FIGURE 101.8 Radiograph showing features of juvenile idiopathic arthritis, including soft tissue swelling, bony overgrowth, and periarticular osteopenia adjacent to affected joints Radiographic features of JIA include soft tissue swelling and periarticular osteopenia adjacent to affected joints ( Fig 101.8 ) Later, narrowing of the joint spaces, bony cysts, erosions, subluxations, and ankylosis may be seen In children in whom physical examination is difficult or inconclusive, ultrasonography may confirm the presence of a joint effusion, and MRI, now increasingly done without contrast, may show both synovial proliferation and increased fluid in the joint space Management General Management