Imaging of Juvenile Idiopathic Arthritis

  • Sergio Lopes Viana
  • Maria Custódia Machado Ribeiro
  • Bruno Beber Machado


The umbrella term juvenile idiopathic arthritis (JIA) encompasses a heterogeneous group of chronic arthritides that share the following features: (1) disease onset before 16 years of age and (2) a minimum duration of 6 weeks. It is the most common rheumatic entity of childhood, consisting of an autoimmune inflammatory disease of unknown etiology whose main target tissue is the synovium. The knee is the most common site of involvement, followed by the ankle, wrist, and hand. Even though the diagnosis is essentially a clinical one, recent therapeutic advances have drastically changed the role of imaging in its management, given that children with JIA must be diagnosed as soon as possible for timely introduction of treatment (“window of opportunity”). Early recognition and rapid attaining of disease remission are crucial for a benign course and improved long-term outcome. Overall, magnetic resonance imaging and ultrasonography are especially useful for early diagnosis and monitoring of patients with JIA, allowing prompt demonstration of abnormal findings, evaluation of disease progression, and accurate assessment of treatment response. Nevertheless, one should have in mind that widespread use of advanced imaging studies in patients with JIA is still relatively recent and interpretation is hampered by gaps in knowledge and lack of standardization regarding the normal appearance of the growing skeleton; therefore, differentiation between normal findings and pathologic changes can be challenging, particularly in early disease. The following topics in this chapter cover the imaging findings of peripheral joint disease in JIA. Juvenile spondyloarthritis is discussed in Chap. 4, while spinal involvement in JIA is part of the subject matter of Chap. 12.


Imaging Joints Radiology Children Adolescents Pediatrics Radiographs X-rays Ultrasonography Computed tomography Magnetic resonance imaging Juvenile idiopathic arthritis Arthritis Synovitis 

Recommended Reading

  1. 1.
    Azouz EM. Juvenile idiopathic arthritis: how can the radiologist help the clinician? Pediatr Radiol. 2008;38(Suppl 3):S403–8.CrossRefGoogle Scholar
  2. 2.
    Babyn P, Doria AS. Radiologic investigation of rheumatic diseases. Rheum Dis Clin N Am. 2007;33:403–40.CrossRefGoogle Scholar
  3. 3.
    Chauvin NA, Doria AS. Ultrasound imaging of synovial inflammation in juvenile idiopathic arthritis. Pediatr Radiol. 2017;47:1160–70.CrossRefGoogle Scholar
  4. 4.
    Chauvin NA, Khwaja A. Imaging of inflammatory arthritis in children: status and perspectives on the use of ultrasound, radiographs, and magnetic resonance imaging. Rheum Dis Clin North Am. 2016;42:587–606.CrossRefGoogle Scholar
  5. 5.
    Collado P, Malattia C. Imaging in paediatric rheumatology: is it time for imaging? Best Pract Res Clin Rheumatol. 2016;30:720–35.CrossRefGoogle Scholar
  6. 6.
    Daldrup-Link HE, Steinbach L. MR imaging of pediatric arthritis. Radiol Clin N Am. 2009;47:939–55.CrossRefGoogle Scholar
  7. 7.
    Damasio MB, de Horatio LT, Boavida P, Lambot-Juhan K, Rosendahl K, Tomà P, et al. Imaging in juvenile idiopathic arthritis (JIA): an update with particular emphasis on MRI. Acta Radiol. 2013;54:1015–23.CrossRefGoogle Scholar
  8. 8.
    Dimitriou C, Boitsios G, Badot V, Lê PQ, Goffin L, Simoni P. Imaging of juvenile idiopathic arthritis. Radiol Clin N Am. 2017;55:1071–83.CrossRefGoogle Scholar
  9. 9.
    Hemke R, Maas M, van Veenendaal M, Dolman KM, van Rossum MA, van den Berg JM, et al. Contrast-enhanced MRI compared with the physical examination in the evaluation of disease activity in juvenile idiopathic arthritis. Eur Radiol. 2014;24:327–34.CrossRefGoogle Scholar
  10. 10.
    Johnson K. Imaging of juvenile idiopathic arthritis. Pediatr Radiol. 2006;36:743–58.CrossRefGoogle Scholar
  11. 11.
    Jordan A, McDonagh JE. Juvenile idiopathic arthritis: the paediatric perspective. Pediatr Radiol. 2006;36:734–42.CrossRefGoogle Scholar
  12. 12.
    Karmazyn B, Bowyer SL, Schmidt KM, Ballinger SH, Buckwalter K, Beam TT, et al. US findings of metacarpophalangeal joints in children with idiopathic juvenile arthritis. Pediatr Radiol. 2007;37:475–82.CrossRefGoogle Scholar
  13. 13.
    Lanni S, Martini A, Malattia C. Heading toward a modern imaging approach in juvenile idiopathic arthritis. Curr Rheumatol Rep. 2014.
  14. 14.
    MacKenzie JD, Vasanawala SS. Advances in pediatric MR imaging. Magn Reson Imaging Clin N Am. 2008;16:385–402.CrossRefGoogle Scholar
  15. 15.
    Magni-Manzoni S, Malattia C, Lanni S, Ravelli A. Advances and challenges in imaging in juvenile idiopathic arthritis. Nat Rev Rheumatol. 2012;8:329–36.CrossRefGoogle Scholar
  16. 16.
    Malattia C, Tzaribachev N, van den Berg JM, Magni-Manzoni S. Juvenile idiopathic arthritis – the role of imaging from a rheumatologist's perspective. Pediatr Radiol. 2018;48:785–91.CrossRefGoogle Scholar
  17. 17.
    Miller E, Uleryk E, Doria AS. Evidence-based outcomes of studies addressing diagnostic accuracy of MRI of juvenile idiopathic arthritis. AJR Am J Roentgenol. 2009;192:1209–18.CrossRefGoogle Scholar
  18. 18.
    Navallas M, Inarejos EJ, Iglesias E, Cho Lee GY, Rodríguez N, Antón J. MR imaging of the temporomandibular joint in juvenile idiopathic arthritis: technique and findings. Radiographics. 2017;37:595–612.CrossRefGoogle Scholar
  19. 19.
    Navallas M, Rebollo Polo M, Riaza L, Muchart López J, Maristany T. Artritis idiopática juvenil, peculiaridades de la imagen en la edad pediátrica con especial interés en la resonancia magnética. Radiologia. 2013;55:373–84.CrossRefGoogle Scholar
  20. 20.
    Nguyen JC, Lee KS, Thapa MM, Rosas HG. US evaluation of juvenile idiopathic arthritis and osteoarticular infection. Radiographics. 2017;37:1181–201.CrossRefGoogle Scholar
  21. 21.
    Nusman CM, Hemke R, Benninga MA, Schonenberg-Meinema D, Kindermann A, van Rossum MA, et al. Contrast-enhanced MRI of the knee in children unaffected by clinical arthritis compared to clinically active juvenile idiopathic arthritis patients. Eur Radiol. 2016;26:1141–8.CrossRefGoogle Scholar
  22. 22.
    Ording Muller LS, Humphries P, Rosendahl K. The joints in juvenile idiopathic arthritis. Insights Imaging. 2015;6:275–84.CrossRefGoogle Scholar
  23. 23.
    Petty RE, Southwood TR, Manners P, Baum J, Glass DN, Goldenberg J, et al. International League of Associations for Rheumatology classification of juvenile idiopathic arthritis: second revision, Edmonton, 2001. J Rheumatol. 2004;31:390–2.PubMedGoogle Scholar
  24. 24.
    Pruthi S, Thapa MM. Infectious and inflammatory disorders. Magn Reson Imaging Clin N Am. 2009;17:423–38.CrossRefGoogle Scholar
  25. 25.
    Shanmugavel C, Sodhi KS, Sandhu MS, Sidhu R, Singh S, Katariya S, et al. Role of power Doppler sonography in evaluation of therapeutic response of the knee in juvenile rheumatoid arthritis. Rheumatol Int. 2008;28:573–8.CrossRefGoogle Scholar
  26. 26.
    Sheybani EF, Khanna G, White AJ, Demertzis JL. Imaging of juvenile idiopathic arthritis: a multimodality approach. Radiographics. 2013;33:1253–73.CrossRefGoogle Scholar
  27. 27.
    Southwood T. Juvenile idiopathic arthritis: clinically relevant imaging in diagnosis and monitoring. Pediatr Radiol. 2008;38(Suppl 3):S395–402.CrossRefGoogle Scholar
  28. 28.
    Sudoł-Szopińska I, Grochowska E, Gietka P, Płaza M, Pracoń G, Saied F, et al. Imaging of juvenile idiopathic arthritis. Part II: ultrasonography and MRI. J Ultrason. 2016;16:237–51.CrossRefGoogle Scholar
  29. 29.
    Tattersall R, Rangaraj S. Diagnosing juvenile idiopathic arthritis. Paediatr Child Health. 2007;18:85–9.CrossRefGoogle Scholar
  30. 30.
    Workie DW, Graham TB, Laor T, Rajagopal A, O’Brien KJ, Bommer WA, et al. Quantitative MR characterization of disease activity in the knee in children with juvenile idiopathic arthritis: a longitudinal pilot study. Pediatr Radiol. 2007;37:535–43.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Sergio Lopes Viana
    • 1
  • Maria Custódia Machado Ribeiro
    • 2
  • Bruno Beber Machado
    • 3
  1. 1.Hospital da Criança de Brasília José Alencar, Hospital Ortopédico e Medicina Especializada (HOME) and Diagnóstico Clínica de Imagens MédicasBrasíliaBrazil
  2. 2.Hospital da Criança de Brasília José AlencarBrasíliaBrazil
  3. 3.Gastren Clínica Médica e Radiológica (Iúna-ES), Clínica Radiológica Med Imagem, Clínica Radiológica Radial, Santa Casa de Misericórdia and Unimed Sul CapixabaCachoeiro de ItapemirimBrazil

Personalised recommendations