THE OFFICIAL NEWS SOURCE OF ACR CONVERGENCE 2022 • NOVEMBER 10-14



JIA treat-to-target approach more often includes MRI and ultrasound for assessment

Johannes Roth, MD, PhD, FRCPC, RhMSUS
Johannes Roth, MD, PhD, FRCPC, RhMSUS

A Monday ACR session will review the current evidence base for the use of ultrasonography and MRI in the assessment of pediatric rheumatic diseases and the potential benefits of each modality in a treat-to-target approach for juvenile idiopathic arthritis (JIA).

T2T in JIA: Ultrasound vs. MRI will be held from 11:00 am – 12:00 pm in Room W471b.

“The validation of imaging techniques, like ultrasonography and MRI, has made significant progress and we are now at the stage where they can and should be part of the patient assessment at every major decision point,” said Johannes Roth, MD, PhD, FRCPC, RhMSUS, Professor of Pediatrics at the University of Ottawa and Chief of the Division of Pediatric Dermatology and Rheumatology at Children’s Hospital of Eastern Ontario in Canada. “This may be especially important in JIA, as our patients tend to be young, with a peak incidence around the age of two, which limits the abilities of taking reliable histories and detecting disease on clinical exam.”

Joining Dr. Roth for the session will be Clara Malattia, MD, PhD, Pediatric Rheumatologist and Researcher at the University of Genoa in Italy. Both will discuss practical aspects of implementing these technologies into daily clinical practice, as well as the limitations and gaps in knowledge and areas of research to improve the utility of imaging in prognosis and management of JIA.

Dr. Roth said that ultrasonography’s benefits include that it is noninvasive and does not require sedation, which is sometimes necessary with MRI in younger children. Additionally, ultrasonography can assess many joints at the same time without the need for contrast or radiation and can be applied at the point of care with immediate availability of information and correlation with clinical findings.

“While it does not replace the clinical assessment, ultrasonography has the potential to significantly enhance it, which has now been documented in recent literature,” Dr. Roth said. “MRI, on the other hand, still has a specific role in the assessment of joints and structural aspects, such as cartilage assessments, that are not accessible by ultrasonography.”

He said that the utility of ultrasonography and MRI have now been validated to the point where they should be used on a regular basis in conjunction with the clinical assessment to ensure effective disease control and optimal outcomes for patients.

“In addition, imaging is a useful visual tool when explaining findings to patients and parents — abstract concepts like inflammation, for example, can be illustrated particularly well using ultrasonography,” he said.

Dr. Roth believes that clinicians need to educate themselves on how to use these techniques and that imaging should be an essential part of pediatric rheumatology care, as it will allow for more effective tailoring of therapies, ultimately improving outcomes and reducing discomfort for patients.

“It may take some investment in time to acquire the skills, but the timesaving for both providers and patients and their families down the road is significant through a more effective clinical assessment and a more timely decision process,” he said.