Background Juvenile idiopathic arthritis (JIA) may lead to structural damage. Yet radiographic assessment is seldom considered in studies.
Objectives To provide pragmatic guidelines concerning conventional radiography (CR) in each subtype of JIA (exclusion of systemic JIA).
Methods A multidisciplinary task force of 15 French experts (rheumatologists, pediatricians, radiologists) plus one patient's representative, was convened. Following the GRADE1 method, they formulated a series of research questions concerning CR assessment, at diagnosis and follow-up of each subtype of JIA. Systemic JIA was ruled out. A systematic literature review was conducted, considering articles in which structural damage was detailed (erosion, joint space narrowing, bone deformities). A series of recommendations was elaborated, following evidence-based data, and expert opinion. It underwent an evaluation from an independant committee (including patient's representative), and a final round of Delphi-voting process from the whole expert group.
Results Of 646 publications identified, 73 original articles were included. The task force produced 4 principles and 31 recommendations. Level of evidence ranked from B to D, level of agreement was high. The experts insisted on weighing indication of CR considering structural risk. The importance of assessing structural progression, the need for constant attention to radioprotection were asserted. Systematic CR of hands and feet are thus recommended in polyarthritis JIA rheumatoid factor positive, and in polyarticular JIA with pejorative prognostic factors. Systematic CR are not recommended in oligoarticular JIA. CR is not the prime imaging technique of the axial skeleton.
Conclusions These are the first pragmatic recommendations upon CR in JIA. They mostly rely on experts' opinion, due to lack of evidence-based data. CR is still relevant in many situations in JIA, but should not be overlooked, while non-irradiating imagine techniques are developing.
Brożek JL, Akl EA, Compalati E, Kreis J, Terracciano L, Fiocchi A, et al. Grading quality of evidence and strength of recommendations in clinical practice guidelines part 3 of 3. The GRADE approach to developing recommendations. Allergy. 2011 May;66(5):588–95.
Acknowledgements Dr Bouchra Amine, Pr Nathalie Boutry, Pr Rolando Cimaz, Pr Bernard Combe, Dr Véronique Despert, M William Fahy and Mrs Céline Obert (association KOURIR), Dr Laurence Goumy, Pr Michael Hofer, Dr Laëtitia Houx, Dr Sylvie Jean, Dr Valérie Merzoug, Pr Michel Panuel, Pr Samira Rostom, Pr Jean Sibilia; the French Society for Rheumatology, the French Society for Radiology, The French Society for Pediatric and antenatal Imaging.
Disclosure of Interest None declared