Imaging assessment of children presenting with suspected or known juvenile idiopathic arthritis : ESSR-ESPR points to consider

Juvenile idiopathic arthritis (JIA) is the most common paediatric rheumatic disease. It represents a group of heterogenous inflammatory disorders with unknown origin and is a diagnosis of exclusion in which imaging plays an important role. JIA is defined as arthritis of one or more joints that begins before the age of 16 years, persists for more than 6 weeks and is of unknown aetiology and pathophysiology. The clinical goal is early suppression of inflammation to prevent irreversible joint damage which has shifted the emphasis from detecting established joint damage to proactively detecting inflammatory change. This drives the need for imaging techniques that are more sensitive than conventional radiography in the evaluation of inflammatory processes as well as early osteochondral change. Physical examination has limited reliability, even if performed by an experienced clinician, emphasising the importance of imaging to aid in clinical decision-making. On behalf of the European Society of Musculoskeletal Radiology (ESSR) arthritis subcommittee and the European Society of Paediatric Radiology (ESPR) musculoskeletal imaging taskforce, based on literature review and/or expert opinion, we discuss paediatric-specific imaging characteristics of the most commonly involved, in literature best documented and clinically important joints in JIA, namely the temporomandibular joints (TMJs), spine, sacroiliac (SI) joints, wrists, hips and knees, followed by a clinically applicable point to consider for each joint. We will also touch upon controversies in the current literature that remain to be resolved with ongoing research

Predictive factors in the long term outcome in gastro-oesophageal reflux disease: six years follow up of 107 patients

There is little information concerning the long term outcome of patients with gastro-oesophageal reflux disease (GORD). Thus 109 patients with reflux symptoms (33 with erosive oesophagitis) with a diagnosis of GORD after clinical evaluation and oesophageal testing were studied. All patients were treated with a stepwise approach: (a) lifestyle changes were suggested aimed at reducing reflux and antacids and the prokinetic agent domperidone were prescribed; (b) H2 blockers were added after two months when symptoms persisted; (c) anti-reflux surgery was indicated when there was no response to (b). Treatment was adjusted to maintain clinical remission during follow up. Long term treatment need was defined as minor when conservative measures sufficed for proper control, and as major if daily H2 blockers or surgery were required. The results showed that one third of the patients each had initial therapeutic need (a), (b), and (c). Of 103 patients available for follow up at three years and 89 at six years, respective therapeutic needs were minor in 52% and 55% and major in 48% and 45%. Eighty per cent of patients in (a), 67% in (b), and 17% in (c) required only conservative measures at six years. A decreasing lower oesophageal sphincter pressure (p < 0.001), radiological reflux (p = 0.028), and erosive oesophagitis (p = 0.031), but not initial clinical scores, were independent predictors of major therapeutic need as shown by multivariate analysis. The long term outcome of GORD is better than previously perceived

Esofagite por refluxo e laringite por refluxo: Estágios clínicos diferentes da mesma doença? Reflux esophagitys and reflux laryngitis: Different stages of the same disease?

Introdução: O refluxo gastro-esofágico (RGE) é uma entidade decorrente de falha anatômica e/ou funcional dos mecanismos de contenção do conteúdo gástrico. As manifestações otorrinolaringológicas do RGE são globus em orofaringe, regurgitação, disfonia, pirose orofaríngea, disfagia e tosse crônica. Objetivo: Pretende-se avaliar os sintomas otorrinolaringológicos do refluxo em pacientes com indicação cirúrgica de hérnia hiatal e comparar com pacientes apenas com queixas laríngeas do RGE. Forma de Estudo: prospectivo clínico randomizado. Material e método: Foram avaliados dois grupos. O grupo A, com 18 pacientes admitidos nos Serviços de Cirurgia do Aparelho Digestivo e Cirurgia Geral que necessitavam de tratamento cirúrgico de esofagite graus III e IV, quanto aos sintomas otorrinolaringológicos do RGE. O grupo B, com 44 pacientes do Serviço de Otorrinolaringologia com queixas laríngeas de RGE. Os pacientes foram submetidos a um protocolo, videolaringoscopia e endoscopia digestiva alta (EDA). Os dados obtidos foram tabulados e comparados com a literatura. Resultados: Os sintomas referidos pelos pacientes do grupo B foram os mesmos do grupo A, porém, disfonia, tosse, regurgitação e pirose em orofaringe foram mais prevalentes no grupo B. As alterações laringoscópicas dos pacientes do grupo B foram mais significativas. As alterações de EDA foram mais prevalentes nos pacientes do grupo A. A partir destes dados nota-se que não existe correlação entre a doença esofageana e os sintomas laríngeos. Conclusão: O trabalho demonstrou a correlação entre sintomas otorrinolaringológicos e o refluxo gastro-esofágico, porém a comparação entre os dois grupos permitiu concluir que, apesar dos quadros apresentarem fisiopatologia semelhante, não se tratam de estágios evolutivos da mesma doença.<br>Introduction: Gastroesophageal reflux disease (GRD) is an entity due to anatomical or functional failure of contention mechanisms of gastric content. Otolaryngology manifestations of GRD are oropharynx globus, dysphonia, oropharyngeal pirosis, dysfagia, chronic cough. The research intends to evaluate the otolaryngology symptoms of reflux in patients with surgical indication of hiatal hernia and compare the patients’ complaints. Study design: prospective clinical randomized. Material and method: The patients were divided in two groups. Group A, with 18 patients admitted in the General Surgery Service with surgical treatment indication for esophagitys, degrees III and IV and group B, with 40 patients of the Otolaryngology Service with reflux laryngitis complaints. Patients were submitted to a protocol, videolaryngoscopy and upper endoscopy (UE). Obtained data were tabulated and compared to the literature. Results: Symptoms referred by the patients of group B were the same of the group A, but dysphonia, cough, oropharynx pirosis were more prevalent in group B. The laryngoscopic evaluation of group B has shown more altered findings than group A. Altered UE were more prevalent in patients of the group A. Considering the results it is possible to verify that the degree of esophageal disease has no correlation with laryngeal disease. Conclusion: The comparison among the two groups allowed concluding that, despite the similarity of the clinical picture and fisiopatology, the gastroesophageal reflux and the laryngeal reflux must not be considered different stages of the same disease

Imaging assessment of children presenting with suspected or known juvenile idiopathic arthritis: ESSR-ESPR points to consider

Abstract: Juvenile idiopathic arthritis (JIA) is the most common paediatric rheumatic disease. It represents a group of heterogenous inflammatory disorders with unknown origin and is a diagnosis of exclusion in which imaging plays an important role. JIA is defined as arthritis of one or more joints that begins before the age of 16 years, persists for more than 6 weeks and is of unknown aetiology and pathophysiology. The clinical goal is early suppression of inflammation to prevent irreversible joint damage which has shifted the emphasis from detecting established joint damage to proactively detecting inflammatory change. This drives the need for imaging techniques that are more sensitive than conventional radiography in the evaluation of inflammatory processes as well as early osteochondral change. Physical examination has limited reliability, even if performed by an experienced clinician, emphasising the importance of imaging to aid in clinical decision-making. On behalf of the European Society of Musculoskeletal Radiology (ESSR) arthritis subcommittee and the European Society of Paediatric Radiology (ESPR) musculoskeletal imaging taskforce, based on literature review and/or expert opinion, we discuss paediatric-specific imaging characteristics of the most commonly involved, in literature best documented and clinically important joints in JIA, namely the temporomandibular joints (TMJs), spine, sacroiliac (SI) joints, wrists, hips and knees, followed by a clinically applicable point to consider for each joint. We will also touch upon controversies in the current literature that remain to be resolved with ongoing research. Key Points: • Juvenile idiopathic arthritis (JIA) is the most common chronic paediatric rheumatic disease and, in JIA imaging, is increasingly important to aid in clinical decision-making. • Conventional radiographs have a lower sensitivity and specificity for detection of disease activity and early destructive change, as compared to MRI or ultrasound. Nonetheless, radiography remains important, particularly in narrowing the differential diagnosis and evaluating growth disturbances. • Mainly in peripheral joints, ultrasound can be helpful for assessment of inflammation and guiding joint injections. In JIA, MRI is the most validated technique. MRI should be considered as the modality of choice to assess the axial skeleton or where the clinical presentation overlaps with JIA. © 2020, The Author(s)