Can quantitative MRI be used in the clinical setting to quantify the impact of intra-articular glucocorticoid injection on synovial disease activity in juvenile idiopathic arthritis?

Autor: Kieren G. Hollingsworth, Nicola Smith, S. Claire Gowdy, Sharmila Jandial, Flora McErlane, Amanda G. Wood, Joshua L. Bennett, Helen E. Foster, John D. Tuckett, Karen Allen, Ravi Mistry
Rok vydání: 2019
Předmět:
Male
medicine.medical_specialty
lcsh:Diseases of the musculoskeletal system
Adolescent
Knee Joint
Remission
Arthritis
Intra-articular glucocorticoid injection
Injections
Intra-Articular
030218 nuclear medicine & medical imaging
Disease activity
03 medical and health sciences
Juvenile Arthritis Disease Activity Score
0302 clinical medicine
Vascularity
Rheumatology
Interquartile range
Surveys and Questionnaires
Synovitis
Internal medicine
Humans
Immunology and Allergy
Medicine
Child
Glucocorticoids
030203 arthritis & rheumatology
business.industry
lcsh:RJ1-570
Synovial volume
lcsh:Pediatrics
Quantitative MRI
Juvenile idiopathic arthritis
Disease activity assessment
medicine.disease
Magnetic Resonance Imaging
Arthritis
Juvenile
Treatment Outcome
Pediatrics
Perinatology and Child Health
Female
lcsh:RC925-935
medicine.symptom
business
Glucocorticoid
Research Article
medicine.drug
Zdroj: Pediatric Rheumatology Online Journal
Pediatric Rheumatology Online Journal, Vol 17, Iss 1, Pp 1-12 (2019)
ISSN: 1546-0096
DOI: 10.1186/s12969-019-0377-7
Popis: Background Juvenile idiopathic arthritis (JIA), the most common chronic rheumatic disease of childhood, is characterised by synovitis. Clinical assessments of synovitis are imperfect, relying on composite and indirect measures of disease activity including clinician-reported measures, patient-reported measures and blood markers. Contrast-enhanced MRI is a more sensitive synovitis assessment technique but clinical utility is currently limited by availability and inter-observer variation. Improved quantitative MRI techniques may enable future development of more stringent MRI-defined remission criteria. The objective of this study was to determine the utility and feasibility of quantitative MRI measurement of synovial volume and vascularity in JIA before and twelve weeks after intra-articular glucocorticoid injection (IAGI) of the knee and to assess the acceptability of MRI to participating families. Methods Children and young people with JIA and a new episode of knee synovitis requiring IAGI were recruited from the Great North Children’s Hospital in Newcastle upon Tyne. Quantitative contrast-enhanced MRI was performed prior to and twelve weeks after IAGI, in addition to standard clinical assessment tools, including the three-variable clinical juvenile arthritis disease activity score (cJADAS) and active joint count. Results Eleven young people (5 male, median age 13 years, range 7–16) with JIA knee flare were recruited and 10 completed follow-up assessment. Following IAGI, the median (interquartile range) cJADAS improved from 8.5 (2.7) to 1.6 (3.9), whilst the median synovial volume improved from 38.5cm3 (82.1cm3) to 0.0cm3 (0.2cm3). Six patients presented with frank synovitis outside normal limits on routine MRI reporting. A further three had baseline MRI reports within normal limits but the quantitative measurements identified measurable synovial uptake. Post-IAGI quantitative measurements highlighted significant improvements in 9 patients. Conclusions IAGI led to a marked reduction in synovial volume, with quantitative MRI identifying more patients with an improved synovial volume than routine qualitative clinical reporting. Improvements in cJADAS scores were more variable with the patient/parent global assessment component contributing most to the scores. Further work is indicated, exploring the utility of quantitative MRI in the assessment of less accessible joints and comparing the impact of different treatment modalities.
Databáze: OpenAIRE
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