Session Information
Date: Sunday, November 5, 2017
Session Type: ACR Poster Session A
Session Time: 9:00AM-11:00AM
Background/Purpose:
Imaging as outcome measure has been studied and extensively used in the assessment of treatment for adult patients with rheumatoid arthritis (RA)1. In children with juvenile idiopathic arthritis (JIA) similar knowledge is very limited. This abstract presents a novel imaging based system for the assessment of treatment efficacy in JRA patients and its initial validation against clinical outcome measures.
Methods:
Patients with polyarticular JIA with insufficient (≥3 affected joints) response or intolerance to ≥3 months of Methotrexate, Etanercept were assessed by imaging. The MCP joints incClinically most affected hand were imaged with Dynamic Contrast Enhanced (DCE)-MRI at baseline (BL), month 3 and 6 of treatment using a 0.2T scanner. Clinical scores included active joint (AJ) counts. Clinical response was considered a state of ≤ 3 AJ. A region of interests (ROIs) were placed in DCE-MRI to quantify the synovium in MCPs 2-5. Output parameters included Dynamic Enhanced MRI Quantification scores (DEMRIQ-Vol) corresponding to the volume of enhancing voxels within the synovial ROIs alone or multiplied with the mean of the maximum enhancement (ME) or the initial rate of enhancement (IRE), DEMRIQ-ME and DEMRIQ-IRE. Differences in DEMRIQ-Vol scores between visits were analyzed using t-test (p<0.05* = statistically significant, p<0.25** = clinically meaningful). Correlation between clinical and DEMRIQ scores were described.
Results:
18 Caucasian patients (12 girls, median age 12,6 years, median disease duration 1,2 years) were included in the study. Two patients discontinued imaging after BL but continued treatment. In all but 3 of the remaining patients statistically significant and/or clinically meaningful changes were documented for DEMRIQ ME between visits.
In 4 patients, clinical and DEMRIQ scores showed corresponded changes. In all other patients, clinical and DEMRIQ scores were non-concordant. Based on DEMRIQ change (irrespective of the clinical scores) the outcome of the patient could be predicted:
- in 5 patients, improvement of DEMRIQ scores predicted response to treatment (within 2-6 months after last MRI examination)
- in 4 patients, an increase or persistence of a high DEMRIQ predicted non-response to treatment
- in 7 patients, increase in DEMRIQ (after initial decrease) or persistence of a high DEMRIQ predicted flare (in 3 of the patients flare occurred after treatment discontinuation)
In all patients, subclinical disease could be detected on MRI in clinically unaffected joints.
Conclusion:
DEMRIQ scores supported clinical examination by detecting subclinical inflammation. In most patients, the imaging scores were predictive of the patient outcomes such as response and non-response to treatment and flare, making it a useful outcome measure in clinical practice and research.
1Kubassova O et al; Eur J Radiol. 2010 Jun;74(3): e67-72.
To cite this abstract in AMA style:
Kubassova O, Tzaribachev N, Hagoug R, Boesen M. Validation of Objective Quantification System for Disease Progression in Patients with Juvenile Idiopathic Arthritis [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/validation-of-objective-quantification-system-for-disease-progression-in-patients-with-juvenile-idiopathic-arthritis/. Accessed .ACR Meeting Abstracts - https://acrabstracts.org/abstract/validation-of-objective-quantification-system-for-disease-progression-in-patients-with-juvenile-idiopathic-arthritis/