Juvenile Idiopathic Arthritis. J Clin Med 2022;12. Review/Other-Dx NA This review describes the specificities of musculoskeletal ultrasound (MSUS) in children, its applications in clinical practice, and its integration into the new juvenile idiopathic arthritis (JIA) treat-to-target therapeutic approach. No results stated in abstract. 4
27. Rossi-Semerano L, Breton S, Semerano L, et al. Application of the OMERACT synovitis ultrasound scoring system in juvenile idiopathic arthritis: a multicenter reliability exercise. Rheumatology (Oxford) 2021;60:3579-87. Observational-Dx 75 To evaluate the reliability of the OMERACT paediatric ultrasound (US) synovitis definitions and scoring system in JIA. Intra-reader reliability was good for binary scoring (Cohen’s kappa 0.62, range 0.47–0.75), synovitis and synovial hypertrophy; excellent for Doppler signals (quadratic weighted kappa 0.77, 0.66–0.86; 0.76, 0.61–0.84; and 0.87, 0.77–0.94, respectively); and moderate for effusion (0.55, 0.24–0.76). Inter-reader reliability was good for synovitis and synovial hypertrophy (Light’s kappa 0.68, 95% CI: 0.61, 0.75 and 0.63, 0.54–0.71, respectively), excellent for Doppler signals (0.85, 95% CI: 0.77, 0.90), and moderate for binary scoring and effusion (0.48, 95% CI: 0.36, 0.64 and 0.49, 0.40–0.60, respectively). We obtained the best scores for the knee (0.71, 0.54–0.85) except for Doppler signals, with reliability higher for MCP-II. We found a trend toward better results in older children. 2
28. Collado P, Martire MV, Lanni S, et al. OMERACT International Consensus for Ultrasound Definitions of Tenosynovitis in Juvenile Idiopathic Arthritis: Systematic Literature Review and Delphi Process. Arthritis Care Res (Hoboken) 2023;75:2277-84. Review/Other-Dx 14 studies This study was undertaken to produce consensus-based US definitions of tenosynovitis in JIA. A total of 14 studies were identified. Most used the US definitions developed for adults to define tenosynovitis in children. Construct validity was reported in 86% of articles using physical examination as a comparator. Few studies reported US reliability and responsiveness in JIA. In step 1, experts reached a strong group agreement (>86%) by applying adult definitions in children after one round. After 4 rounds of step 2, the final definitions were validated on all tendons and at all locations, except for biceps tenosynovitis in children <4 years old. 4
29. Rossi-Semerano L, Ravagnani V, Collado P, et al. Validity of ultrasonography in detecting enthesitis in children: A systematic literature review. Joint, Bone, Spine: Revue du Rhumatisme. 90(4):105538, 2023 Jul. Review/Other-Dx 5 studies A systemic review to assess the value of ultrasonography (US) for detecting enthesitis in JIA. Five publications met the inclusion criteria (26 to 146 patients and 1 to 10 bilaterally examined entheses). All studies focused on lower-limb entheses. The elementary lesions included in the definition of adult enthesitis were generally assessed. Few studies reported US reliability and none evaluated sensitivity to change of US. US revealed entheseal abnormalities in 9.4 to 53% of JIA patients and 20 to 83% of enthesitis-related arthritis cases. No significant abnormalities were found in healthy children. US findings were poorly correlated with clinical examination. The overall quality of the studies was low, mainly because of the lack of a reference standard. 4
30. Ventura-Rios L, Faugier E, Barzola L, et al. Reliability of ultrasonography to detect inflammatory lesions and structural damage in juvenile idiopathic arthritis. Pediatric Rheumatology Online Journal. 16(1):58, 2018 Sep 17. Observational-Dx 30 children The objective of this study was to evaluate the reliability of MSUS to detect elementary lesions: synovitis, tenosynovitis, cartilage damage and bone erosions in the wrist and metacarpal (MCP) joints of patients with JIA. US detected more synovitis than the clinical examination (62% vs 28%, 30% vs 23% and 22% vs 17% in the wrist, second and third MCP joints respectively). The intra-observer concordance for synovitis in all joints was excellent in B-Mode (k 0.84 .63–1.0 p = 0.001), except for MCP 2, where it was good (0.61, IC 95% .34–89, p = 0.001). For both modalities (PD, B-Mode) tenosynovitis, cartilage damage and bone erosions it was also excellent. Regarding synovitis grading the concordance was excellent for all grades (0.83–1.0, IC 95% 0.51.1.0, p = 0.001), except for grade 1 where it was good (0.61, IC 95% 0.43–.83, p = 0.001). Reliability inter-observer for grayscale synovitis (0.67–0.95, IC 95% 0.67–1.0, p = 0.001), tenosynovitis grayscale (0.89, IC 95% 0.78–0.99, p.001), damage cartilage (0.89, IC 95% 0.78–0.99, p = 0.001), PD (0.66, IC 95% 0.39–1.0, p = 0.001). The concordance for grading synovitis was excellent, but for grayscale grade 1 and 2 (.66, IC 95% .53–.74, p = 0.007) and PD grade 1 and 2 (0.63, IC 95% .58–.91, p = 004) was good. 1
31. Vega-Fernandez P, Esteban Y, Oberle E, et al. Reliability of the Pediatric Specific Musculoskeletal Ultrasound Scoring Systems for the Elbow, Wrist, and Finger Joints. Journal of Rheumatology. 50(2):236-239, 2023 02. Review/Other-Dx 17 pediatric rheumatologists To assess the reliability of these scoring systems when used by sonographers with different levels of expertise. Seventeen pediatric rheumatologists with different levels of MSUS expertise (1-15 yrs) completed a 2-hour training session and calibration exercise for each joint. Excellent reliability (ICC > 0.75) was found after the first scoring exercise for all the finger and elbow views evaluated on B mode and PD mode, and for all of the wrist views on B mode. After a second training session and a scoring exercise, the wrist PD mode views reached excellent reliability as well. 4
32. De Lucia O, Ravagnani V, Pregnolato F, et al. Baseline ultrasound examination as possible predictor of relapse in patients affected by juvenile idiopathic arthritis (JIA). Annals of the Rheumatic Diseases. 77(10):1426-1431, 2018 10. Observational-Dx 88 patients To define the correlation between joint ultrasonography and clinical examination in patients with juvenile idiopathic arthritis (JIA) and to assess whether synovitis detected by ultrasonography in clinically inactive patients predicts arthritis flares. US was abnormal in 20/88 (22.7%) patients and in 38/3872 (0.98%) joints. Extended oligoarthritis and rheumatoid factor-negative polyarthritis were more frequent in US-positive than in US-negative patients (35.0% vs 11.8% and 30.0% vs 13.2%, respectively; P=0.005). During 4 years of follow-up, 41/88 (46.6%) patients displayed a flare; 26/68 (38.2%) were US-negative and 15/20 (75%) were US-positive at baseline. Abnormality on US examination, after correction for therapy modification, significantly increased the risk of flare (OR=3.8, 95% CI 1.2 to 11.5). The combination of grey scale and PD abnormalities displayed a much higher predictive value of relapse (65%, 13/20) than grey scale alone (33%, 6/18). 3
33. Ntoulia A, Barnewolt CE, Doria AS, et al. Contrast-enhanced ultrasound for musculoskeletal indications in children. [Review]. Pediatric Radiology. 51(12):2303-2323, 2021 Nov. Review/Other-Dx NA In this review article we present current experience regarding a wide range of CEUS applications in musculoskeletal conditions in adults and children, with emphasis on the latter, and discuss imaging techniques and CEUS findings in musculoskeletal applications. No results stated in abstract. 4
34. Hospach T, Maier J, Muller-Abt P, Patel A, Horneff G, von Kalle T. Cervical spine involvement in patients with juvenile idiopathic arthritis - MRI follow-up study. Pediatric Rheumatology Online Journal. 12:9, 2014 Mar 04. Review/Other-Dx 13 patients To describe magnetic resonance imaging (MRI) and clinical findings in patients with juvenile idiopathic arthritis with cervical spine involvement at onset and follow-up under therapy. At the onset of cervical spine involvement all patients showed limited range of motion, whereas only 5 of them complained of pain. In MR images joint hyperintensity, contrast enhancement, malalignment, ankylosis, erosion and narrowing of the spinal canal at cranio-cervical junction were found at 28, 32, 15, 2, 2 and 3 sites in 12 (93%), 13 (100%), 8 (62%), 2 (15%), 2 and 3 (20%) patients respectively. 3 of the 5 patients with pain (60%) showed ankylosis, erosions or narrowing of the spinal canal at cranio-cervical junction on MRI. At follow-up - after a median disease duration of cervical spine arthritis of 2.1 years and a variable duration of treatment with methotrexate (all patients) and biological agents (12 patients) - joint hyperintensity, enhancement and malalignment decreased to 15, 19 and 6 sites in 10 (77%), 11 (85%) and 3 (20%) patients respectively whereas ankylosis, erosion and narrowing of the spinal canal at cranio-cervical junction increased to 7, 6 and 4 sites in 3 (20%), 4 (31%) and 4 patients respectively. Pain was no longer reported, but 9 of 13 (69%) patients still had a limited range of motion with 6 of them (46%) showing skeletal changes on MRI. 4
35. Demir S, Ergen FB, Taydas O, et al. Spinal involvement in juvenile idiopathic arthritis: what do we miss without imaging?. Rheumatology International. 42(3):519-527, 2022 03. Observational-Dx 72 patients Our aim was to assess the frequency and spectrum of magnetic resonance imaging (MRI) findings of spine involvement in patients with joint idiopathic arthritis (JIA) and determine if the axial involvement is always clinically symptomatic in patients with positive MRI findings. In this retrospective cross-sectional observational study we included known or suspected JIA patients who underwent spinal MRI examination between 2015 and 2017 and followed up in the Pediatric Rheumatology outpatient clinic. The demographic and clinical data were reviewed from the medical charts and electronic records. All patients were grouped as clinically symptomatic and asymptomatic for spinal involvement and MRI findings were re-evaluated for presence of inflammatory and erosive lesions. Of the 72 JIA patients, 57 (79.2%) were diagnosed with ERA, and 15 (20.8%) with non-ERA subtypes of JIA. Overall, 49 (68%) patients with JIA had positive spinal MRI findings (inflammatory and/or erosive lesions). Twenty-seven (47%) ERA patients were clinically symptomatic for spine involvement and among them, 19 (70.3%) had positive spinal MRI findings. Although 30 ERA (53%) patients were clinically asymptomatic, 23 of them (77%) had positive spinal MRI findings, as well. Eleven (73%) patients diagnosed with non-ERA JIA subtypes were clinically symptomatic for spine involvement at the time of MRI. Among them, four (36.3%) had inflammatory and/or erosive lesions on spine MRI. Four (26%) non-ERA patients were clinically asymptomatic for spine involvement, but three (75%) of them showed positive findings on spinal MRI. Inflammatory and/or erosive lesions of the thoracolumbar spine could exist in patients with JIA, regardless of the presence of symptoms. Not only because the significant proportion of ERA patients show asymptomatic axial involvement but also the presence of axial involvement in patients who were classified as non-ERA depending on current ILAR classification underlines the necessity of using MRI for accurate classification of patients with JIA. 3
36. Srinivasalu H, Sikora KA, Colbert RA. Recent Updates in Juvenile Spondyloarthritis. [Review]. Rheumatic Diseases Clinics of North America. 47(4):565-583, 2021 11. Review/Other-Dx NA No purpose stated in abstract. No results stated in abstract. 4
37. Naveen R, Guleria S, Aggarwal A. Recent updates in enthesitis-related arthritis. Rheumatol Int 2023;43:409-20. Review/Other-Dx NA No purpose stated in abstract. No results stated in abstract. 4
38. Weiss PF, Xiao R, Biko DM, Johnson AM, Chauvin NA. Detection of inflammatory sacroiliitis in children with magnetic resonance imaging: is gadolinium contrast enhancement necessary? Arthritis Rheumatol 2015;67:2250-6. Review/Other-Dx 51 patients To determine if magnetic resonance imaging (MRI) contrast is necessary to assess lesions consistent with inflammatory sacroiliitis in children. No results stated in abstract. 4
39. Tsoi C, Griffith JF, Lee RKL, Wong PCH, Tam LS. Imaging of sacroiliitis: Current status, limitations and pitfalls. Quant Imaging Med Surg 2019;9:318-35. Review/Other-Dx NA No purpose stated in abstract. No results stated in abstract. 4
40. Bray TJ, Amies T, Vendhan K, et al. Discordant inflammatory changes in the apophyseal and sacroiliac joints: serial observations in enthesitis-related arthritis. Br J Radiol 2016;89:20160353. Observational-Dx 31 patients To determine the extent to which inflammation of the sacroiliac joints (SIJs) and apophyseal joints (AJs) changes concordantly after treatment in enthesitis-related arthritis (ERA). Of a total of 43 scan pairs, the changes in inflammation were concordant in 16 scan pairs and discordant in 27 scan pairs. There was no significant correlation between ?nfla and ?AJ (R = 0.14, p = 0.37). 2
41. Herregods N, Jaremko JL, Baraliakos X, et al. Limited role of gadolinium to detect active sacroiliitis on MRI in juvenile spondyloarthritis. Skeletal Radiology. 44(11):1637-46, 2015 Nov. Observational-Dx 80 patients To determine the added diagnostic value of contrast-enhanced (CE) magnetic resonance imaging (MRI) compared to routine non contrast-enhanced MRI to detect active sacroiliitis in clinically juvenile spondyloarthritis (JSpA). Materials and methods: A total of 80 children clinically suspected for sacroiliitis prospectively underwent MRI of the sacroiliac (SI) joints. Axial and coronal T1-weighted (T1), Short-tau inversion recovery (STIR) and fat-saturated T1-weighted gadolinium-DTPA (Gd) contrast-enhanced (T1/Gd) sequences were obtained. The presence of bone marrow edema (BME), capsulitis, enthesitis, high intra-articular STIR signal, synovial enhancement and a global diagnostic impression of the MRI for diagnosis of sacroiliitis was recorded.Results: STIR and T1/Gd sequences had 100% agreement for depiction of BME, capsulitis and enthesitis. High intra-articular STIR signal was seen in 18/80 (22.5%) patients, 15 (83%) of whom also showed synovial enhancement in the T1/Gd sequence. Sensitivity (SN) and specificity (SP) for a clinical diagnosis of JSpA were similar for high STIR signal (SN = 33%, SP = 85%) and T1/Gd synovial enhancement (SN = 36%, SP = 92%). Positive likelihood ratio (LR+) for JSpA was twice as high for synovial enhancement than high STIR signal (4.5 compared to 2.2). Global diagnostic impression was similar (STIR: SN = 55%, SP = 87%, LR + =4 .2; T1/Gd: SN = 55%, SP = 92%, LR + = 6.9). 1
42. Wagle S, Gu JT, Courtier JL, Phelps AS, Lin C, MacKenzie JD. Value of dedicated small-field-of-view sacroiliac versus large-field-of-view pelvic magnetic resonance imaging for evaluating pediatric sacroiliitis. Pediatr Radiol 2019;49:933-40. Observational-Dx 58 patients To compare dedicated MR images of the SI joints with survey imaging (large-FOV pelvic MRI) for detecting sacroiliitis. Dedicated sacroiliac small-FOV MRI detected more sacroiliitis compared to survey pelvic imaging with large FOV (?2=6.125, P=0.013). Readers detected significantly more features of inflammation on small- compared to large-FOV images, e.g., erosions (P=0.039), synovitis (P=0.009), sclerosis (P=0.017) and osteitis (P=0.001). Test characteristics for pelvic large-FOV imaging were sensitivity=0.76, specificity=1.00, positive predictive value = 1.00 and negative predictive value = 0.75. 2
43. Weiss PF, Xiao R, Brandon TG, et al. Radiographs in screening for sacroiliitis in children: what is the value?. Arthritis Res Ther. 20(1):141, 2018 07 11. Observational-Dx 60 patients To evaluate the diagnostic utility of pelvic radiographs versus magnetic resonance imaging (MRI) of the sacroiliac joints in children with suspected sacroiliitis. The interrater agreement for global impression was ? = 0.34 (95% CI 0.19-0.52) for radiographs and ? = 0.72 (95% CI 0.52-0.86) for MRI. Across raters, the sensitivity of radiographs ranged from 25 to 77.8% and specificity ranged from 60.8 to 92.2%. Positive and negative predictive values ranged from 25.9 to 52% and from 82.7 to 93.9%, respectively. The misclassification rate ranged from 6 to 17% for negative radiographs/positive MRI scans and from 48 to 74% for positive radiographs/negative MRI scans. When the reference standard was changed to structural lesions consistent with sacroiliitis on MRI, the misclassification rate was higher for negative radiographs/positive MRI scans (9-23%) and marginally improved for positive radiographs/negative MRI scans (33-52%). 2
44. Rongo R, Alstergren P, Ammendola L, et al. Temporomandibular joint damage in juvenile idiopathic arthritis: Diagnostic validity of diagnostic criteria for temporomandibular disorders. Journal of Oral Rehabilitation. 46(5):450-459, 2019 May. Observational-Dx 50 patients To assess the validity of DC/TMD 3.B for the identification of TMJ damage in JIA-patients, using magnetic resonance imaging (MRI) as gold standard, and to investigate the relation between clinical findings and TMJ damage. The DC/TMD 3.B were inadequate in the identification of TMJ damage (sensitivity = 0.15, specificity = 0.92, PPV = 0.85, NPV = 0.28, P = 0.350). Chin deviation and TMJ crepitus were associated with worse TMJ damage (P = 0.006; P = 0.034). Reduced mouth opening (OR = 3.91, P = 0.039) and chin deviation (OR = 13.7, P = 0.014) were associated with the presence of TMJ damage. Combining "pain" (history of pain, TMJ pain, pain during movements) and "function" (TMJ crepitus, reduced mouth opening, chin deviation) clinical findings, the sensitivity and the specificity were 0.88 and 0.54. 3
45. Inarejos Clemente EJ, Tolend M, Navallas M, Doria AS, Meyers AB. MRI of the temporomandibular joint in children with juvenile idiopathic arthritis: protocol and findings. [Review]. Pediatric Radiology. 53(8):1498-1512, 2023 07. Review/Other-Dx NA In this pictorial essay, we describe a consensus MRI protocol for the study of the TMJ and illustrate the degree of normal and pathological MRI findings using currently available MRI scoring systems of the TMJ developed for JIA. No results stated in abstract. 4
46. Miller E, Inarejos Clemente EJ, Tzaribachev N, et al. Imaging of temporomandibular joint abnormalities in juvenile idiopathic arthritis with a focus on developing a magnetic resonance imaging protocol. [Review]. Pediatric Radiology. 48(6):792-800, 2018 06. Review/Other-Dx NA No purpose listed in abstract No results listed in abstract 4
47. Rosa VLM, Zwir LMF, Dutra MEP, Russo GCS, Rodrigues WDR, Terreri MT. Does the use of panoramic radiography add information in the temporomandibular joint evaluation in Juvenile Idiopathic Arthritis patients? A case control study. Advances in Rheumatology. 63(1):6, 2023 02 13. Observational-Dx 137 radiographies To determine the frequency of radiographic changes in the temporomandibular joint, in a representative population of patients with Juvenile Idiopathic Arthritis (JIA) and to compare with fndings in healthy controlsmatched by sex and age. 102 (74.5%) JIA patients and 47 (34.3%) controls showed at least one radiological alteration (p<0.001). The following radiographic alterations were more frequently observed in JIA patients than in controls: erosion (p<0.001), altered condylar morphology (p<0.001), disproportion between condylar process and the coronoid process (p<0.001) and accentuated curve in the antegonial notch (p=0.002). Twenty patients (14.6%) presented the four radiographic alterations simultaneously compared to only two controls (1.5%) (p<0.001). 3
48. Zwir LF, Terreri MT, do Amaral E Castro A, Rodrigues WDR, Fernandes ARC. Is power Doppler ultrasound useful to evaluate temporomandibular joint inflammatory activity in juvenile idiopathic arthritis?. Clinical Rheumatology. 39(4):1237-1240, 2020 Apr. Review/Other-Dx 90 patients To define the prevalence of subclinical synovitis on magnetic resonance imaging (MRI) in a large cohort of patients with juvenile idiopathic arthritis (JIA) in clinical remission and to evaluate its predictive value in terms of disease flare and joint deterioration. CE-MRI was acquired in 45 wrists, 30 hips, 13 ankles, and 2 knees. Subclinical synovitis was detected in 59 (65.5%) of 90 patients and bone marrow edema in 42 (46.7%) of 90 patients. Fifty-seven of 90 (63.3%) patients experienced a disease flare during follow-up. Forty-four of 59 (74.6%) patients with subclinical synovitis experienced a disease flare versus 13 (41.9%) of 31 patients with no residual synovitis on MRI (P = 0.002). The presence of subclinical synovitis was the best predictor of disease flare on multivariable regression analysis (hazard ratio [HR] 2.45, P = 0.003). Baseline and follow-up radiographs were available for 54 patients, and 17 (31.5%) of 54 patients experienced radiographic damage progression. The presence of bone marrow edema (HR 4.40, P = 0.045) and being >17 years old (HR 3.51, P = 0.04) were strong predictors of joint damage progression in the multivariable analysis. 4
49. Tateishi U, Imagawa T, Kanezawa N, et al. PET assessment of disease activity in children with juvenile idiopathic arthritis. Pediatr Radiol 2010;40:1781-8. Observational-Dx 560 joints in 28 children To assess the relationship between (18)F-FDG PET uptake and disease activity in children with JIA. A total of 560 joints in 28 children (mean age, 5.4 years; range, 1-16 years) with JIA who had undergone whole-body (18)F-FDG PET before treatment were retrospectively assessed clinically, biochemically and radiographically. PET images were assessed independently by two readers. We investigated the relationships between the degree of synovial (18)F-FDG uptake and radiographic and clinical symptoms and laboratory findings. Joint tenderness and swelling had a positive association with abnormal (18)F-FDG uptake in the joint [odds ratio (OR) 5.37, 7.12, respectively]. The standardized uptake value (SUV) max correlated with the neutrophil count, plasma C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and matrix metalloproteinase (MMP) 3. Joint erosion (OR, 6.17), soft-tissue swelling (OR, 3.77), major joints involvement (OR, 3.50), tenderness (OR, 5.22), and CRP concentration in plasma (OR, 1.81) were positively associated with SUVmax. 1
50. Mazzoni M, Pistorio A, Magnaguagno F, et al. Predictive Value of Magnetic Resonance Imaging in Patients With Juvenile Idiopathic Arthritis in Clinical Remission. Arthritis care & research. 75(1):198-205, 2023 01. Review/Other-Dx 90 To define the prevalence of subclinical synovitis on magnetic resonance imaging (MRI) in a large cohort of patients with juvenile idiopathic arthritis (JIA) in clinical remission and to evaluate its predictive value in terms of disease flare and joint deterioration. CE-MRI was acquired in 45 wrists, 30 hips, 13 ankles, and 2 knees. Subclinical synovitis was detected in 59 (65.5%) of 90 patients and bone marrow edema in 42 (46.7%) of 90 patients. Fifty-seven of 90 (63.3%) patients experienced a disease flare during follow-up. Forty-four of 59 (74.6%) patients with subclinical synovitis experienced a disease flare versus 13 (41.9%) of 31 patients with no residual synovitis on MRI (P = 0.002). The presence of subclinical synovitis was the best predictor of disease flare on multivariable regression analysis (hazard ratio [HR] 2.45, P = 0.003). Baseline and follow-up radiographs were available for 54 patients, and 17 (31.5%) of 54 patients experienced radiographic damage progression. The presence of bone marrow edema (HR 4.40, P = 0.045) and being >17 years old (HR 3.51, P = 0.04) were strong predictors of joint damage progression in the multivariable analysis. 4
51. Panwar J, Tolend M, Redd B, et al. Consensus-driven conceptual development of a standardized whole body-MRI scoring system for assessment of disease activity in juvenile idiopathic arthritis: MRI in JIA OMERACT working group. Seminars in Arthritis & Rheumatism. 51(6):1350-1359, 2021 12. Review/Other-Dx 22 surveys Whole body-MRI is helpful in directing diagnostic and treatment approaches, and as a research outcome measure. We describe our initial consensus-driven phase towards developing a whole body-MRI scoring system for juvenile idiopathic arthritis. Twenty-two experts participated in at least one of three rounds of Delphi surveys and a concluding consensus meeting. A first iteration scoring system was developed which ultimately included the assessment of 100 peripheral, 23 chest, and 76 axial joints, and 64 entheses, with 2 4 diagnostic items graded in each of the items, using binary (presence/absence) and 2-3-level ordinal scores. Recommendations on anatomic MRI planes and sequences were specified as the minimally necessary imaging protocol for the scoring system. 4
52. Saoussen M, Yasmine M, Hiba B, Alia F, Kawther BA, Ahmed L. The role of ultrasonography in assessing remission in juvenile idiopathic arthritis: a systematic review. [Review]. European Journal of Pediatrics. 182(7):2989-2997, 2023 Jul. Review/Other-Dx 8 studies This systematic review aimed to provide the most up-to-date published literature regarding the added value of MSUS in JIA patients in remission. No results stated in abstract. 4
53. Vega-Fernandez P, Oberle EJ, Henrickson M, et al. Musculoskeletal Ultrasound and the Assessment of Disease Activity in Juvenile Idiopathic Arthritis. Arthritis care & research. 75(8):1815-1820, 2023 08. Review/Other-Dx 30 To determine the frequency of subclinical synovitis on musculoskeletal ultrasound (MSUS) in Juvenile Idiopathic Arthritis (JIA) and correlate patient- and provider-reported outcome measures with MSUS synovitis. In 30 patients subclinical synovitis was detected in 30% of joints. Clinical arthritis of the fingers, wrists, and knee joints was significantly associated with MSUS synovitis of these joints. PGA and the CHAQ had a moderate (rs: 0.44, p=0.014) to weak (rs: 0.37, p=0.045) correlation with MSUS synovitis. There was a statistically significant strong correlation between MSUS synovitis and PhGA (rs: 0.61, p=0.001), but weak correlation with AJC (rs: 0.37, p=0.048) at the follow-up visit. 4
54. Kotecki M, Gietka P, Posadzy M, Sudol-Szopinska I. Radiographs and MRI of the Cervical Spine in Juvenile Idiopathic Arthritis: A Cross-Sectional Retrospective Study. J Clin Med 2021;10. Observational-Dx 34 patients The aim of this study was to assess the frequency of cervical spine lesions on radiographs and MRI in JIA patients with clinical signs of cervical spine involvement and to verify if with the addition of MRI, the use of radiographs could be abandoned. The cervical spine was affected in 35% of patients. The most frequent lesions were subaxial subluxations (SAS; 24%), apophyseal joint ankylosis (9%), and C1/C2 joint lesions (9%). Anterior atlanto-axial subluxation (AAS) was diagnosed only by radiography, and most of the SAS were seen on radiography, whereas only a few on MRI. Reversely, C1/C2 soft tissue involvement were seen on MRI only. Cervical spine involvement was associated with raised ESR (p = 0.012) and CRP (p = 0.014). 2
55. Vendhan K, Sen D, Fisher C, Ioannou Y, Hall-Craggs MA. Inflammatory changes of the lumbar spine in children and adolescents with enthesitis-related arthritis: magnetic resonance imaging findings. Arthritis Care Res (Hoboken) 2014;66:40-6. Observational-Dx 79 patients To describe and profile abnormalities of the lumbar spine in a cohort of patients with enthesitis-related arthritis (ERA) as compared to a control group of adolescents with mechanical back pain. The contrast agent used was gadoterate meglumine, which was administered as an intravenous bolus at a dose of 0.2 mmoles/kg. One or more abnormalities of the lumbar spine were found in 39 (67%) of 58 cases and sacroiliitis was present in 45 (78%) of the cases. Apophyseal joint synovitis was seen in 22 (38%) cases and in 1 (5%) control patient. This difference was highly significant (P = 0.004). Inflammatory changes in the interspinous ligaments were seen in a higher percentage of cases than controls and this observation was of statistical significance (P = 0.04). 2
56. Al-Shwaikh H, Urtane I, Pirttiniemi P, et al. Radiologic features of temporomandibular joint osseous structures in children with juvenile idiopathic arthritis. Cone beam computed tomography study. Stomatologija. 18(2):51-60, 2016. Observational-Dx 65 patients This study aims to report these features as seen in CBCT and thus comparing them with the features observed in a control group within the same age group and in females and males The radiologic features of the osseous structures of the TMJ occurred asymmetrically between the right and left sides when compared in the JIA and control groups. The most prevalent feature in the JIA group is condyle surface flattening for both sides. Condyle surface erosion and osteophyte were also frequent and occurred with high statistical significance in both males and females. 3
57. Hara GF, de Souza-Pinto GN, Brasil DM, et al. What is the image appearance of juvenile idiopathic arthritis in MRI, CT, and CBCT of TMJ? A systematic review. Clinical Oral Investigations. 27(5):2321-2333, 2023 May. Review/Other-Dx 6 studies We performed a systematic review to investigate the appearance of imaging signs on magnetic resonance imaging (MRI), cone-beam computed tomography (CBCT), and conventional computed tomography (CT) scans of the temporomandibular joints (TMJs) of patients with juvenile idiopathic arthritis (JIA). A total of six studies met the inclusion criteria, four involving MRI and two involving CBCT. Additionally, all six studies analyzed the imaging findings of pathological TMJ affected by JIA. The results showed that synovial membrane enhancement, condylar erosions, and condylar flattening were the most prevalent imaging findings in JIA. 4
58. Measuring Sex, Gender Identity, and Sexual Orientation. Review/Other-Dx N/A Sex and gender are often conflated under the assumptions that they are mutually determined and do not differ from each other; however, the growing visibility of transgender and intersex populations, as well as efforts to improve the measurement of sex and gender across many scientific fields, has demonstrated the need to reconsider how sex, gender, and the relationship between them are conceptualized. No abstract available. 4
59. American College of Radiology. ACR Appropriateness Criteria® Radiation Dose Assessment Introduction. Available at: https://edge.sitecorecloud.io/americancoldf5f-acrorgf92a-productioncb02-3650/media/ACR/Files/Clinical/Appropriateness-Criteria/ACR-Appropriateness-Criteria-Radiation-Dose-Assessment-Introduction.pdf. Review/Other-Dx N/A To provide evidence-based guidelines on exposure of patients to ionizing radiation. No abstract available. 4
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