Abstract
BackgroundPublished methods for quantification of magnetic resonance imaging (MRI) evidence of inflammation in the sacroiliac joint lack validation in pediatric populations. We evaluated the reliability and construct validity of the Spondyloarthritis Research Consortium of Canada (SPARCC) sacroiliac joint inflammation score (SIS) in children with suspected or confirmed juvenile spondyloarthritis (JSpA).MethodsThe SPARCC SIS measures the presence, depth, and intensity of bone marrow inflammation on MRI through the cartilaginous part of the joint. Six readers blinded to clinical details except age, participated in two reading exercises, each preceded by a calibration exercise. Inter-observer reliability was assessed using intraclass correlation coefficients (ICCs) and for pre-specified acceptable reliability the inraclass correlation coefficient (ICC) was > 0.8.ResultsThe SPARCC SIS had face validity and was feasible to score in pediatric cases in both reading exercises. Cases were mostly male (64%) and the median age at the time of imaging was 14.9 years. After calibration, the median ICC across all readers for the SIS total score was 0.81 (IQR 0.71–0.89). SPARCC SIS had weak correlation with disease activity (DA) as measured by the JSpADA (r = − 0.12) but discriminated significantly between those with and without elevated C-reactive protein (p = 0.03).ConclusionThe SPARCC SIS was feasible to score and had acceptable reliability in children. The ICC improved with additional calibration and reading exercises, for both experienced and inexperienced readers.
Highlights
Published methods for quantification of magnetic resonance imaging (MRI) evidence of inflammation in the sacroiliac joint lack validation in pediatric populations
Children with spondyloarthritis (SpA) and axial arthritis are at risk of progression to ankylosing spondylitis, an inflammatory disease that causes joint fusion and leads to permanent functional impairment
Noteworthy limitations were that imaging was not part of the protocol and the primary outcome was achievement of an Assessment of SpA International Society (ASAS) working group 40 response criteria [7], which has never been validated in
Summary
Published methods for quantification of magnetic resonance imaging (MRI) evidence of inflammation in the sacroiliac joint lack validation in pediatric populations. Children with spondyloarthritis (SpA) and axial arthritis are at risk of progression to ankylosing spondylitis, an inflammatory disease that causes joint fusion and leads to permanent functional impairment. There has only been one trial of biologic agents in children with axial arthritis [6]. This trial had several limitations leading to findings that were not statistically significant for the primary outcome. Noteworthy limitations were that imaging was not part of the protocol and the primary outcome was achievement of an Assessment of SpA International Society (ASAS) working group 40 response criteria [7], which has never been validated in
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