From the Guidelines
The treatment plan for periarticular foci on a 12-year-old's ankle MRI should initially involve a trial of scheduled nonsteroidal anti-inflammatory drugs (NSAIDs) as part of initial therapy, as conditionally recommended by the 2021 American College of Rheumatology guideline for the treatment of juvenile idiopathic arthritis 1. Given the age of the patient and the presence of periarticular foci, which could be indicative of oligoarticular juvenile idiopathic arthritis (JIA), it is crucial to consider the guidelines for managing oligoarticular JIA.
- The use of NSAIDs is recommended for initial therapy, with the option to add intraarticular glucocorticoids (IAGCs) if necessary, as they are strongly recommended as part of initial therapy 1.
- The choice of NSAID and the dosage should be tailored to the individual patient, considering factors such as pain level and inflammation.
- It is also important to monitor disease activity and adjust the treatment plan accordingly, using validated disease activity measures to guide treatment decisions, especially to facilitate treat-to-target approaches 1.
- If there is inadequate response to scheduled NSAIDs and/or IAGCs, conventional synthetic disease-modifying antirheumatic drugs (DMARDs) such as methotrexate (MTX) are strongly recommended, with MTX being conditionally recommended as a preferred agent over other options like leflunomide (LEF), sulfasalazine (SSZ), and hydroxychloroquine (HCQ) 1.
- Biologic DMARDs may be considered if there is inadequate response to or intolerance of NSAIDs and/or IAGCs and at least one conventional synthetic DMARD, although there is no preferred biologic DMARD 1.
- Regular follow-up and monitoring of the patient's condition, including the use of imaging studies as necessary, are crucial to adjust the treatment plan and ensure the best possible outcome.
From the Research
Periarticular Foci on 12-Year-Old Ankle MRI
Treatment Plan
The treatment plan for periarticular foci on a 12-year-old ankle MRI depends on the underlying condition. Based on the provided evidence, the following are possible treatment plans:
- For osteochondritis dissecans (OCD), the treatment plan may include:
- Conservative therapy for stage I lesions with intact cartilage, contrast enhancement of the lesion, and absent "cystic" defects 2
- Arthroscopy with possible intervention for stage II lesions with cartilage defect, fluid around an undetached fragment, or a dislodged fragment 2
- Lesion excision, excision and curettage, excision combined with curettage and microfracturing, filling the defect with autogenous cancellous bone graft, antegrade (transmalleolar) drilling, retrograde drilling, fixation, and techniques such as osteochondral transplantation or autologous chondrocyte implantation for symptomatic osteochondral lesions 3
- For acute calcific periarthritis, the treatment plan may include:
- Rest and pain management, as the condition is self-limiting and resolves within 3-4 weeks 4
Considerations
When developing a treatment plan, consider the following: