Wrist Arthritis in Juvenile Idiopathic Arthritis: Disease Burden, MRI-Guided Management, and Joint Damage in a Pediatric Cohort

Abstract

Background: Wrist involvement in juvenile idiopathic arthritis (JIA) is associated with a more aggressive disease course and poorer long-term outcomes. However, data integrating imaging findings, treatment decisions, and procedural outcomes remains limited. Methods: We conducted a single-center retrospective cohort study of children with JIA and wrist involvement managed at a tertiary pediatric rheumatology center between 2014 and 2019. Clinical, treatment, and imaging data were collected, including magnetic resonance imaging (MRI) findings and their impact on management. Outcomes included disease activity, structural damage, and response to arthroscopic synovectomy. Results: Eighty-eight patients were included (81% female), with a mean age at diagnosis of 6.0 ± 4.5 years. Wrist involvement was present at diagnosis in 68% and became bilateral in 75%. In the overall cohort, the median time to wrist synovitis was 0 months, while the mean was 15 months, reflecting delayed onset in a subset of patients. MRI was performed in 55 patients (163 scans) and influenced management in approximately two-thirds of cases, prompting treatment escalation or modification, while preventing unnecessary escalation in one-third by demonstrating established damage. Erosive changes were detected early, with a median time of approximately 2.5–3 years from diagnosis. Most patients (88%) required biologic therapy, and 34% required two or more biologics. Twelve patients (14%) underwent arthroscopic synovectomy, with approximately half demonstrating improvement in pain and function and no perioperative complications. Conclusions: Wrist arthritis in JIA represents a severe disease phenotype characterized by early bilateral involvement, high treatment burden, and frequent structural damage. MRI plays a central role in distinguishing active inflammation from irreversible damage and directly informs clinical decision-making. Arthroscopic synovectomy appears to be a safe adjunct for selected refractory cases. These findings support the integration of structured imaging strategies into the management of high-risk joints in JIA.

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