Abstract
This study reports the reliability of the juvenile idiopathic arthritis magnetic resonance imaging scoring system (JAMRIS-SIJ). The study comprised of eight raters—two rheumatologists and six radiologists—and 30 coronal T1 and Short-Tau Inversion Recovery (STIR) MRI scans of patients with enthesitis-related juvenile spondylarthritis. The median age of patients was 15 years with a mean disease duration of 5 years and 22 (73.3%) of the sample were boys. The inter-rater agreement of scores for each of the JAMRIS-SIJ items was calculated using a two-way random effect, absolute agreement, and single rater intraclass correlation coefficient (ICC 2.1). The ICC was interpreted together with kurtosis, since the ICC is also affected by the distribution of scores in the sample. The eight-rater, single measure inter-rater ICC (and kurtosis) values for JAMRIS-SIJ inflammation and damage components were the following: bone marrow edema (BME), 0.76 (1.2); joint space inflammation, 0.60 (1.8); capsulitis, 0.58 (9.2); enthesitis, 0.20 (0.1); ankylosis, 0.89 (35); sclerosis, 0.53 (4.6); erosion, 0.50 (6.5); fat lesion, 0.40 (21); backfill, 0.38 (38). The inter-rater reliability for BME and ankylosis scores was good and met the a priori set ICC threshold, whereas for the other items it was variable and below the selected threshold. Future directives should focus on refinement of the scores, definitions, and methods of interpretation prior to validation of the JAMRIS-SIJ through the assessment of its measurement properties.
Highlights
IntroductionJuvenile idiopathic arthritis (JIA) is a chronic inflammatory disease of childhood that affects peripheral and axial joints with onset in a child less than 16 years of age
Juvenile idiopathic arthritis (JIA) is a chronic inflammatory disease of childhood that affects peripheral and axial joints with onset in a child less than 16 years of age.It is characterized by persistent arthritis for at least 6 weeks and the exclusion of other known conditions
The degree of disease activity at the time of imaging ranged from minimally active, moderately active, and severe, as 16 (53.3%) cases showed negligible disease burden as reported by the median count of active joints and tender enthesitis of 1, and the remainder of cases showed moderate to severe self-reported pain and a physician global assessment of 5 and 6, respectively
Summary
Juvenile idiopathic arthritis (JIA) is a chronic inflammatory disease of childhood that affects peripheral and axial joints with onset in a child less than 16 years of age. It is characterized by persistent arthritis for at least 6 weeks and the exclusion of other known conditions. Several JIA disease activity measures exist [4,5,6]; their reliability is variable [7], and they often do not represent or include arthritis in axial joints. Clinical examination of the SIJ is a commonly used measure of SIJ disease activity in JIA and is often defined as pain with palpation of the SIJ. The validity of clinical assessment is limited by the anatomy and deep location of the SIJ and is not useful in truly differentiating true arthritis from a normal joint in many cases [8,9]
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