PMC9763560_01
Diagram of disease progression, diagnostic evaluation, and therapeutic interventions.
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F1
Imaging examinations. (A) Initial MRI scanning of the right knee [MRI Proton Density with Fat Saturation (PDFS), sagittal plane; MRI T1 weighted image, coronal plane; MRI T1 weighted image, sagittal plane] showed the extended intra-articular synovial proliferation with fat inclusions combined with multiple marginal bony erosion of the proximal tibia, both femoral condyles and patella along with altered morphology of both menisci. (B) Control MRI of both knees (MRI T1 weighted image, coronal plane; MRI Proton Density with Fat Saturation (PDFS), sagittal plane, right; MRI Proton Density with Fat Saturation (PDFS), sagittal plane, left) performed after 2 years of MTX therapy with almost the same, bilateral lesions as one on the initial MRI of the right knee. (C) Second MRI control of both knees [MRI Proton Density with Fat Saturation (PDFS), sagittal/coronal plane, right/left] with almost complete regression of the synovial proliferation in the right, and partial regression in the left knee after 6 months of TNF inhibitor therapy.
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F2
It depicted extended intra-articular synovial proliferation with fat inclusions, multiple marginal bony erosion of the proximal tibia, both femoral condyles and patella along with altered morphology of both menisci (Figure 2A). Control MRI of both knees at the age of 15 revealed almost the same, bilateral lesions similar to one described on the initial MRI of the right knee (Figure 2B). Within the next 6 months, bilateral knee swelling, and reduced flexion improved with almost complete LA regression in the right, and partial regression in the left knee, confirmed by final MRI control (Figure 2C).