Questionnaire for pediatric rheumatology experts on initial diagnostic investigations for systemic juvenile idiopathic arthritis

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  • 全身型若年性特発性関節炎の初発時の検査の考察 〜専門家へのアンケート調査を踏まえて
  • ゼンシンガタ ジャクネンセイ トクハツセイ カンセツエン ノ ショハツジ ノ ケンサ ノ コウサツ : センモンカ エ ノ アンケート チョウサ オ フマエテ

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Abstract

Currently, there are no specific diagnostic investigations for systemic juvenile idiopathic arthritis （s-JIA）. Various investigations are considered when making a differential diagnosis. During the 5th Pediatric Rheumatology Workshop held in 2017, we interviewed 17 Japanese pediatric rheumatology experts about the investigations they conduct in the initial diagnostic process for s-JIA. Bone marrow aspiration was preferred by 82％ of experts. Routine use of joint magnetic resonance imaging and measurement of serum IL-18 for an initial diagnostic approach appeared to be controversial. Fluorodeoxyglucose-positron emission tomography or Gallium scintigraphy were not frequently conducted. Although each investigation was known to play a certain role in the diagnosis of s-JIA, they were often not conducted for reasons such as radiation exposure, invasiveness, availability of the investigation in that hospital, and health insurance coverage. In addition, investigations necessary for diagnosis should be selected on an individual basis because patients with s-JIA show diverse initial manifestations. There was consensus among the experts that exclusion of malignancy is important when diagnosing s-JIA； therefore, selected investigations should be performed carefully.

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