JUVENILE CHRONIC ARTHRITIS - IMAGING OF THE KNEES AND HIPS BEFORE ANDAFTER INTRAARTICULAR STEROID INJECTION

Intraarticular steroid therapy in juvenile chronic arthritis (JCA) is performed because of high local efficacy with few side effects. Imagin g is used for initial evaluation and for monitoring of treatment respo nse. The aim of this study was to compare imaging findings in diseased hips and knees before and after therapy. A prospective study was perf ormed on 10 patients (15 joints) scheduled for intraarticular therapy. Pretherapeutic assessment included clinical work-up, radiographs, ult rasound (US), and magnetic resonance imaging (MRI) of affected joints. Following therapy, clinical and sonographic examinations were perform ed at 1 week and 1 month. MRI was repeated at 1 month. MRI and US demo nstrated pannus formation and effusion, but differentiation was less d istinct on US. Popliteal cysts and lymph nodes were visible in both mo dalities. MRI additionally revealed articular cartilage loss and subch ondral cysts, not shown by US. Epiphyseal overgrowth and osteopenia we re best seen radiographically. At present MRI is the best tool to asse ss the inflammatory changes of the joints in JCA. Initial staging of t he joints may be done with plain films and MRI. US is useful to assess effusion and pannus and may be used to monitor treatment response.