Session Type: Abstract Submissions (ACR)
Evidence that early therapeutic intervention prevents structural damage in juvenile idiopathic arthritis (JIA) patients requires focus on early-stage disease activity scores. Most outcome measures in JIA, such as the validated paediatric-targeted MRI scoring system (PTMRIS)1, are based on adult equivalents with extensive focus on late-stage structural damage. Using our recently validated juvenile arthritis MRI scoring system (JAMRIS) for the knee2, we have developed a similar analysis tool for the wrist to assess disease activity at an early stage. This focus shift to early-stage disease activity is achieved through extending soft tissue structure scores and specifying the grading of bone items affecting <25% of the bone. The objectives of this study were (1) to assess the intra- and interreader reliability of the JAMRIS system for the evaluation of early-stage disease activity in the wrist and (2) to compare the reliability of JAMRIS and PTMRIS.
MRI datasets from 20 JIA patients with wrist involvement were evaluated independently by three readers using JAMRIS and PTMRIS. JAMRIS for the wrist comprises synovial hypertrophy (6 locations, grading from 0-3), tenosynovitis (2 locations, grading from 0-1), bone marrow changes (15 locations, grading from 0-3) and bone erosions (15 locations, grading from 0-3) as scoring items. The intraclass correlation coefficient (ICC) or Cohen’s kappa was used to assess inter- and intrareader reliability. The ICC of each JAMRIS scoring item was compared with the ICC of its equivalent in PTMRIS.
The interreader reliability (ICC or Cohen’s kappa) of JAMRIS varied from 0.62 to 0.89. Interreader reliability for tenosynovitis score was low (0.24 to 0.48). Intrareader reliability (ICC or Cohen’s kappa) of JAMRIS varied with from 0.28 to 0.95 for reader 1 and from 0.41 to 0.97 for reader 2. JAMRIS and PTMRIS showed similar results of interreader reliability.
Early-stage JIA disease activity in the wrist can be reliably evaluated with three-out-of-four JAMRIS scoring items. JAMRIS, especially focussed on early-stage disease presentation, has comparable reliability to PTMRIS. Correlating clinical disease assessment and responsiveness to change will be needed to validate JAMRIS for the wrist as outcome measure and disease monitoring tool.
1 Malattia C, Damasio MB, Pistorio A, Ioseliani M, Vilca I, Valle M et al. 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 2011; 70(3):440-446.
2 Hemke R, van Rossum MA, van Veenendaal M, van den Berg JM, Dolman KM, Kuijpers TW et al. The Reliability of a New Juvenile Arthritis MRI Scoring System for the Knee; JAMRIS. [abstract]. Arthritis Rheum 2011;63 Suppl 10:956
C. M. Nusman,
T. W. Kuijpers,
E. E. Deurloo,
J. M. Van den Berg,
K. M. Dolman,
M. A. J. Van Rossum,
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/a-novel-mri-scoring-system-for-the-evaluation-of-early-stage-disease-activity-of-the-wrist-in-juvenile-idiopathic-arthritis/