ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 288

MRI Findings In Juvenile Spondyloarthopathy and Effects Of Treatment On Subsequent MRI

Clara Lin1 and Diana Milojevic2, 1Pediatric Rheumatology, University of California-San Francisco, San Francisco, CA, 2Dept of Pediatric Rheumatology, University of California, San Francisco, San Francisco, CA

Meeting: 2013 ACR/ARHP Annual Meeting

Keywords: ,

Session Information

Title: Pediatric Rheumatology - Clinical and Therapeutic Aspects I: Juvenile Idiopathic Arthritis

Session Type: Abstract Submissions (ACR)

Background/Purpose: : The aim of our study was to

  • describe pelvic MRI findings of juvenile spondyloarthopathy
  • describe the treatment effects on subsequent MRIs in juvenile spondyloarthropathy
  • determine predictors of active sacroiliitis in children

Methods: This was a retrospective chart and imaging review of children ages 5 to 21 year old seen in the pediatric rheumatology clinic from 2009 to 2012 with a MRI of the sacroiliac joints (MRI-SI).  Data collected included demographics, patient’s history, physical exam, and laboratory results at each visit.  The pelvic joints (sacroiliac, hip, and facet)and entheses were reviewed on MRI-SI, and the sacroiliac joints were graded on a semi-quantitative scale (0-3) for bone marrow edema (BME), synovial enhancement, erosions to create a composite score ratio.

Results: 50 subjects with 76 MRI-SI were studied, and 32 subjects had sacroiliitis on 48 MRIs.  Of the subjects with sacroiliitis, mean age± standard deviation was 13.68±2.59 years, 71% were male and 41% were HLA-B27 positive.  In 22.9% of subjects with sacroiliitis, history and physical exam did not reveal signs of sacroiliitis. Inflammatory markers (ESR, CRP, WBC, Platelet count) were normal in 50% of cases of (+) sacroiliitis.  In 16.7% of cases of sacroiliitis (n=8) in 7 subjects, physical exam of SI joints, Modified Schober’s exam, and inflammatory markers were normal.  In subjects with sacroiliitis, MRI also revealed hip arthritis and pelvic enthesitis in 71.4%and 40.6% of exams, respectively.  Longitudinal data was available for 13 subjects.  MRI-SI composite score ratio improved in 8 subjects with the greatest improvement occurring with initiation of etanercept therapy.  Improvements in composite score ratio were due to improvement of BME and SE components, but erosion scores remained stable or worsened in all but 1 subject.

Conclusion: In our group of children with sacroiliitis, male:female ratio was 2.56 and HLA-B27 was present in 41% of subjects. Predicting active sacroiliitis from history, physical exam, and laboratory findings remains a challenge.  Hip arthritis and pelvic enthesitis were common findings in cases of sacroiliitis in children.  Greatest improvement of sacroiliitis on MRI was seen after initiating etanercept by decreasing bone marrow edema and synovial enhancement; however, erosions did not seem to improve on therapy.

Disclosure:

C. Lin,
None;

D. Milojevic,
None.

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