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Detection of inflammation by whole-body MRI in young people with juvenile idiopathic arthritis
Varvara Choida1,2,3, Timothy J P Bray1,4, Niels van Vucht4
1Centre for Medical Imaging, University College London, University College London, London, UK.
Objectives:
To assess the frequency of joint inflammation detected by whole-body MRI (WBMRI) in young people (YP) with JIA and controls, and to determine the relationship between WBMRI-detected inflammation and clinical findings.
Methods:
YP aged 14-24 years, with JIA (patients) or arthralgia without JIA (controls), recruited from one centre, underwent a WBMRI scan after formal clinical assessment. Consensus between at least two of the three independent radiologists was required to define inflammation and damage on WBMRI, according to predefined criteria. YP with JIA were deemed clinically active as per accepted definitions. The proportions of YP with positive WBMRI scans for joint inflammation (one or more inflamed joint) as well as serum biomarkers were compared between active vs inactive JIA patients and controls.
Results:
Forty-seven YP with JIA (25 active and 22 inactive patients) and 13 controls were included. WBMRI detected joint inflammation in 60% (28/47) of patients with JIA vs 15% (2/13) of controls (difference: 44%, 95% CI 20%, 68%). More active than inactive JIA patients had WBMRI-detected inflammation [76% (19/25) vs 41% (9/22), difference: 35% (95% CI 9%, 62%)], and this was associated with a specific biomarker signature. WBMRI identified inflammation in one or more clinically inactive joint in 23/47 (49%) patients (14/25 active vs 9/22 inactive JIA patients).
Conclusions:
WBMRI's validity in joint assessment was demonstrated by the higher frequency of inflammation in JIA patients vs controls, and in active vs inactive JIA patients. WBMRI found unsuspected joint inflammation in 49% YP with JIA, which needs further investigation of potential clinical implications.
Insights
Whole-body MRI (WBMRI) detected joint inflammation in 60% of young people with juvenile idiopathic arthritis (JIA), significantly more than controls. This advanced imaging identified unsuspected inflammation in nearly half of JIA patients, highlighting its clinical utility.
Area of Science:
- Rheumatology
- Medical Imaging
- Pediatrics
Background:
- Juvenile idiopathic arthritis (JIA) is a complex autoimmune condition affecting young people.
- Accurate assessment of joint inflammation is crucial for effective JIA management.
- Whole-body MRI (WBMRI) offers a comprehensive view of musculoskeletal inflammation.
Purpose of the Study:
- To evaluate the frequency of joint inflammation detected by WBMRI in young people with JIA compared to controls.
- To explore the relationship between WBMRI-detected inflammation and clinical disease activity in JIA.
- To assess WBMRI's ability to detect subclinical joint inflammation in JIA patients.
Main Methods:
- A cohort of young people (14-24 years) with JIA and healthy controls underwent WBMRI.
- Clinical assessments determined JIA activity status.
- Three independent radiologists evaluated WBMRI scans for joint inflammation and damage using predefined criteria.
Main Results:
- WBMRI detected joint inflammation in 60% of JIA patients versus 15% of controls.
- Active JIA patients showed higher rates of WBMRI-detected inflammation (76%) compared to inactive JIA patients (41%).
- Nearly half (49%) of JIA patients had WBMRI-identified inflammation in clinically inactive joints.
Conclusions:
- WBMRI demonstrates high validity in detecting joint inflammation in JIA, differentiating patients from controls and active from inactive disease.
- WBMRI identified significant subclinical joint inflammation in a substantial proportion of young people with JIA.
- These findings suggest WBMRI's potential role in refining JIA assessment and management strategies, warranting further investigation into clinical implications.
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