MRI Findings in Hip in Juvenile Idiopathic Arthritis

The aim of this study was to evaluate if magnetic resonance imaging allows hip arthritis in JIA to be differentiated from hip arthralgia of unknown etiology in juveniles clinically suspected for hip arthritis. This was a retrospective observational study which included 97 children with clinically suspected hip arthritis. Each hip was assessed and scored in MRI for signs of active and destructive inflammatory lesions and developmental lesions. MRI findings between JIA-confirmed patients and without final diagnosis of JIA were compared and the MRI summarized score was calculated, as the sum of scorings of all 24 hip lesions in an individual patient (i.a., effusion, synovitis, bone marrow edema, enthesitis). MRI showed at least one lesion in the majority of patients (95 patients; 98%). Effusion was the most common feature, followed by bone marrow oedema and synovitis. All lesions were more common in patients with a final diagnosis of JIA, especially synovitis and enthesitis (p = 0.037 and p = 0.047). The MRI summarized score was significantly higher in the JIA group than the non-JIA group: 3 (2–5) vs. 2 (2–2), respectively, p = 0.002. Using a cut-off score of 6, the MRI summarized score showed 25% sensitivity and 100% specificity indicating a good ability in discriminating hip arthritis during JIA from non-JIA patients. MRI allows hip arthritis in JIA to be differentiated from hip arthralgia of unknown etiology with good specificity, thus, may be helpful in confirming the diagnosis of JIA.

The Clinical and MRI Effect of TNF-α Inhibitors in Spondyloarthritis Patients With Hip Involvement: A Real-World Observational Clinical Study

ObjectivesHip involvement is an important cause of disability and poor prognosis in patients with spondyloarthritis (SpA). Tumor necrosis factor (TNF)-α inhibitor treatment has been demonstrated to be effective in SpA patients with hip arthritis; however, quantitative assessment using MRI in long-term follow-up needs further application and observation.MethodsA total of 239 patients were involved in this study. Methotrexate and sulfasalazine were given as basic treatment. In total, 165 patients received TNF-α inhibitors plus basic treatment, and 74 received basic treatment only, as controls. Clinical symptoms were assessed at baseline and at weeks 12, 24, and 52. MRI performances of hip arthritis, including bone marrow edema (BME) and synovitis, were quantitatively assessed using the Hip Inflammation MRI Scoring System (HIMRISS).ResultsThe clinical values of erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Harris hip score, and Ankylosing Spondylitis Disease Activity Score (ASDAS)-ESR in both groups showed significant clinical remission at week 52 (p < 0.001). However, the change in disease activity levels at week 52 in the control group was significantly worse than in the TNF-α inhibitor group. At week 52, MRI showed a significant remission trend in the TNF-α inhibitor group versus baseline, and total HIMRISS scores were significantly decreased (26.49 ± 10.37 vs. 20.59 ± 9.41, p < 0.001); the control group only had slight improvement (p < 0.05).ConclusionsTNF-α inhibitors could significantly improve clinical and MRI manifestations of hip involvement in patients with SpA. Quantitative MRI assessment combined with clinical assessment can be used to accurately evaluate the treatment effect of TNF-α in SpA patients with hip involvement to help guide targeted treatment.

The importance of lower extremity involvement type on exercise performances, function, and quality of life in peripheral predominant forms of juvenile idiopathic arthritis

Background Juvenile idiopathic arthritis (JIA) can cause reduced exercise capacity, deterioration in functional activities, and poor health-related quality of life. This study aims to objectively reveal lower extremity involvement in the peripheral predominant forms of juvenile idiopathic arthritis through qualitative evaluations and to determine the effects of these involvements on exercise, function, and quality of life. Methods Thirty-two patients with a history of peripheral arthritis and aged between 7 and 16 years participated in the study. Demographics, JIA subtype, disease duration, arthritis and deformities of the lower extremity, disease activity score, 6-min walk test (6MWT), cycling exercise test (CYC-E), childhood health assessment questionnaire (CHAQ), and pediatric quality of life inventory (PedsQoL) scores were recorded. In case of clinical suspicion of arthritis, an ultrasonographic examination was performed for a definitive diagnosis. Regression analyses were performed to explore the most associated lower extremity involvement and patient characteristics for each of the dependent variables including 6MWT, CYC-E, CHAQ, and PedsQoL. Results Of the total number of patients, with a mean age of 12.91 (SD 2.37) years, 28.1% had knee arthritis, 15.6% foot arthritis, 12.5% hip arthritis, and 37.5% lower extremity deformity. The parameters that were most associated with CHAQ and PedsQoL were hip and knee arthritis, whereas CYC-E was found to be most associated with knee arthritis and height, and 6MWT was found to be most associated with hip arthritis, knee arthritis, and demographic characteristics. Conclusion This study emphasizes the importance of hip and knee arthritis, which are among the determinants of walking endurance, function, and quality of life; and knee arthritis, which is among the determinants of cycling performance in JIA with lower extremity involvement.

Novel Use of the Muscle Sparing Anterolateral Approach for Septic Arthritis of the Native Hip Joint in an Adult: A Case Report

Introduction: Septic arthritis of a native hip is a relatively uncommon condition in adults. Prompt diagnosis and treatment of septic hip arthritis are imperative to preserve joint integrity, as failure to quickly intervene can allow rapid degenerative changes. Case Report: This is a case report of a 50-year-old male that presented with right septic hip arthritis in the acute setting. He complained of pain with attempted range of motion and log-roll. Laboratory workup demonstrated no leukocytosis, but elevated inflammatory markers. A hip aspiration under fluoroscopy was performed, revealing a cell count of 100,600/cm3 with 91% neutrophils. His right hip underwent irrigation and debridement with a muscle-sparing anterolateral approach (Rottinger). Conclusion: This case report describes the successful use of the anterior based muscle-sparing approach for incision and drainage of septic arthritis of the native hip joint in an adult patient. Advantages to this strategy include lower rate of nerve injury compared to classical anterior and lateral approaches, less muscle damage than the posterior approach, and no requirement for special skills or equipment as in the case of hip arthroscopy. Keywords: Septic arthritis, anterior based muscle sparing and anterolateral