European Radiology

, Volume 4, Issue 1, pp 27–32 | Cite as

A radiographic classification system in juvenile rheumatoid arthritis applied to the knee

  • K. Dale
  • A. C. Paus
  • K. Laires
Original articles Musculoskeletal radiology


A new radiographic grading system for evaluation of juvenile rheumatoid arthritis (JRA) for the knee is presented. The classification is based on known arthritic criteria in childhood. Joints with erosion are given a higher score than growth disturbances alone. Signs of osteoarthrosis including joint space narrowing were excluded from the classification. The femorotibial and patello-femoral joints are assessed together. Verbal definitions are used for the classification, but, regarding the erosions, standard reference films are used. The intra- and inter-observer variations of the method were low. (P <0.01)

Key words

Juvenile rheumatoid arthritis and radiology Radiographic score Knee joints 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Larsen A, Dale K, Eek M (1977) Radiographic evaluation of rheumatoid arthritis and related conditions by standard reference films. Acta Radiol Diagnosis 18: 481–491Google Scholar
  2. 2.
    Fiszman P, Ansell BM, Renton P (1981) Radiological assessment of knees in juvenile chronic arthritis (juvenile rheumatoid arthritis). Scand J Rheumatol 10: 145–152Google Scholar
  3. 3.
    Martel W, Holt JF, Cassidy JT (1965) Roentgenologic manifestations of juvenile rheumatoid arthritis. Am J Roentgenol 88: 400–423Google Scholar
  4. 4.
    Williams RA, Ansell BM (1985) Radiological findings in seropositive juvenile chronic arthritis (juvenile rheumatoid arthritis) with particular reference to progression. Ann Rheum Dis 44: 685–692Google Scholar
  5. 5.
    Petterson H, Rydholm U (1984) Radiologic classification of knee joint destruction in juvenile chronic arthritis. Pediatr Radiol 14: 419–421Google Scholar
  6. 6.
    Paus AC, Dale K (1993) Arthroscopic and radiographic examination of patients with juvenile rheumatoid arthritis before and after open synovectomy of the knee joint. Ann Chir Gynaecol 82: 55–61Google Scholar
  7. 7.
    Brewer EJ, Bass J, Baum J, Cassidy JT, Fink C, Jacobs J, Hanson V, Levinson JE, Schaller J, Stillmann JS (1977) Current proposed revision JRA criteria. Arthritis Rheum 20: 195–199PubMedGoogle Scholar
  8. 8.
    Cohen J (1969) A coefficient of agreement for nominal scales. Educ Psychol Meas 20: 37–46Google Scholar
  9. 9.
    Caffey J (1978) Textbook of Pediatric X-Ray Diagnosis. Vol. 2, Seventh Edition, Year Book Medical Publishers, ChicagoGoogle Scholar
  10. 10.
    Cassidy JI, Petty RE (1990) Textbook of Pediatric Rheumatology. Second Edition, Churchill Livingstone, New YorkGoogle Scholar
  11. 11.
    Forrester DM, Brown JC (1987) The Radiology of Joint Disease. Vol. 2, Third Edition, WB Saunders, PhiladelphiaGoogle Scholar
  12. 12.
    Brattström M (1963) Asymmetri of ossification and rate of growth of long bones in children with unilateral juvenile gonarthritis. Acta Rheum Scand 9: 102–115Google Scholar
  13. 13.
    Cassidy JT, Martel W (1977) Juvenile rheumatoid arthritis: Clinicoradiologic correlations. Arthritis Rheum 20: 207–211Google Scholar
  14. 13.
    Scheller S (1965) Roentgenographic studies on the ossification of the distal femoral epiphysis. Acta Radiol Suppl 248Google Scholar
  15. 15.
    Larsen A, Dale K, Eek M (1975) Standard Radiographs of Rheumatoid Arthritis Ed. Kodak A/S, Oslo, NorwayGoogle Scholar
  16. 16.
    Sjöblom KG, Petterson H, Saxne T, Wollheim FA (1984) Factors related to the progression of joint destruction in rheumatoid arthritis. Scand J Rheumatol 13: 21–27Google Scholar
  17. 17.
    Rydholm U (1990) Surgery for juvenile chronic arthittis. Ed. Ortolani AB. Wallin et Dalholm, Lund, SwedenGoogle Scholar
  18. 18.
    Keats TE et Smith TH (1977) An atlas of normal developmental roentgen anatomy, Year Book Medical Publishers, ChicagoGoogle Scholar
  19. 19.
    Brattström M, Czuda R, Geschwend N, Hagena FW, Kinell I, Köhler G, Mori M, Pavlov VP, Thabe H (1985) Long-terms results of knee synovectomy in early cases of rheumatoid arthritis. Clin Rheumatol 4: 19–22Google Scholar
  20. 20.
    König H, Sieper J, Wolf K-J (1990) Evaluation of hypervascular fibrous pannus with dynamic MR imaging enhanced with Gd-DTPA. Radiology 176: 473–477Google Scholar

Copyright information

© Springer-Verlag 1994

Authors and Affiliations

  • K. Dale
    • 1
  • A. C. Paus
    • 2
  • K. Laires
    • 1
  1. 1.Department of RadiologyOslo Sanitetsforening Rheumatism HospitalOsloNorway
  2. 2.Department of SurgeryOslo Sanitetsforening Rheumatism HospitalOsloNorway

Personalised recommendations