Conventional Radiography and Ultrasound Imaging of Rheumatic Diseases Affecting the Pediatric Population

2021 ◽  
Vol 25 (01) ◽  
pp. 068-081
Author(s):  
Grzegorz Pracoń ◽  
Maria Pilar Aparisi Gómez ◽  
Paolo Simoni ◽  
Piotr Gietka ◽  
Iwona Sudoł-Szopińska
Keyword(s):  
Juvenile Idiopathic Arthritis ◽  
Lupus Erythematosus ◽  
Soft Tissues ◽  
Juvenile Dermatomyositis ◽  
Pediatric Population ◽  
Connective Tissue Diseases ◽  
Young Patients ◽  
Chronic Recurrent Multifocal Osteomyelitis ◽  
Disease Monitoring ◽  
Juvenile Scleroderma

AbstractJuvenile idiopathic arthritis is the most frequent rheumatic disease in the pediatric population, followed by systemic lupus erythematosus, juvenile scleroderma syndromes, juvenile dermatomyositis, chronic recurrent multifocal osteomyelitis, and juvenile vasculopathies. The imaging approach to inflammatory connective tissue diseases in childhood has not changed dramatically over the last decade, with radiographs still the leading method for bony pathology assessment, disease monitoring, and evaluation of growth disturbances. Ultrasonography is commonly used for early detection of alterations within the intra- and periarticular soft tissues, assessing their advancement and also disease monitoring. It offers several advantages in young patients including nonionizing radiation exposure, short examination time, and high resolution, allowing a detailed evaluation of the musculoskeletal system for the features of arthritis, tenosynovitis, enthesitis, bursitis, myositis, as well as pathologies of the skin, subdermis, vessels, and fasciae. In this pictorial essay we discuss radiographic and ultrasound inflammatory features of autoimmune pediatric inflammatory arthropathies: juvenile idiopathic arthritis, lupus erythematosus, juvenile scleroderma, juvenile dermatomyositis and polymyositis.

Imaging Features of the Juvenile Inflammatory Arthropathies

2018 ◽  
Vol 22 (02) ◽  
pp. 147-165
Author(s):  
Lennart Jans ◽  
Anne Jurik ◽  
Robert Hemke ◽  
Iris Eshed ◽  
Nathalie Boutry ◽  
...  
Keyword(s):  
Juvenile Idiopathic Arthritis ◽  
Connective Tissue ◽  
Lupus Erythematosus ◽  
Soft Tissues ◽  
Early Recognition ◽  
Systemic Disease ◽  
Connective Tissue Diseases ◽  
Disease Process ◽  
Imaging Features ◽  
Disease Modifying Drugs

AbstractWe discuss the imaging of several juvenile inflammatory arthropathies including juvenile idiopathic arthritis, juvenile systemic lupus erythematosus, juvenile scleroderma, juvenile dermatomyositis, and chronic recurrent multifocal osteomyelitis. Juvenile idiopathic arthritis is the most common autoimmune chronic systemic disease of connective tissue in children. The remaining systemic juvenile connective tissue diseases are rare. However, they require early diagnosis and initiation of treatment to prevent injury, not only to the musculoskeletal system but also to the internal organs, and even death. Imaging of juvenile inflammatory arthropathies has relied for years on radiography. Recent advances in disease-modifying drugs have led to a greater emphasis on the detection of early inflammation not evident on plain radiography. Ultrasound examination allows for the early recognition of the disease process in the soft tissues. Magnetic resonance imaging detects early inflammatory changes involving the soft tissues, the subcortical bone of peripheral joints, the spine, and entheses.

scholarly journals The state of the digestive system in children with systemic connective tissue diseases

2020 ◽  
Vol 65 (1) ◽  
pp. 65-70
Author(s):  
I. D. Chyzhevskaya ◽  
L. M. Belyaeva
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Juvenile Idiopathic Arthritis ◽  
Connective Tissue ◽  
Lupus Erythematosus ◽  
Inflammatory Process ◽  
Digestive System ◽  
Connective Tissue Diseases ◽  
Systemic Lupus ◽  
Juvenile Scleroderma

Purpose. To study the prevalence of the digestive system pathology in children with systemic connective tissue diseases.Characteristics of children and research methods. We carried out a clinical and instrumental examination of 108 children with systemic connective tissue diseases hospitalized in the rheumatology department of the 4th City Children’s Clinical Hospital in Minsk from 2008 to 2015. 60 patients suffered from juvenile idiopathic arthritis (mean age 12.3 [9.4; 15.6] years), 23 children suffered from juvenile scleroderma (mean age 11.8 [9.7; 14.9] years) and 25 children suffered from systemic lupus erythematosus (mean age 13.1 [12.2; 16.3] years). All patients received long-term immunosuppressive and anti-inflammatory therapy.Results. 75.9% patients had gastroenterological complaints, such as abdominal pains, nausea, heartburn. 69.4% of patients had endoscopic changes in the esophagus, stomach, and/or duodenum. According to the results of the morphological study, 43.5% of patients with systemic connective tissue diseases had mild inflammatory process, 29.6% of patients had average inflammatory process, and 3.7% of patients had severe inflammatory process. Among the children examined, 33 (55%) patients with juvenile idiopathic arthritis, 12 (48%) children with systemic lupus erythematosus and 11 (47.8%) patients with juvenile scleroderma were infected with Helicobacter pylori. Pathological changes of the hepatobiliary system and pancreas were diagnosed in 83.3% of children with systemic connective tissue diseases.Conclusion. The revealed changes indicate a probable connection between the pathology of the digestive organs in children with systemic connective tissue diseases and substantiate the gastroenterological examination of this category of patients. 

MR Imaging of Rheumatic Diseases Affecting the Pediatric Population

2021 ◽  
Vol 25 (01) ◽  
pp. 082-093
Author(s):  
Eva Schiettecatte ◽  
Lennart Jans ◽  
Jacob Lester Jaremko ◽  
Min Chen ◽  
Caroline Vande Walle ◽  
...  
Keyword(s):  
Rheumatic Diseases ◽  
Lupus Erythematosus ◽  
Pediatric Population ◽  
Vascular Diseases ◽  
Unknown Origin ◽  
Chronic Recurrent Multifocal Osteomyelitis ◽  
Joint Inflammation ◽  
Response To Treatment ◽  
Collagen Vascular Diseases ◽  
Juvenile Spondyloarthritis

AbstractThis article reviews the application of magnetic resonance imaging (MRI) to pediatric rheumatic diseases. MRI can detect early manifestations of arthritis, evaluate the extent of disease, and monitor disease activity and response to treatment.Juvenile idiopathic arthritis (JIA) is the most common pediatric rheumatic disorder, representing a diverse group of related diseases that share a definition of joint inflammation of unknown origin with onset before 16 years of age and lasting > 6 weeks. JIA may lead to significant functional impairment and is increasingly imaged with MRI to assess for active inflammation as a target for therapy. This is particularly true for juvenile spondyloarthritis that includes multiple subgroups of JIA and primarily involves the spine and sacroiliac joints.Other less common pediatric rheumatic diseases considered here are chronic recurrent multifocal osteomyelitis and collagen vascular diseases including polymyositis, dermatomyositis, scleroderma, and juvenile systemic lupus erythematosus.

scholarly journals Embolic Stroke as the Initial Manifestation of Systemic Lupus Erythematosus

2015 ◽  
Vol 2015 ◽  
pp. 1-5
Author(s):  
Reshma M. Khan ◽  
Rajaie Namas ◽  
Sachin Parikh ◽  
Bernard Rubin
Keyword(s):  
Lupus Erythematosus ◽  
Early Recognition ◽  
Connective Tissue Diseases ◽  
Young Patients ◽  
Retinal Artery Occlusion ◽  
Artery Occlusion ◽  
African American Female ◽  
Systemic Lupus ◽  
Initial Manifestation ◽  
History Of

We present a case of a 21-year-old African-American female with no significant medical history, who presented to the emergency department with a one-week history of blurry and double vision. Ophthalmology evaluation revealed bilateral retinal artery occlusion. Further workup with imaging of the brain was consistent with an ischemic stroke. Hereditary hypercoagulable workup was unremarkable and initial testing for antiphospholipid syndrome was positive. She underwent transesophageal echocardiogram (TEE), which showed severe mitral regurgitation and thickening of mitral valve leaflets consistent with Libman-Sacks endocarditis. Autoimmune workup was positive for IF-ANA, anti-RNP, and anti-Smith antibody. She fulfilled 4/11 of the ACR criteria and met 5 of the SLICC (Systemic Lupus International Collaborating Clinics) criteria for lupus (nonscaring alopecia, thrombocytopenia, positive ANA, and positive anti-Smith and positive anti-phospholipid antibodies). This case highlights the importance of early recognition of underlying connective tissue diseases and timely management of these diseases in young patients with no previous manifestations of diseases.

An immunoradiometric assay for erythrocyte complement (C3b) receptor activity applied to a pediatric population with connective tissue disease.

1983 ◽  
Vol 29 (10) ◽  
pp. 1720-1723
Author(s):  
G J Buffone ◽  
C M Leatherwood ◽  
D A Person ◽  
E J Brewer
Keyword(s):  
Rheumatoid Arthritis ◽  
Connective Tissue ◽  
Juvenile Rheumatoid Arthritis ◽  
Lupus Erythematosus ◽  
Pediatric Population ◽  
Connective Tissue Diseases ◽  
Complement C3 ◽  
Immunoradiometric Assay ◽  
C3b Receptor

Abstract The number of receptors for complement component C3b per erythrocyte reportedly is decreased in over half of adults with systemic lupus erythematosus. We have devised an immunoradiometric assay for C3b receptor (CR1) on erythrocytes, with which one can assess CR1 saturation due to in vivo binding of immune complexes or activated complement fragments (C3b). Using this assay, we examined binding by CR1 in normal adults and newborns, in lupus and juvenile rheumatoid arthritis patients, and in a population of patients with various general medical problems, including other connective tissue diseases. Binding by CR1 was decreased in eight of 15 SLE patients, four of 25 juvenile rheumatoid arthritis patients, and one of 14 patients with other diseases. We found no significant correlation between CR1 binding and either C1q binding, antinuclear antibody titer, results for complement C3 and C4, or the presence of renal disease. Using this assay, we were also able to show that the observed reduction in CR1 binding was not ascribable to prior saturation of CR1 or to blocking antibody against CR1. The assay is precise and easy enough for routine application.

scholarly journals P051 Symptoms of COVID-19 and anxiety levels in adult patients receiving b-and ts-DMARDS using an online reporting system

Rheumatology ◽  
2021 ◽  
Vol 60 (Supplement_1) ◽  
Author(s):  
May Nwe Lwin ◽  
Christopher Holroyd ◽  
Dinny Wallis ◽  
Saul Faust ◽  
Hans De Graaf ◽  
...  
Keyword(s):  
Lupus Erythematosus ◽  
Joint Pain ◽  
Connective Tissue Diseases ◽  
Anxiety Score ◽  
Online Portal ◽  
Inflammatory Conditions ◽  
Advanced Therapy ◽  
Number Of Patients ◽  
Patient Reported ◽  
Anxiety Levels

Abstract Background/Aims  The coronavirus disease-2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is responsible for over 120,000 UK deaths. Those with chronic inflammatory conditions or receiving immunosuppressive medications are at higher risk of COVID-19 than the general population. As a result, rheumatology patients taking b- or ts-DMARDs were advised to shield. We planned to observe COVID-19 related symptoms and anxiety levels reported by rheumatology patients during the pandemic. Methods  From April 2020, 1,004 rheumatology patients from an advanced therapy database were invited to participate in the adult ImmunoCOVID study to collect daily symptoms (fever, cough, shortness of breath (SOB), sore throat, blocked nose, red-eye, headache, fatigue, joint pain, muscle pain, chills, nausea, diarrhoea and vomiting, loss of senses) and anxiety level using an online portal. Loss of senses were not recorded until week 7 as these were not officially recognized at the pandemic onset. Results  153 patients (rheumatoid arthritis, n = 75, psoriatic arthritis, n = 28, Axial spondyloarthropathy, n = 24, systemic lupus erythematosus, n = 2 and other connective tissue diseases, n = 24) consented and participated. By week 25, 142 patients remained. Among those, 36.57% (±6.09%) (average (±SD)) reported no symptoms over the 25 week period. The main symptoms reported were joint pain (mean=47.94%) followed by fatigue (27.17%). Few patients reported fever (0.94%), cough (8.34%), SOB (4.53%), or loss of senses (1.11%) with more symptoms reported during the first 8 weeks (April/May 2020) and another increase in September/October 2020. The anxiety score (pragmatic 10-point scale) mean (±SD) was 5.60 (±0.34) and remained elevated throughout the study though higher when lockdown began. Conclusion  During the first peak of SARS-CoV-2, the number of patients reporting COVID-19 symptoms appeared high and was associated with high levels of anxiety. As only a small number have been swab-tested, this may suggest that larger numbers of untested individuals have had COVID-19 with mild symptoms. Features of inflammatory rheumatic illnesses may mimic COVID-19 symptoms and create diagnostic difficulty (joint pain and fatigue) whilst anxiety may lead to over-reporting of symptoms in the absence of infection. The key symptoms of fever, cough and SOB were less common and may be most reliable. Disclosure  M. Lwin: None. C. Holroyd: None. D. Wallis: None. S. Faust: None. H. De Graaf: None. C.J. Edwards: Honoraria; Abbvie, Biogen, BMS, Celgene, Fresenius, GSK, Janssen, Lilly, Mundipharma, Pfizer, Roche, Sanofi, UCB. Member of speakers’ bureau; Abbvie, Biogen, BMS, Celgene, Janssen, Lilly, Sanofi, Pfizer, Roche. Grants/research support; Abbvie, Biogen, Pfizer. P051 Table 1:patient reported symptoms and anxiety score from immunoCOVID studyWeek & (number of participants)Fever (%)Cough (%)SOB (%)Joint pain (%)Fatigue (%)Loss of senses (%)No symptoms (%)Tested (n)Test positive (n)Anxiety score1 (26)3.857.6911.5446.1530.77NA30.77006.312 (42)2.3311.639.3052.3834.88NA28.57005.833 (69)1.4514.494.3552.1737.68NA23.19415.884 (92)1.0911.966.5254.3531.52NA27.17206.225 (110)0.0011.716.3145.9533.33NA30.00006.156 (108)0.0010.193.7050.0026.85NA34.26205.747 (119)0.8410.084.2049.5828.57NA34.45205.938 (120)0.007.505.0051.6734.170.8329.17305.629 (124)0.817.263.2352.4229.840.8136.29405.6410 (118)0.008.473.3948.3129.660.8534.75205.2811 (116)0.858.476.7849.1529.661.6933.62305.6512 (131)0.006.114.5856.4926.720.7635.11205.4513 (110)0.916.362.7350.0029.091.8242.73105.4414 (121)0.837.442.4847.1125.620.8339.67805.2815 (100)1.007.003.0046.0023.001.0041.00405.4816 (114)0.887.893.5139.4725.441.7542.98905.2717 (105)0.008.573.8144.7622.860.9543.81425.1018 (107)0.006.543.7443.9319.630.9343.93405.3019 (99)0.005.052.0240.4019.191.0145.45505.0820 (110)0.914.552.7350.9124.550.9139.09NA0Missing data21 (106)0.946.602.8350.0020.750.9439.62405.2822 (104)2.889.626.7349.0430.770.9635.58305.5023 (106)1.897.553.7742.4526.420.9436.79805.8924 (108)0.938.332.7844.4422.220.9341.67605.6125 (94)1.067.454.2641.4915.962.1344.68605.49Average0.948.344.5347.9427.171.1136.575.60SD0.972.312.254.395.350.426.090.34Weekly data are the average of daily reported symptoms and anxiety levels.

scholarly journals Imaging of Joint and Soft Tissue Involvement in Systemic Lupus Erythematosus

2021 ◽  
Vol 23 (9) ◽  
Author(s):  
Andrea Di Matteo ◽  
Gianluca Smerilli ◽  
Edoardo Cipolletta ◽  
Fausto Salaffi ◽  
Rossella De Angelis ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Soft Tissue ◽  
Lupus Erythematosus ◽  
Structural Damage ◽  
Structural Changes ◽  
Soft Tissues ◽  
Imaging Techniques ◽  
Joint Involvement ◽  
Systemic Lupus ◽  
Muscle Involvement

Abstract Purpose of Review To highlight the potential uses and applications of imaging in the assessment of the most common and relevant musculoskeletal (MSK) manifestations in systemic lupus erythematosus (SLE). Recent Findings Ultrasound (US) and magnetic resonance imaging (MRI) are accurate and sensitive in the assessment of inflammation and structural damage at the joint and soft tissue structures in patients with SLE. The US is particularly helpful for the detection of joint and/or tendon inflammation in patients with arthralgia but without clinical synovitis, and for the early identification of bone erosions. MRI plays a key role in the early diagnosis of osteonecrosis and in the assessment of muscle involvement (i.e., myositis and myopathy). Conventional radiography (CR) remains the traditional gold standard for the evaluation of structural damage in patients with joint involvement, and for the study of bone pathology. The diagnostic value of CR is affected by the poor sensitivity in demonstrating early structural changes at joint and soft tissue level. Computed tomography allows a detailed evaluation of bone damage. However, the inability to distinguish different soft tissues and the need for ionizing radiation limit its use to selected clinical circumstances. Nuclear imaging techniques are valuable resources in patients with suspected bone infection (i.e., osteomyelitis), especially when MRI is contraindicated. Finally, dual energy X-ray absorptiometry represents the imaging mainstay for the assessment and monitoring of bone status in patients with or at-risk of osteoporosis. Summary Imaging provides relevant and valuable information in the assessment of MSK involvement in SLE.

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