Although the disease mainly affects peripheral joints, it is classified as a spondyloarthropathy spondyloarthritis. Evaluation is made based on X-ray images in 2 projections AP and Y-gamma and computerized tomography usually with 3D reconstruction. They are usually observed to occur in the carpal, metacarpophalangeal MCP , metatarsal and interphalangeal joints. Considering 3- and 4-part fractures sometimes the only reasonable way of proceeding is humeral hemiarthroplasty. Moreover, certain dilemmas associated with the monitoring of the disease are reviewed. Piśmiennictwo 1.
Radiography is the primary modality employed in the diagnostic imaging in order to identify changes typical of this disease entity and rule out other bone-related pathologies, such as Trauma Shoulder Sustain Klasyfikacja, posttraumatic changes, developmental defects and other forms of arthritis.
The standard procedure involves the performance of comparative joint radiographs in two planes.
Radiographic changes in juvenile idiopathic arthritis are detected in later stages of the disease. Bone structures are assessed in the first place. Radiographs can also indirectly indicate the presence of soft tissue inflammation i.
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Signs of articular cartilage defects are also seen in radiographs indirectly — based on joint space width changes. The first part of the publication presents the classification of juvenile idiopathic arthritis and discusses its radiographic images.
Trauma Shoulder Sustain Klasyfikacja authors list the affected joints as well as explain the spectrum and specificity of radiographic signs resulting from inflammatory changes overlapping with those caused by the maturation of the skeletal system. Moreover, certain dilemmas associated with the monitoring of the disease are reviewed. The second part of the publication will explain issues associated with ultrasonography and magnetic resonance imaging, which are more and more commonly applied in Trauma Shoulder Sustain Klasyfikacja idiopathic arthritis for early detection of pathological features as well as the disease complications.
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Młodzieńcze idiopatyczne zapalenie stawów to najczęstsza przewlekła choroba układowa tkanki łącznej wieku rozwojowego o podłożu immunologicznym. Badanie radiograficzne jest pierwszą metodą, od której rozpoczyna się diagnostykę obrazową w celu rozpoznania zmian chorobowych typowych dla tej jednostki, jak również wykluczenia innych patologii kostnych, tj.
Standardowo wykonywane są zdjęcia porównawcze stawów w dwóch projekcjach. Zmiany na radiogramach w przebiegu młodzieńczego idiopatycznego zapalenia stawów są obserwowane w późniejszym okresie choroby.
Ocenie podlegają przede wszystkim struktury kostne. Pośrednio zdjęcie radiograficzne wskazuje na obecność zmian zapalnych także w tkankach miękkich tj. W sposób pośredni — na podstawie zmiany szerokości szpary stawowej — na radiogramach są stwierdzane cechy uszkodzenia chrząstki stawowej.
W pierwszej części publikacji omówiono klasyfikację młodzieńczego idiopatycznego zapalenia stawów oraz przedstawiono obraz radiograficzny tej jednostki chorobowej, wskazując na rodzaj zajętych stawów, spektrum oraz specyfikę zmian radiograficznych wynikającą z nakładania się zmian zapalnych na zmiany spowodowane dojrzewaniem układu kostnego.
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Przedstawiono dylematy związane z monitorowaniem choroby. W drugiej części pracy zostaną omówione badanie ultrasonograficzne i rezonans magnetyczny, które u dzieci i młodzieży są wykonywane coraz częściej w celu wczesnego rozpoznania zmian chorobowych oraz powikłań młodzieńczego idiopatycznego zapalenia stawów. The course of JIA varies and is difficult to predict. The most commonly affected joints include the knees frequently monoarticular onset followed by hands and wrists, hip, ankle and tarsal joints, more rarely tarsometatarsal joints, cervical spine or temporomandibular joints 7 — 9.
The involvement of the wrist, ankle, hip or cervical spine is associated with more severe JIA, worse functionality and a worse response to treatment 9. Patients with polyarthritis are at the greatest risk of disease progression and joint destruction.
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- Imaging of juvenile idiopathic arthritis. Part I: Clinical classifications and radiographs
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Epidemiology JIA can develop at any age in childhood. Data on its incidence are probably underestimated. Nonetheless, they indicate that the incidence of JIA in European children younger than 16 years of age is approximately 3—15 per 1. Etiopathogenesis The etiopathogenesis of the disease is unknown. Genetic predisposition and environmental factors have a significant impact on its development. The genetic predisposition can be associated with sex, class 1 and 2 HLA alleles, cytokine-coding genes, adhesion molecules or signal-transmitting proteins.
Environmental factors include: bacterial and viral infections as well as physical and even mental trauma, which can lead to the breaking of the immune tolerance and development of the disease in predisposed children 1 Since its etiopathogenesis is unknown, the diagnosis is established on the basis of the clinical picture and once other diseases, of so-called exclusion Trauma Shoulder Sustain Klasyfikacja, are ruled out such as infectious, reactive, allergic, toxic arthritis, arthritis Trauma Shoulder Sustain Klasyfikacja other connective tissue conditions and arthropathies in the course of neoplastic, hematologic or autoimmune diseases 1712 Despite the fact that JIA meets the aforementioned criteria, it still remains a heterogeneous group of arthritis which has been divided into several subtypes based on prevailing clinical signs in the first 6 months from the onset and laboratory findings 112 These subtypes are: systemic-onset juvenile idiopathic arthritis; pauciarticular or oligoarticular juvenile idiopathic arthritis oligoarthritisincluding persistent or extended arthritis; polyarticular rheumatoid factor-positive juvenile idiopathic arthritis; polyarticular rheumatoid factor-negative juvenile idiopathic arthritis; psoriatic juvenile idiopathic Lucian wspolny krem enthesitis-related arthritis; other types of arthritis so-called undifferentiated forms in which: the clinical picture of the disease does not meet the criteria for any of the aforementioned type, or the clinical picture combines two or more JIA types.
This form develops equally frequently in boys and girls and can occur at any age. The diagnosis is established based on signs of arthritis in at least one joint with concomitant or preceding fever lasting at least 2 weeks as well as the presence of at least one of the following symptoms: evanescent and erythematous rash, generalized lymphadenopathy, hepato- or splenomegaly or serositis 1.
The knee is usually affected first followed by the ankle joint. In this case, arthritis is asymmetrical. Clinical signs and immune disorders presented by patients with this form of JIA resemble rheumatoid arthritis in adults. This form is usually observed in Trauma Shoulder Sustain Klasyfikacja 1. The clinical picture includes symmetrical polyarthritis in small joints of the hands and feet.
This form of JIA most frequently leads to joint damage. Erosions are detected in radiographs in nearly all children during the first 5 years from the onset. They are usually observed to occur in the carpal, metacarpophalangeal MCPmetatarsal and interphalangeal joints.
Biological therapy delays this process considerably. Severe extra-articular complications of this form of JIA are rare. They include aortic insufficiency 1 and interstitial changes within the lungs.
Acute or chronic uveitis develops sporadically. It is characterized by arthritis in small and large joints.
There are two incidence peaks: between the age of 2 and 4 and between the age of 6— Trauma Shoulder Sustain Klasyfikacja develop this form twice as frequently as boys. Apart from usually symmetrical arthritis in large joints and small joints of the hands and feet, general symptoms, such as: morning stiffness, slightly raised temperature, weakness or weight loss, are observed as well.
Psoriatic arthritis PsA mainly affects small joints of the hands and feet. The ILAR states that this form can be diagnosed when arthritis occurs in conjunction with psoriatic features or psoriasis in a family member parents, siblingsTrauma Shoulder Sustain Klasyfikacja so-called sausage fingers or typical nail changes nail pitting, onycholysis or oil drop sign.
At the onset, the disease is typically oligoarticular, but can develop into asymmetrical polyarthritis. In a half of patients, arthritis precedes psoriasis. In the initial stages of the disease, synovitis is usually observed in the knee, ankle and metatarsophalangeal MTP joints and occurs in conjunction with dactylitis.
Sternoclavicular joints are typically involved 5. Trauma Shoulder Sustain Klasyfikacja is the only form of juvenile idiopathic arthritis found to occur mainly in boys, usually older than 6 years of age. Most patients present with positive HLA-B27 antigen. Apart from arthritis or enthesitis, the condition that must be met for ERA to be identified is the presence of at least two of the following criteria: sacroiliac tenderness on palpation or inflammatory back pain, positive HLA-B27 antigen, arthritis with onset before the age of 6, acute symptomatic uveitis, ankylosing spondylitis, arthritis with enthesitis, sacroiliitis associated with inflammatory bowel disease, reactive arthritis and uveitis in a first-degree relative.
Moreover, psoriasis or its family history in first-degree relatives must be ruled out and IgM RF must be found negative at least twice with a 3-month interval 5.
The most typical sign of this form of JIA is enthesitis, usually involving the attachment of the Achilles tendon to the calcaneal tuberosity and the attachment of the quadriceps muscle to the patella 5.
Furthermore, a clinical examination usually reveals features of oligo- or polyarthritis in, among others, the hip and other joints of the lower limb 1 Although the disease mainly affects peripheral Trauma Shoulder Sustain Klasyfikacja, it is classified as a spondyloarthropathy spondyloarthritis. The classification of JIA presented above, based on the clinical picture in the first months of the disease, raises controversies and therefore attempts have been made to find other markers to define given forms.
An example is the usage of antinuclear antibodies ANA. Imaging Radiography Trauma Shoulder Sustain Klasyfikacja the standard modality in the assessment of JIA. However, it is capable of showing only advanced destructive changes and does not enable early detection of soft tissue inflammation, which can be observed in an ultrasound or magnetic resonance scan which will be discussed in the second part of the publication 216 Early diagnosis enables rapid implementation of treatment that can prevent serious complications in numerous patients.
This mainly concerns the cervical spine, in which ankylosis develops rapidly in children, and peripheral joints, including temporomandibular joints, the involvement of which can lead to facial deformities. Radiographs Imaging in JIA begins with radiography in order to identify typical pathological changes and rule out other bone-related pathologies cancer, trauma, developmental defects, other forms of arthritis 8. Radiographic changes in JIA are observed in late stages of the disease and their progression is usually slow.
The major structures assessed are bones. Signs of articular cartilage defects are also seen in radiographs indirectly — based on changes in joint space width 8. Typical radiographic changes Inflammatory changes in JIA usually involve 7 — 9 : the knee joint frequently with monoarticular onset, which makes it necessary to differentiate with tuberculosis, proliferative process and trauma ; the joints of the wrists and hands; the ankle and tarsal joints, more rarely MTP; the elbow joints.