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Quantitative Magnetic Resonance Imaging of Skeletal Muscle Disease
Published on: December 18, 2016
Can Whole-Body Magnetic Resonance Imaging Predict Relapse in Juvenile Idiopathic Arthritis? A Longitudinal Pilot
Deeksha Bhalla1, Narendra Bagri2, Manisha Jana1
1From the Departments of Radiodiagnosis.
Objective:
To determine the utility of whole-body magnetic resonance imaging (WB MRI) to predict relapse in children with juvenile idiopathic arthritis (JIA) in clinical remission.
Methods:
Consecutive patients with JIA who fulfilled the Wallace criteria for remission were recruited into this longitudinal pilot study and underwent WB MRI. A radiological score was devised, incorporating synovitis, bone marrow edema, sacroiliitis, enthesitis, and bone erosions. Two readers independently scored the MR data sets. The same score was calculated for both knee joints individually and correlated with outcome for that joint. Score-based models incorporating clinical and laboratory variables were generated. Logistic regression analysis was done to determine predictors for relapse. Receiver operating characteristic curve was drawn for significant variables.
Results:
Twenty-two children (median age, 12 years; interquartile range, 9.5-14.25 years) were included in the final analysis. At 24 months' follow-up, 15 joints in 5 children relapsed; knee was the most common site. Seven knee joints had disease relapse. On univariate analysis, synovitis and total score on WB MRI were significant predictors of relapse at follow-up, with odds ratios of 9.46 (bias-corrected 95% confidence interval, 3.07-29.13) and 2.8 (bias-corrected 95% confidence interval, 1.23-6.39) respectively. Two models, which included a higher number of joints involved at presentation and abrupt drug withdrawal strategy as predictor variables, were also statistically significant (odds ratio, approximately 1.9). On multivariate analysis of the predictors variables in models where p < 0.6, it was found that only synovitis score and total score were near statistical significance ( p = 0.06); no clinical or laboratory variables were significant. The areas under the receiver operating characteristic curve for relapse prediction were approximately 0.82, 0.87, 0.79, and 0.81 for synovitis score, total MRI score, and both models, respectively.
Conclusion:
Synovitis on WB MRI is the strongest independent predictor for disease relapse in children with JIA in remission.
Insights
Whole-body MRI can predict relapse in children with juvenile idiopathic arthritis (JIA) who are in remission. Synovitis detected on WB MRI is the strongest indicator of future disease activity.
Area of Science:
- Pediatric Rheumatology
- Diagnostic Imaging
- Medical Biomarkers
Background:
- Juvenile idiopathic arthritis (JIA) is a chronic autoimmune disease affecting children.
- Achieving clinical remission in JIA is a primary treatment goal.
- Predicting relapse is crucial for optimizing long-term management and preventing joint damage.
Purpose of the Study:
- To evaluate the effectiveness of whole-body magnetic resonance imaging (WB MRI) in forecasting relapse in pediatric patients with JIA.
- To identify specific MRI findings that correlate with disease recurrence in children achieving remission.
Main Methods:
- A longitudinal pilot study included children with JIA meeting Wallace criteria for remission.
- Whole-body MRI was performed, and a radiological score assessing synovitis, bone marrow edema, sacroiliitis, enthesitis, and erosions was developed.
- Logistic regression and receiver operating characteristic (ROC) curve analyses were used to identify predictors of relapse.
Main Results:
- In 22 children followed for 24 months, relapse occurred in 5 children, most commonly in the knee.
- Univariate analysis identified synovitis and total WB MRI score as significant predictors of relapse (ORs 9.46 and 2.8, respectively).
- Multivariate analysis indicated synovitis and total MRI scores were near statistical significance (p=0.06), while clinical/laboratory variables were not significant. ROC curves showed good predictive values (0.79-0.87).
Conclusions:
- Synovitis visualized on WB MRI is the most potent independent predictor of disease relapse in children with JIA in remission.
- WB MRI, particularly assessment of synovitis, offers valuable prognostic information for JIA patients in remission.
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