Abstract
Background
Bony depressions at the wrist resembling erosions are frequently seen on MRI in healthy children. The accuracy of MRI in detecting early bony destruction is therefore questionable. We compared findings on MRI of the wrist in healthy children and those with juvenile idiopathic arthritis (JIA) to investigate markers for true disease.
Materials and methods
We compared the number and localisation of bony depressions at the wrist in 85 healthy children and 68 children with JIA, ages 5–15 years. The size of the wrist was assessed from a radiograph of the wrist performed on the same day as the MRI.
Results
No significant difference in the number of bony depressions in the carpal bones was seen between healthy children and children with JIA at any age. Depressions are found in similar locations in the two groups, except for a few sites, where bony depressions were seen exclusively in the JIA group, particularly at the CMC joints. The wrist was significantly smaller in children with JIA (P < 0.001).
Conclusions
Using adult scoring systems and standard MR sequences in the assessment of bone destruction in children may lead to overstaging or understaging of disease. At present, standard MRI sequences cannot easily be used for assessment of early signs of erosions in children.
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References
Ruperto N, Lovell DJ, Cuttica R et al (2010) Long-term efficacy and safety of infliximab plus methotrexate for the treatment of polyarticular course juvenile rheumatoid arthritis: findings from an open-label treatment extension. Ann Rheum Dis 69:718–722
Ruperto N, Lovell DJ, Cuttica R et al (2007) A randomized, placebo-controlled trial of infliximab plus methotrexate for the treatment of polyarticular-course juvenile rheumatoid arthritis. Arthritis Rheum 56:3096–3106
Ringold S, Wallace CA (2007) Measuring clinical response and remission in juvenile idiopathic arthritis. Curr Opin Rheumatol 19:471–476
Oen K, Malleson PN, Cabral DA et al (2002) Disease course and outcome of juvenile rheumatoid arthritis in a multicenter cohort. J Rheumatol 29:1989–1999
Poznanski AK, Hernandez RJ, Guire KE et al (1978) Carpal length in children—a useful measurement in the diagnosis of rheumatoid arthritis and some concenital malformation syndromes. Radiology 129:661–668
Johnson K (2006) Imaging of juvenile idiopathic arthritis. Pediatr Radiol 36:743–758
Ravelli A, Ioseliani M, Norambuena X et al (2007) Adapted versions of the Sharp/van der Heijde score are reliable and valid for assessment of radiographic progression in juvenile idiopathic arthritis. Arthritis Rheum 56:3087–3095
Rossi F, Di Dia F, Galipo O et al (2006) Use of the Sharp and Larsen scoring methods in the assessment of radiographic progression in juvenile idiopathic arthritis. Arthritis Rheum 55:717–723
Malattia C, Damasio MB, Magnaguagno F et al (2008) Magnetic resonance imaging, ultrasonography, and conventional radiography in the assessment of bone erosions in juvenile idiopathic arthritis. Arthritis Rheum 59:1764–1772
Muller LS, Avenarius D, Damasio B et al (2011) The paediatric wrist revisited: redefining MR findings in healthy children. Ann Rheum Dis 70:605–610
Ostergaard M, Edmonds J, McQueen F et al (2005) An introduction to the EULAR-OMERACT rheumatoid arthritis MRI reference image atlas. Ann Rheum Dis 64(Suppl 1):i3–i7
Ostergaard M, Peterfy C, Conaghan P et al (2003) OMERACT Rheumatoid Arthritis Magnetic Resonance Imaging Studies. Core set of MRI acquisitions, joint pathology definitions, and the OMERACT RA-MRI scoring system. J Rheumatol 30:1385–1386
Malattia C, Damasio MB, Pistorio A et al (2011) Development and preliminary validation of a paediatric-targeted MRI scoring system for the assessment of disease activity and damage in juvenile idiopathic arthritis. Ann Rheum Dis 70:440–446
Petty RE, Southwood TR, Manners P et al (2004) International League of Associations for Rheumatology classification of juvenile idiopathic arthritis: second revision, Edmonton, 2001. J Rheumatol 31:390–392
Ejbjerg B, McQueen F, Lassere M et al (2005) The EULAR-OMERACT rheumatoid arthritis MRI reference image atlas: the wrist joint. Ann Rheum Dis 64(Suppl 1):i23–i147
Avenarius DM, Ording Muller LS, Eldevik P et al (2012) The paediatric wrist revisited-findings of bony depressions in healthy children on radiographs compared to MRI. Pediatr Radiol 42:791–798
Boavida P, Hargunani R, Owens CM et al (2012) Magnetic resonance imaging and radiographic assessment of carpal depressions in children with juvenile idiopathic arthritis: normal variants or erosions? J Rheumatol 39:645–650
Nanno M, Buford WL Jr, Patterson RM et al (2007) Three-dimensional analysis of the ligamentous attachments of the second through fifth carpometacarpal joints. Clin Anat 20:530–544
Pyle SI, Waterhouse AM, Greulich WW (1971) Attributes of the radiographic standard of reference for the National Health Examination Survey. Am J Phys Anthropol 35:331–337
Kight AC, Dardzinski BJ, Laor T et al (2004) Magnetic resonance imaging evaluation of the effects of juvenile rheumatoid arthritis on distal femoral weight-bearing cartilage. Arthritis Rheum 50:901–905
Borrero CG, Mountz JM, Mountz JD (2011) Emerging MRI methods in rheumatoid arthritis. Nat Rev Rheumatol 7:85–95
Tamai M, Kawakami A, Uetani M et al (2012) Magnetic resonance imaging (MRI) detection of synovitis and bone lesions of the wrists and finger joints in early-stage rheumatoid arthritis: comparison of the accuracy of plain MRI-based findings and gadolinium-diethylenetriamine pentaacetic acid-enhanced MRI-based findings. Mod Rheumatol 22:654–658
Goldbach-Mansky R, Woodburn J, Yao L et al (2003) Magnetic resonance imaging in the evaluation of bone damage in rheumatoid arthritis: a more precise image or just a more expensive one? Arthritis Rheum 48:585–589
Acknowledgments
We wish to thank Dr. Clarissa Pilkington, Dr. Sandrine Lacassagne and Professor Pierre Quartier for providing the clinical data for the children from Great Ormond Street Hospital and NEM. This study was funded, in part, by a grant from the European Union, Health-e-Child Integrated Project (IST 2004-027749).
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Ording Muller, LS., Boavida, P., Avenarius, D. et al. MRI of the wrist in juvenile idiopathic arthritis: erosions or normal variants? A prospective case-control study. Pediatr Radiol 43, 785–795 (2013). https://doi.org/10.1007/s00247-012-2575-z
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DOI: https://doi.org/10.1007/s00247-012-2575-z