Contrast-enhanced MRI compared with the physical examination in the evaluation of disease activity in juvenile idiopathic arthritis |
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Authors: | Robert Hemke Mario Maas Mira van Veenendaal Koert M Dolman Marion A J van Rossum J Merlijn van den Berg Taco W Kuijpers |
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Institution: | 1. Department of Radiology, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands 2. Department of Paediatric Haematology, Immunology, Rheumatology and Infectious Disease, Emma Children’s Hospital AMC, University of Amsterdam, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands 3. Department of Paediatric Rheumatology, Reade, Dr. Jan van Breemenstraat 2, Amsterdam, The Netherlands 4. Department of Paediatrics, St. Lucas Andreas Hospital, Jan Tooropstraat 164, Amsterdam, The Netherlands
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Abstract: | Objectives To assess the value of magnetic resonance imaging (MRI) in discriminating between active and inactive juvenile idiopathic arthritis (JIA) patients and to compare physical examination outcomes with MRI outcomes in the assessment of disease status in JIA patients. Methods Consecutive JIA patients with knee involvement were prospectively studied using an open-bore MRI. Imaging findings from 146 JIA patients were analysed (59.6 % female; mean age, 12.9 years). Patients were classified as clinically active or inactive. MRI features were evaluated using the JAMRIS system, comprising validated scores for synovial hypertrophy, bone marrow oedema, cartilage lesions and bone erosions. Results Inter-reader reliability was good for all MRI features (intra-class correlation coefficient ICC]?=?0.87–0.94). No differences were found between the two groups regarding MRI scores of bone marrow oedema, cartilage lesions or bone erosions. Synovial hypertrophy scores differed significantly between groups (P?=?0.016). Nonetheless, synovial hypertrophy was also present in 14 JIA patients (35.9 %) with clinically inactive disease. Of JIA patients considered clinically active, 48.6 % showed no signs of MRI-based synovitis. Conclusions MRI can discriminate between clinically active and inactive JIA patients. However, physical examination is neither very sensitive nor specific in evaluating JIA disease activity compared with MRI. Subclinical synovitis was present in >35 % of presumed clinically inactive patients. Key points ? MRI is sensitive for evaluating juvenile idiopathic arthritis (JIA) disease activity. ? Contrast-enhanced MRI can distinguish clinically active and inactive JIA patients. ? Subclinical synovitis is present in 35.9?% of presumed clinically inactive patients. ? Physical examination is neither sensitive nor specific in evaluating JIA disease activity. |
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