A 17 year old with isolated proximal tibiofibular joint arthritis

Abstract The proximal tibiofibular joint (TFJ) is rarely affected in rheumatic diseases, and we frequently interpret pain of the lateral knee as the result of overuse or trauma. Nonetheless, the TFJ is a synovial joint that communicates with the tibiofemoral joint in a proportion of patients. While proximal TFJ arthritis has been rarely associated with existing spondyloarthritis, isolated TFJ arthritis as the presenting manifestation of spondyloarthritis has not yet been described. Here, we report the clinical and radiographic presentation of an adolescent with chronic proximal TFJ arthritis heralding spondyloarthritis highly suggestive of ankylosing spondylitis.</p

Radiographs in screening for sacroiliitis in children: what is the value?

Abstract Background We aimed to evaluate the diagnostic utility of pelvic radiographs versus magnetic resonance imaging (MRI) of the sacroiliac joints in children with suspected sacroiliitis. Methods This was a retrospective cross-sectional study of children with suspected or confirmed spondyloarthritis who underwent pelvic radiograph and MRI within 6 months of one another. Images were scored independently by five raters. Interrater reliability was calculated using Fleiss’s kappa coefficient (κ). Test properties of radiographs for depiction of sacroiliitis were calculated using MRI global sacroiliitis impression as the reference standard. Results The interrater agreement for global impression was κ = 0.34 (95% CI 0.19–0.52) for radiographs and κ = 0.72 (95% CI 0.52–0.86) for MRI. Across raters, the sensitivity of radiographs ranged from 25 to 77.8% and specificity ranged from 60.8 to 92.2%. Positive and negative predictive values ranged from 25.9 to 52% and from 82.7 to 93.9%, respectively. The misclassification rate ranged from 6 to 17% for negative radiographs/positive MRI scans and from 48 to 74% for positive radiographs/negative MRI scans. When the reference standard was changed to structural lesions consistent with sacroiliitis on MRI, the misclassification rate was higher for negative radiographs/positive MRI scans (9–23%) and marginally improved for positive radiographs/negative MRI scans (33–52%). Conclusion Interrater reliability of MRI was superior to radiographs for global sacroiliitis impression. Misclassification for both negative and positive radiographs was high across raters. Radiographs have limited utility in screening for sacroiliitis in children and result in a significant proportion of both false negative and positive findings versus MRI findings

Feasibility and reliability of the Spondyloarthritis Research Consortium of Canada sacroiliac joint inflammation score in children

Abstract Background Published methods for quantification of magnetic resonance imaging (MRI) evidence of inflammation in the sacroiliac joint lack validation in pediatric populations. We evaluated the reliability and construct validity of the Spondyloarthritis Research Consortium of Canada (SPARCC) sacroiliac joint inflammation score (SIS) in children with suspected or confirmed juvenile spondyloarthritis (JSpA). Methods The SPARCC SIS measures the presence, depth, and intensity of bone marrow inflammation on MRI through the cartilaginous part of the joint. Six readers blinded to clinical details except age, participated in two reading exercises, each preceded by a calibration exercise. Inter-observer reliability was assessed using intraclass correlation coefficients (ICCs) and for pre-specified acceptable reliability the inraclass correlation coefficient (ICC) was > 0.8. Results The SPARCC SIS had face validity and was feasible to score in pediatric cases in both reading exercises. Cases were mostly male (64%) and the median age at the time of imaging was 14.9 years. After calibration, the median ICC across all readers for the SIS total score was 0.81 (IQR 0.71–0.89). SPARCC SIS had weak correlation with disease activity (DA) as measured by the JSpADA (r = − 0.12) but discriminated significantly between those with and without elevated C-reactive protein (p = 0.03). Conclusion The SPARCC SIS was feasible to score and had acceptable reliability in children. The ICC improved with additional calibration and reading exercises, for both experienced and inexperienced readers

Interrater Reliability and Age-Based Normative Values for Radiographic Indices of the Ankle Syndesmosis in Children

Background:. While recent research has investigated the normative values, discriminative capacity, and interrater reliability of radiographic indices for the evaluation of the syndesmosis in adults, no such data exist for children. The purposes of the present study were (1) to determine the interrater reliability of common radiographic measures of syndesmosis and deltoid ligament competency in children and (2) to establish age-based normative values. Methods:. A consecutive series of patient radiographs from a Level-I pediatric trauma center were identified and were used to create an age and sex-balanced cohort of 282 patients. Subjects between 2 and 17 years of age were randomly selected from a pool of patients who had a complete 3-view (anteroposterior, lateral, and mortise) radiographic ankle series and a final diagnosis without osseous or ligamentous injury. Eight age and sex-balanced groups were created for analysis. Three independent raters evaluated all radiographs and recorded radiographic indices that are commonly used for the evaluation of ankle trauma: width of medial clear space, width of superior clear space, tibiofibular clear space, tibiofibular overlap, and medial clear space/superior clear space ratio. Interrater reliability was calculated with use of the intraclass correlation coefficient (ICC); means and standard deviations were used to report age-group normative values. Results:. Two hundred and eighty-two patients (mean age [and standard deviation], 9.6 ± 4.6 years) were analyzed. The superior clear space and tibiofibular overlap demonstrated excellent interrater reliability (ICC = 0.915 and 0.964, respectively), the medial clear space and tibiofibular clear space demonstrated substantial agreement (ICC = 0.656 and 0.635, respectively), and the medial clear space/superior clear space ratio demonstrated moderate agreement (ICC = 0.418). The medial clear space could not be reliably measured until the age of 8 years because of insufficient ossification of the medial malleolus. Tibiofibular overlap demonstrated a linear increase over time, ranging from −1.4 mm in 2 and 3-year-old patients to 6.7 mm in 16 and 17-year-old patients (R2 = 0.995). Normative values varied by age and sex. Conclusions:. The medial clear space and medial clear space/superior clear space ratio could not be reliably assessed for children under 8 years of age and were thus characterized by suboptimal interrater reliability. Tibiofibular overlap had excellent interrater agreement, changed predictably with skeletal growth, and may be useful for future research as well as the clinical assessment of pediatric ankle injuries to guide clinical decision-making. Level of Evidence:. Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence