Session Information
Session Type: Abstract Submissions (ACR)
Background/Purpose:
Despite clinical remission, a substantial proportion of Juvenile Idiopathic Arthritis (JIA) patients will flare after a period of inactive disease. MRI has proven to depict subclinical inflammation as reflected by synovial hypertrophy, and may therefore be useful to identify patients at risk for flaring during follow-up.
The purpose of this study, focussing on the main target joint, was to use MRI in JIA patients in clinical remission, and to identify inflammatory changes as compared to clinical status over time.
Methods:
In this prospective study, 16 patients with JIA (median age 11.8 years [IQR, 10.5-14.5], median disease duration 3.2 years [IQR, 1.8-5.6]) in clinical remission (fulfilling the Pediatric Rheumatology International Trials Organization (PRINTO) preliminary criteria for clinical remission) were studied with MRI at 2 consecutive time points (median interval 16.1 months [IQR 14.4-17.1]) and assessed for clinical relapse. Initial clinical remission was achieved in 14 patients on medication (CRM) (median duration inactive disease 11.0 months [IQR 7.2-13.7]) and in 2 patients off medication (CR) (median duration inactive disease 28.7 months [IQR 15.7-28.7]). Contrast-enhanced MRI of the formerly most involved knee was performed to evaluate the degree of synovial hypertrophy, using the validated Juvenile Arthritis MRI Scoring (JAMRIS) (synovial hypertrophy score; <2 mm=0, 2-4 mm=1 and >4 mm=2, at 8 knee regions).
Results:
The first MRI showed signs of subclinical synovitis in 8 patients (50 %) and no synovitis in 8 patients. The second MRI in follow-up demonstrated an increased score of synovial hypertrophy as compared to the first MRI in the 6 patients with relapse of arthritis. In contrast, all patients with sustained clinical remission showed either stable (6 patients) or improved (4 patients) scores of synovial hypertrophy. CRP and erythrocyte sedimentation rate were not increased at both MRI time points.
Conclusion:
A large degree of JIA patients who satisfy the PRINTO remission criteria with normal findings on clinical and laboratory assessment had MRI based synovitis in this study, suggestive of ongoing disease activity. Increase of synovial hypertrophy over time was related to disease flaring, whereas stable or further reduction of synovial hypertrophy was associated with sustained clinical remission. Serial MRI allows for adequate follow-up of underlying disease even when clinically silent.
Disclosure:
M. van Veenendaal,
None;
R. Hemke,
None;
M. I. Bos,
None;
M. Maas,
None;
M. A. J. Van Rossum,
None;
T. W. Kuijpers,
None.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/magnetic-resonance-imaging-in-follow-up-of-clinical-remission-in-juvenile-idiopathic-arthritis/