Working with juvenile idiopathic arthritis

In this thesis, multiple interpretations of the phrase “working with juvenile idiopathic arthritis” were highlighted. The pediatric rheumatologist who works with the patient with JIA, a diagnosis per exclusionem, using diagnostic means which all have their limitations. The radiologist who works with imaging of a developing skeleton of which many aspects are not entirely known. The researcher who works with large amounts of data, often navigating between different opinions and interests of national and international research groups. And, as being the most important player in care and research, the patient who has to work while being afflicted by JIA.
With a multidisciplinary team consisting of pediatric rheumatologists, a pediatric immunologist, musculoskeletal and pediatric radiologists as well as researchers we aim to uncover the truth behind our measurements in juvenile idiopathic arthritis (JIA) consisting of physical examination, laboratory and imaging assessments. As clinicians, the pediatricians and radiologists combine their clinical expertise to define and assess those measurements and their clinical value.
We combined and compared clinical assessment with magnetic resonance imaging (MRI). MRI scoring systems were applied to quantify disease activity in the knee and describe the wrist not affected by JIA. For the ankle a new scoring system is presented. This thesis is concluded by a qualitative study on perspectives and expectations of adolescents with JIA regarding entering the labor market. While creating awareness, the importance of patient-specific management of disease (activity) is put in (the patients’) perspective.