Skeletal Radiology

, 37:987 | Cite as

MRI findings of juvenile psoriatic arthritis

  • Edward Y. Lee
  • Robert P. Sundel
  • Susan Kim
  • David Zurakowski
  • Paul K. Kleinman
Scientific Article

Abstract

Objective

The aim of this study was to describe the magnetic resonance imaging (MRI) features of juvenile psoriatic arthritis (JpsA) in children in order to facilitate early diagnosis and proper management.

Materials and methods

Two pediatric radiologists retrospectively reviewed in consensus a total of 37 abnormal MRI examinations from 31 pediatric patients (nine boys, 22 girls; age range 1–17 years; mean age 9.4 years) who had a definite diagnosis of JpsA and underwent MRI. Each MRI was evaluated for synovium abnormality (thickening and enhancement), joint effusion (small, moderate, and large), bone marrow abnormality (edema, enhancement, and location of abnormality), soft tissue abnormality (edema, enhancement, atrophy, and fatty infiltration), tendon abnormality (thickening, edema, tendon sheath fluid, and enhancement), and articular abnormality (joint space narrowing and erosion). The distribution of abnormal MRI findings among the six categories for the 37 MRI examinations was evaluated. The number of abnormal MRI findings for each MRI examination was assessed. Age at MRI examination and all six categories of abnormal MRI findings according to gender were evaluated.

Results

There were a total 96 abnormal MRI findings noted on 37 abnormal MRI examinations from 31 pediatric patients. The 37 abnormal MRI examinations included MRI of the hand (n = 8), knee (n = 8), ankle (n = 5), pelvis (n = 5), temporomandibular joint (n = 4), wrist (n = 3), foot (n = 2), elbow (n = 1), and shoulder (n = 1). Twenty-eight diffuse synovial thickening and/or enhancement were the most common MRI abnormality (29.2%). Joint effusion comprised 22 abnormal MRI findings (22.9%). There were 16 abnormal MRI bone marrow edema and/or enhancement findings (16.7%), and in seven (7.3%) the edema involved non-articular sites. Soft tissue abnormality manifested as edema and/or enhancement constituted 14 abnormal MRI findings (14.5%). There were ten MRI abnormalities (10.4%) involving tendons. Articular abnormality seen as joint space narrowing and/or bone erosion comprised six abnormal MRI findings (6.2%). Most MRI examinations had more than one abnormal finding (84%). Age at which MRI examinations were performed was not significantly different between boys and girls. All six categories of abnormal MRI findings were not significantly different between boys and girls.

Conclusion

Children with JpsA typically present with more than one abnormal finding on their MRI studies. While synovial abnormality is the most common MR finding in children with JpsA, multi-focal bone marrow edema and enhancement at both articular and non-articular sites are also notable findings in children with JpsA. The rate of articular abnormality is much lower in children with JpsA in comparison to adults with psoriatic arthritis. Our findings suggest that MRI can play a useful role in the diagnosis and ongoing assessment of this uncommon, though important, pediatric rheumatologic disorder.

Keywords

Juvenile psoriatic arthritis (JpsA) MRI findings Children 

References

  1. 1.
    Lewkowicz D, Gottlieb AB. Pediatric psoriasis and psoriatic arthritis. Dermatol Ther 2004;17:364–75.PubMedCrossRefGoogle Scholar
  2. 2.
    Southwood TR, Petty RE, Malleson PN, et al. Psoriatic arthritis in children. Arthritis Rheum 1989;32(8):1007–13.PubMedCrossRefGoogle Scholar
  3. 3.
    Hafner R, Michels H. Psoriatic arthritis in children. Curr Opin Rheumatol 1996;8:467–72.PubMedCrossRefGoogle Scholar
  4. 4.
    Roberton DM, Cabral DA, Malleson PN, Petty RE. Juvenile psoriatic arthritis: follow up and evaluation of diagnostic criteria. J Rheumatol 1996;23:166–70.PubMedGoogle Scholar
  5. 5.
    Oriente CB, Scarpa R, Oriente P. Prevalence and clinical features of juvenile psoriatic arthritis in 425 psoriatic patients. Acta Derm Venereol 1994;186:109–10.Google Scholar
  6. 6.
    Kredich D, Patrone NA. Pediatric spondyloarthropathies. Clin Orthop Relat Res 1990;259:18–22.PubMedGoogle Scholar
  7. 7.
    Farber EM, Nall L. Childhood psoriasis. Cutis 1999;64(5):309–14.PubMedGoogle Scholar
  8. 8.
    Cuellar ML, Espinoza LR. Psoriatic arthritis: current developments. J Fla Med Assoc 1995;82(5):338–42.PubMedGoogle Scholar
  9. 9.
    McGonagle D, Conaghan PG, Emery P. Psoriatic arthritis—a unified concept 20 years on. Arthritis Rheum 1999;42:1080–6.PubMedCrossRefGoogle Scholar
  10. 10.
    Ory PA, Gladman DD, Mease PJ. Psoriatic arthritis and imaging. Ann Rheum Dis 2005;64:ii55–ii57.PubMedCrossRefGoogle Scholar
  11. 11.
    Scarpa R, Mathieu A. Psoriatic arthritis: evolving concepts. Curr Opin Rheumatol 2000;12:274–80.PubMedCrossRefGoogle Scholar
  12. 12.
    Gladman DD, Stafford-Brady F, Chang C, Lewandowski K, Russell ML. Longitudinal study of clinical and radiological progression in psoriatic arthritis. J Rheumatol 1990;17(6):809–12.PubMedGoogle Scholar
  13. 13.
    Manners P, Lesslie J, Speldewinde D, Tunbridge D. Classification of juvenile idiopathic arthritis: should family history be included in the criteria? J Rheumatol 2003;30(8):1857–63.PubMedGoogle Scholar
  14. 14.
    Buchmann RF, Jaramillo D. Imaging of articular disorders in children. Radiol Clin North Am 2004;42(1):151–68.PubMedCrossRefGoogle Scholar
  15. 15.
    Schoellnast H, Deutschmann HA, Hermann J, et al. Psoriatic arthritis and rheumatoid arthritis: findings in contrast-enhanced MRI. AJR 2006;187:351–7.PubMedCrossRefGoogle Scholar
  16. 16.
    Savnik A, Malmskov H, Thomsen HS, et al. MRI of the wrist and finger joints in inflammatory joint diseases at 1-year interval: MRI features to predict bone erosions. Eur Radiol 2002;12:1203–10.PubMedCrossRefGoogle Scholar
  17. 17.
    Jevtic V, Watt I, Rozman B, Kos-Golja M, Demsar F, Jarh O. Distinctive radiological features of small hand joints in rheumatoid arthritis and seronegative spondyloarthritis demonstrated by contrast-enhanced (Gd-DTPA) magnetic resonance imaging. Skeletal Radiol 1995;24:351–5.PubMedCrossRefGoogle Scholar
  18. 18.
    Offidani A, Cellini A, Valeri G, Giovagnoni A. Subclinical joint involvement in psoriasis: magnetic resonance imaging and X-ray findings. Acta Derm Venereol 1998;78:463–5.PubMedCrossRefGoogle Scholar
  19. 19.
    Prieur AM. Spondylarthropathies in childhood. Baillieres Clin Rheum 1998;12(2):287–307.CrossRefGoogle Scholar
  20. 20.
    Gare BA, Fasth A. Epidemiology of juvenile chronic arthritis in southwestern Sweden: a 5-year prospective population study. Pediatrics 1992;90:950–8.PubMedGoogle Scholar
  21. 21.
    Scarpa R, Oriente P, Pucino A, et al. Psoriatic arthritis in psoriatic patients. Br J Rheumatol 1984;23:246–50.PubMedCrossRefGoogle Scholar
  22. 22.
    Gladman DD, Shuckett R, Russell ML, Thorne JC, Schachter RK. Psoriatic arthritis (PSA)—an analysis of 220 patients. Q J Med 1987;238:127–41.Google Scholar
  23. 23.
    Martel W, Stuck KJ, Dworin AM, Hylland RG. Erosive osteoarthritis and psoriatic arthritis: a radiological comparison in the hand, wrist, and foot. AJR 1980;134:125–35.PubMedGoogle Scholar
  24. 24.
    Azouz EM, Duffy CM. Juvenile spondyloarthropathies: clinical manifestations and medical imaging. Skeletal Radiol 1995;24:399–408.PubMedCrossRefGoogle Scholar
  25. 25.
    Bollow M, Braun J, Biedermann T. Use of contrast-enhanced MR imaging to detect sacroiliitis in children. Skeletal Radiol 1998;27:606–16.PubMedCrossRefGoogle Scholar
  26. 26.
    Bollow M, Biedermann T, Kannenberg J, et al. Use of dynamic magnetic resonance imaging to detect sacroiliitis in HLA-B27 positive and negative children with juvenile arthritides. J Rheumatol 1998;25(3):556–64.PubMedGoogle Scholar
  27. 27.
    Weishaupt D, Schweitzer ME, Alam F, Karasick D, Wapner K. MR imaging of inflammatory joint diseases of the foot and ankle. Skeletal Radiol 1999;28:663–9.PubMedCrossRefGoogle Scholar
  28. 28.
    McQueen FM, Stewart N, Crabbe J, et al. Magnetic resonance imaging of the wrist in early rheumatoid arthritis reveals a high prevalence of erosions at four months after symptom onset. Ann Rheum Dis 1998;57:350–6.PubMedCrossRefGoogle Scholar
  29. 29.
    McQueen FM, Stewart N, Crabbe J, et al. Magnetic resonance imaging in early rheumatoid arthritis reveals progression of erosions despite clinical improvement. Ann Rheum Dis 1999;58:156–63.PubMedGoogle Scholar
  30. 30.
    McQueen FM, Benton N, Perry D, et al. Bone edema scored on magnetic resonance imaging scans of the dominant carpus at presentation predicts radiographic joint damage of the hands and feet six years later in patients with rheumatoid arthritis. Arthritis Rheum 2003;48:1814–27.PubMedCrossRefGoogle Scholar
  31. 31.
    Laxer RM, Shore AD, Manson D, King S, Silverman ED, Wilmot DM. Chronic recurrent multifocal osteomyelitis and psoriasis—a report of a new association and review of related disorders. Semin Arthritis Rheum 1988;17(4):260–70.PubMedCrossRefGoogle Scholar
  32. 32.
    Tehranzadeh J, Ashikyan O, Anavim A, Shin J. Detailed analysis of contrast-enhanced MRI of hands and wrists in patients with psoriatic arthritis. Skeletal Radiol. 2008;37(5):433–42.PubMedCrossRefGoogle Scholar
  33. 33.
    Ranson MED, Babyn PS. The joints. In: Slovis TL, editor. Caffey’s pediatric diagnostic imaging. Philadelphia: Mosby Elsevier; 2008. p. 3013–48.Google Scholar

Copyright information

© ISS 2008

Authors and Affiliations

  • Edward Y. Lee
    • 1
  • Robert P. Sundel
    • 2
  • Susan Kim
    • 2
  • David Zurakowski
    • 1
    • 3
  • Paul K. Kleinman
    • 1
  1. 1.Department of RadiologyChildren’s Hospital Boston and Harvard Medical SchoolBostonUSA
  2. 2.Rheumatology Program, Division of Immunology and the Department of PediatricsChildren’s Hospital Boston and Harvard Medical SchoolBostonUSA
  3. 3.Department of Orthopaedic SurgeryChildren’s Hospital Boston and Harvard Medical SchoolBostonUSA

Personalised recommendations