Arthritis, a condition of inflammation causing joint pain and stiffness, is not just a disease of adulthood. It can affect children also.
Image: MRI image of an ankle, sagittal view, showing inflamed tendon sheath, area of arthritis pain.
July is Juvenile Arthritis Awareness Month. Nearly 1 in 1,000 children will develop some type of juvenile arthritis, most commonly juvenile idiopathic arthritis (JIA). The underlying cause is not precisely known, but the result is a malfunction of the immune system that causes inflammation of the lining of the joints and tendon. Most commonly this affects the knee, ankle, or wrist.
Related article: Front Knee Pain: A Common Symptom In Children
A pediatric bone and joint doctor (rheumatologist) is the specialist who usually cares for children with JIA. A variety of medical treatments are available, including steroids that can be given orally or injected into the affected joint. Achieving a state of disease inactivity or remission is the goal of therapy, but this can be difficult to confirm on examination in up to 30% of patients. Also, superimposed injury may confound this assessment.
Image: Ultrasound image of ankle, inflamed tendon sheath marked in yellow, showing area of arthritis pain.
MRI provides the most detailed evaluation of joints, but it requires injection of contrast in a vein, and usually only one joint can be imaged at a time. Ultrasound affords the ability to see inside joints and tendons closer to the skin surface and assess for inflammation using color Doppler imaging without the need for contrast injection. The presence or absence of fluid inside the joint or about the overlying tendons is readily seen and dynamic evaluation is easily performed. This can help to confirm remission and help sort out whether joint swelling is due to arthritis or injury. Patients and parents can watch as the pictures are obtained and actively participate in the examination. At Cincinnati Children’s, ultrasound is being increasingly used to help guide therapeutic injections, confirm remission of disease, or assess disease activity in patients with joint symptoms.
Contributions by Dr. Kathleen Emery and edited by Catherine Leopard (CLS).