Consider the wrist: a retrospective study on pediatric connective tissue disease with MRI

Area of Science:

• Pediatric Rheumatology
• Musculoskeletal Imaging
• Connective Tissue Diseases

Background:

• Connective tissue diseases (CTDs) in children often present with musculoskeletal symptoms.
• Assessing disease activity and joint involvement in pediatric CTDs can be challenging.
• Wrist involvement is common but may not always correlate with clinical disease severity.

Purpose of the Study:

• To characterize the clinical features and wrist magnetic resonance imaging (MRI) findings in children with CTD and musculoskeletal involvement.
• To evaluate the utility of MRI in detecting subclinical inflammation in pediatric CTDs.
• To determine the extent of inflammatory and osteochondral abnormalities in pediatric CTD wrist involvement.

Main Methods:

• Retrospective chart review for clinical data and prospective data collection for MRI findings.
• Analysis of wrist MRI datasets from ten pediatric patients diagnosed with CTD.
• Consensus evaluation of MRI findings by three readers, assessing synovitis, tenosynovitis, bone marrow changes, bone erosions, and myositis.

Main Results:

• Seven out of ten patients showed extensive inflammatory abnormalities, including synovitis and tenosynovitis, on wrist MRI.
• Despite low clinical arthritis activity scores, significant subclinical inflammation was detected.
• Osteochondral involvement was observed in three patients, indicating potential for joint damage.

Conclusions:

• Wrist MRI is a valuable tool for detecting significant subclinical inflammation in pediatric CTDs.
• Clinicians should consider the wrist as a vulnerable site for joint damage in these patients.
• MRI can aid in the comprehensive management of pediatric CTD patients with musculoskeletal involvement.