Hello OCAD-
I have a 15 yo female with an established diagnosis of RF negative polyarticular JIA. I don’t see many JIA patients in practice and wondering about her ankle MRI. A prior radiologist reported as PVNS (or now preferred term diffuse TSGCT). While the MRI is certainly reminiscent of diffuse TSGCT/PVNS with dark synovial thickening, it’s odd to me she would have two different processes at play. I’m wondering if the changes on MRI are from chronic JIA with hemosiderin stained synovium or siderotic synovitis? Can JIA patients have recurrent hemoarthrosis or have these changes chronically? Or more of a fibrotic pannus. She has prior wrist and bilateral hip MRIs (not shown), which demonstrate obvious synovitis and erosions more classically JIA (but not the dark synovial thickening like this case). No report of hemophilia. In isolation, I would also think diffuse TSGCT/PVNS but again seems odd to have with concurrent JIA. I believe the orthopedist is considering synovectomy given report of TSGCT/PVNS, although I do not know if synovectomy would be considered regardless given the extent of synovial thickening to help improve function.
Thank you,
Drew
