Juvenile spondyloarthritis (also called juvenile spondyloarthropathies) comprises a heterogeneous group of conditions characterized by inflammation of the sacroiliac joints and of the spine, varied degrees of enthesitis and arthritis, association with HLA-B27 antigen, and disease onset before age 16, accounting for 15–20% of all forms of arthritis in skeletally immature patients. Even though classification of juvenile spondyloarthritis is a controversial issue (which is beyond the scope of this chapter), this group of diseases classically encompasses juvenile ankylosing spondylitis, juvenile psoriatic arthritis, reactive arthritis, arthritis associated with inflammatory bowel disease, and the undifferentiated forms of spondyloarthritis. In addition to the axial skeleton, juvenile spondyloarthritis also affects the peripheral joints, mostly in the lower extremities, and prominent enthesopathy is often present. Peripheral arthritis and enthesitis of the lower extremities usually preponderate during the initial stage, and sacroiliitis and/or spondylitis are late findings, so that children with early-stage juvenile spondyloarthritis may be incorrectly diagnosed as having classic juvenile idiopathic arthritis. Radiographic criteria employed for adult-type disease are fairly insensitive for early diagnosis of juvenile spondyloarthritis, and, therefore, more sensitive imaging methods such as ultrasonography (US) and magnetic resonance imaging (MRI) have become increasingly important in this setting, given that early diagnosis and timely introduction of treatment are paramount for improved outcome and better quality of life. Pediatric collagen vascular disorders, on their turn, are multisystemic autoimmune diseases of uncertain etiology that are similar in many ways to their adult counterparts. Nonetheless, peculiarities in the presentation and evolution of the juvenile forms of collagen diseases make them unique, thus deserving separate study. Even though osteoarticular manifestations are not the more relevant in most patients, some imaging findings are quite typical, and it is important for the radiologist to be acquainted with them.
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Aquino MR, Tse SM, Gupta S, Rachlis AC, Stimec J. Whole-body MRI of juvenile spondyloarthritis: protocols and pictorial review of characteristic patterns. Pediatr Radiol. 2015;45:754–62.CrossRefGoogle Scholar
Babyn P, Doria AS. Radiologic investigation of rheumatic diseases. Rheum Dis Clin N Am. 2007;33:403–40.CrossRefGoogle Scholar
Buchmann RF, Jaramillo D. Imaging of articular disorders in children. Radiol Clin N Am. 2004;42:151–68.CrossRefGoogle Scholar
Burgos-Vargas R. The juvenile-onset spondyloarthritides. Rheum Dis Clin N Am. 2002;28:531–60.CrossRefGoogle Scholar
Daldrup-Link HE, Steinbach L. MR imaging of pediatric arthritis. Magn Reson Imaging Clin N Am. 2009;17:451–67.CrossRefGoogle Scholar
Eshed I, Bollow M, McGonagle DG, Tan AL, Althoff CE, Asbach P, et al. MRI of enthesitis of the appendicular skeleton in spondyloarthritis. Ann Rheum Dis. 2007;66:1553–9.CrossRefGoogle Scholar
Fink AZ, Gittler JK, Nakrani RN, Alis J, Blumfield E, Levin TL. Imaging findings in systemic childhood diseases presenting with dermatologic manifestations. Clin Imaging. 2018;49:17–36.CrossRefGoogle Scholar
Hartman GH, Renaud DL, Sundaram M, Reed AM. Spondyloarthropathy presenting at a young age: case report and review. Skelet Radiol. 2007;36:161–4.CrossRefGoogle Scholar
Herregods N, Dehoorne J, Joos R, Jaremko JL, Baraliakos X, Leus A, et al. Diagnostic value of MRI features of sacroiliitis in juvenile spondyloarthritis. Clin Radiol. 2015;70:1428–38.CrossRefGoogle Scholar
Herregods N, Jaremko JL, Baraliakos X, Dehoorne J, Leus A, Verstraete K, et al. Limited role of gadolinium to detect active sacroiliitis on MRI in juvenile spondyloarthritis. Skelet Radiol. 2015;44:1637–46.CrossRefGoogle Scholar
Horger M, Fierlbeck G, Kuemmerle-Deschner J, Tzaribachev N, Wehrmann M, Claussen CD, et al. MRI findings in deep and generalized morphea (localized scleroderma). AJR Am J Roentgenol. 2008;190:32–9.CrossRefGoogle Scholar
Jadon DR, Ramanan AV, Sengupta R. Juvenile versus adult-onset ankylosing spondylitis – clinical, radiographic, and social outcomes. A systematic review. J Rheumatol. 2013;40:1797–805.CrossRefGoogle Scholar
Jaremko JL, Liu L, Winn NJ, Ellsworth JE, Lambert RG. Diagnostic utility of magnetic resonance imaging and radiography in juvenile spondyloarthritis: evaluation of the sacroiliac joints in controls and affected subjects. J Rheumatol. 2014;41:963–70.CrossRefGoogle Scholar
Johnson K, Davis PJ, Foster JK, McDonagh JE, Ryder CA, Southwood TR. Imaging of muscle disorders in children. Pediatr Radiol. 2006;36:1005–18.CrossRefGoogle Scholar
Lalani TA, Kanne JP, Hatfield GA, Chen P. Imaging findings in systemic lupus erythematosus. Radiographics. 2004;24:1069–86.CrossRefGoogle Scholar
Lee EY, Sundel RP, Kim S, Zurakowski D, Kleinman PK. MRI findings of juvenile psoriatic arthritis. Skelet Radiol. 2008;37:987–96.CrossRefGoogle Scholar
Lin C, MacKenzie JD, Courtier JL, Gu JT, Milojevic D. Magnetic resonance imaging findings in juvenile spondyloarthropathy and effects of treatment observed on subsequent imaging. Pediatr Rheumatol Online J. 2014. https://doi.org/10.1186/1546-0096-12-25.
Mier RJ, Shishov M, Higgins GC, Rennebohm RM, Wortmann DW, Jerath R, et al. Pediatric-onset mixed connective tissue disease. Rheum Dis Clin N Am. 2005;31:483–96.CrossRefGoogle Scholar
Orr KE, Andronikou S, Bramham MJ, Holjar-Erlic I, Menegotto F, Ramanan AV. Magnetic resonance imaging of sacroiliitis in children: frequency of findings and interobserver reliability. Pediatr Radiol. 2018;48:1621–8.CrossRefGoogle Scholar
Pruthi S, Thapa MM. Infectious and inflammatory disorders. Magn Reson Imaging Clin N Am. 2009;17:423–38.CrossRefGoogle Scholar
Rennie WJ, Jans L, Jurik AG, Sudoł-Szopińska I, Schueller-Weidekamm C, Eshed I. Anterior chest wall in axial spondyloarthritis: imaging, interpretation, and differential diagnosis. Semin Musculoskelet Radiol. 2018;22:197–206.CrossRefGoogle Scholar
Sudoł-Szopińska I, Jans L, Jurik AG, Hemke R, Eshed I, Boutry N. Imaging features of the juvenile inflammatory arthropathies. Semin Musculoskelet Radiol. 2018;22:147–65.CrossRefGoogle Scholar
Tomasová Studynková J, Charvát F, Jarosová K, Vencovsky J. The role of MRI in the assessment of dermatomyositis and polymyositis. Rheumatology (Oxford). 2007;46:1174–9.CrossRefGoogle Scholar
Uson J, Loza E, Möller I, Acebes C, Andreu JL, Batlle E, et al. Recommendations for the use of ultrasound and magnetic resonance in patients with spondyloarthritis, including psoriatic arthritis, and patients with juvenile idiopathic arthritis. Reumatol Clin. 2018;14:27–35.CrossRefGoogle Scholar
Wagner-Weiner L. Pediatric rheumatology for the adult rheumatologist. J Clin Rheumatol. 2008;14:109–19.CrossRefGoogle Scholar
Weiss PF, Xiao R, Biko DM, Chauvin NA. Assessment of sacroiliitis at diagnosis of juvenile spondyloarthritis by radiography, magnetic resonance imaging, and clinical examination. Arthritis Care Res (Hoboken). 2016;68:187–94.CrossRefGoogle Scholar
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.CrossRefGoogle Scholar
Weiss PF, Xiao R, Brandon TG, Biko DM, Maksymowych WP, Lambert RG, et al. Radiographs in screening for sacroiliitis in children: what is the value? Arthritis Res Ther. 2018. https://doi.org/10.1186/s13075-018-1642-8.
Zulian F. Systemic sclerosis and localized scleroderma in childhood. Rheum Dis Clin N Am. 2008;34:239–55.CrossRefGoogle Scholar