Session Type: ACR Poster Session B
Session Time: 9:00AM-11:00AM
Methods: Approval was obtained from the Internal Review Board
Results: Forty-five JDM children were identified, of which 32 were females. The median age at diagnosis was 5.8 years. Eighty percent had weakness at diagnosis, 100% typical rash, 73% typical nail fold capillary changes. At diagnosis, muscle enzymes were compatible with JDM generally (CK 52%, LDH 62%, aldolase 72%, AST 54% abnormal), EMG abnormal in 3/8, muscle biopsy typical of JDM in 10/11, and MRI abnormal demonstrating myositis in 31/40. Thirteen of the 45 subjects had a repeat MRI for a possible flare-up with differing indications: general proximal weakness in 4 subjects, hip, thigh or calf pain in 3 subjects, rash in 3 subjects, worsening nail fold changes in one subject, elevated enzymes in one subject, and to confirm remission in one subject. Three of 13 repeat MRI’s were abnormal, demonstrating myositis. There was moderate agreement between the flare-up MRI findings and the physician’s treatment decision (kappa=0.59); in each abnormal MRI case the physician decided to increase treatment (Bayes rule 100% agreement). When the MRI was negative for myositis in 10 patients, 7/10 physicians chose to continue same medications or to taper medications (70% agreement).
Conclusion: Our study suggests that MRI at a time of a JDM flare-up is useful, yielding a sensitivity of 50% and a specificity of 100% for flare-up using a physician’s assessment of disease flare-up as the gold standard. Using Bayes rule, when an MRI shows myositis, physicians tend to treat 100% of the time and when an MRI shows no myositis, physicians in this study continued the same medications or tapered medications 70% of the time.
To cite this abstract in AMA style:Abdul Aziz R, Spencer CH, Bout-Tabaku SM, Yu CY, Adler B, Lintner K, Moore-Clingenpeel M. The Role of Muscle MRI in Detecting a Flare-up of Juvenile Dermatomyositis [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/the-role-of-muscle-mri-in-detecting-a-flare-up-of-juvenile-dermatomyositis/. Accessed November 28, 2020.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-role-of-muscle-mri-in-detecting-a-flare-up-of-juvenile-dermatomyositis/