Table 1

Points to consider, level of evidence, grade of recommendation and level of agreement

Point to considerLevel of evidenceGrade of recommendationLevel of agreement, mean NRS 0–10 (range)
1US and MRI are superior to clinical examination in the evaluation of joint inflammation; these techniques should be considered for more accurate detection of inflammation, in diagnosis and assessing extent of joint involvement.3bC9.07 (6–10)
2When there is clinical diagnostic doubt, CR, US or MRI can be used to improve the certainty of a diagnosis of JIA above clinical features alone.3bC9.43 (9–10)
3If detection of structural abnormalities or damage is required, CR can be used. However MRI or US may be used to detect damage at an earlier time point than CR.3bC8.71 (5–10)
4In JIA imaging may be of particular benefit over routine clinical evaluation when assessing certain joints, particularly the use of MRI in detecting inflammation of the TMJ and axial involvement.3bC9.64 (8–10)
5Imaging in JIA may be considered for use as a prognostic indicator. Damage on CR can be used for the prediction of further joint damage. Persistent inflammation on US or MRI may be predictive of subsequent joint damage.4C9.07 (5–10)
6In JIA, US and MRI can be useful in monitoring disease activity given their sensitivity over clinical examination and good responsiveness. MRI should be considered for monitoring axial disease and TMJ.3bC9.07 (7–10)
7The periodic evaluation of joint damage should be considered. The imaging modality used may be joint dependent.3bC8.29 (5–10)
8US can be used for accurate placement of intra-articular injections.3bC9.64 (8–10)
9US and MRI can detect inflammation when clinically inactive disease is present; this may have implications for monitoring.3bC8.86 (5–10)
  • The level of evidence and grade of recommendation are based on the Oxford Centre for Evidence-Based Medicine system.5

  • Level of evidence scale, 1a–5; grade of recommendation scale; A–D. NRS, numerical rating scale (0–10; 0=do not agree at all, 10=fully agree).

  • CR, conventional radiography; JIA, juvenile idiopathic arthritis; TMJ, temporomandibular joint; US, ultrasound.