Juvenile Arthritis: Current Treatment and Future Advances

Our research with advanced imaging aims to help the children suffering from juvenile arthritis that we are treating today, as well as children in the future.

Though rare, arthritis in children is extremely debilitating. For this reason, it is a subject to which I have dedicated a great deal of attention as a pediatric radiologist. In juvenile arthritis, the immune system attacks the joints and they lose mobility and function. The joints become red, swollen and eventually they fuse. This fusion limits their ability to move.

It is encouraging to work with the world’s leaders in juvenile arthritis research and treatment. In our roles, we have the privilege of witnessing advances in the field. These advances are making a difference in the lives of the juvenile arthritis patients today and bringing hope to children of the future.

As specialists in Pediatric Radiology, we work with pediatric rheumatologists to help diagnose juvenile arthritis through a variety of imaging techniques, including MRI, radiographs, ultrasound, and sometimes CT.  We are also testing exciting new imaging approaches including PET-MRI, a new hybrid imaging technology that incorporates magnetic resonance imaging (MRI) and positron emission tomography (PET) functional imaging. The state-of-the-art PET-MRI equipment and technical team at UCSF allows us to look at smaller joints with more clarity and lower dose radiation.

Accurate diagnosis is extremely important as arthritis is difficult to treat, and our scans, along with clinical and lab reports, are integrated into the final diagnosis. The imaging results are then used to precisely diagnose and treat juvenile arthritis. We focus on getting the information necessary, while using the lowest radiation exposure.

Imaging guidance is used for treatment, in addition to diagnosis of arthritis. At UCSF, we use image-guided technologies to inject medication directly into patients’ affected joints. This is critical for juvenile patients because it provides an alternative to systemic medicine, a type of treatment that goes throughout the entire body. By targeting medication delivery, we make it less invasive to the body, and more effective in treating the arthritis.

It is my hope that in the future there will be tools to help patients even more effectively than we can today. We are studying the next advances in arthritis diagnosis and treatment monitoring through our research. The PET/MRI research is one area of intense focus where we hope to help children with JIA and adults with rheumatoid arthritis. This represents the next generation of imaging and helps us to understand the function of the disease and to precisely identify the activity of a child's immune system. This new imaging modality will positively impact the quality of treatments going forward.

John MacKenzie, MD is an Associate Professor in Residence, Chief of Radiology at UCSF Mission Bay Medical Center, and Section Chief of Pediatric Radiology. He is a nationally recognized expert in the imaging of the pediatric musculoskeletal system and his research focuses on developing imaging techniques for the detection and treatment monitoring of autoimmune diseases of the bones and joints.