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Contrast-enhanced MRI compared with the physical examination in the evaluation of disease activity in juvenile idiopathic arthritis

  • Pediatric
  • Published:
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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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Acknowledgments

This work was supported by a research grant received from the Dutch Arthritis Association (Reumafonds, Amsterdam, The Netherlands). The Dutch Arthritis Association was not involved in designing and conducting this study, did not have access to the data and was not involved in data analysis or preparation of this manuscript.

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Authors and Affiliations

  1. Department of Radiology, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands

    Robert Hemke & Mario Maas

  2. Department of Paediatric Haematology, Immunology, Rheumatology and Infectious Disease, Emma Children’s Hospital AMC, University of Amsterdam, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands

    Mira van Veenendaal, Marion A. J. van Rossum, J. Merlijn van den Berg & Taco W. Kuijpers

  3. Department of Paediatric Rheumatology, Reade, Dr. Jan van Breemenstraat 2, Amsterdam, The Netherlands

    Koert M. Dolman, Marion A. J. van Rossum & J. Merlijn van den Berg

  4. Department of Paediatrics, St. Lucas Andreas Hospital, Jan Tooropstraat 164, Amsterdam, The Netherlands

    Koert M. Dolman

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  1. Robert Hemke
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  2. Mario Maas
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  3. Mira van Veenendaal
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  5. Marion A. J. van Rossum
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  6. J. Merlijn van den Berg
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  7. Taco W. Kuijpers
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Correspondence to Robert Hemke.

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Hemke, R., Maas, M., van Veenendaal, M. et al. Contrast-enhanced MRI compared with the physical examination in the evaluation of disease activity in juvenile idiopathic arthritis. Eur Radiol 24, 327–334 (2014). https://doi.org/10.1007/s00330-013-3036-2

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  • DOI: https://doi.org/10.1007/s00330-013-3036-2

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