As noted in Dr. Cron’s presentation, imaging may be the only accurate way to detect early TMJ arthritis, and it’s important when evaluating for axial skeletal involvement. Dr. Oberle pointed out that common pitfalls in MRI include misinterpreting physiologic variability, such as bone marrow signal changes in healthy children that can resemble marrow edema, and that delay in contrast administration for contrast-enhanced images can result in over-enhancement and false positives.
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Dr. Oberle discussed what the future may hold with regard to imaging for monitoring and assessment of treatment efficacy. Results of imaging modalities, such as ultrasound, can provide helpful information, such as surveillance for presence or absence of effusions, evaluation for joint or tendon enlargement, and assessment for active blood flow within tissue (i.e., a positive Doppler signal indicative of active synovitis).
However, identification of synovial hypertrophy alone does not necessarily mean there is active disease. Synovial hypertrophy may indicate either the start of a flare or represent remnant inflammation from a flare that has resolved. It’s true that imaging can be helpful to monitor for long-term damage, such as erosions, osteophytes, tendon thinning, tears and calcifications. A take-home message from Dr. Oberle’s talk was that imaging should represent one of many data points physicians use to diagnose and treat JIA.
The session as a whole was wide-ranging. By using an evidence-based approach to discuss these issues, the three speakers gave the audience an invaluable gift: insights from bench to bedside that can help refine clinical practice in the care of JIA.
Jason Liebowitz, MD, completed his fellowship in rheumatology at Johns Hopkins University, Baltimore, where he also earned his medical degree. He is currently in practice with Skylands Medical Group, N.J.
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