Disease Activity In Juvenile Idiopathic Arthritis Research Articles

Determinants of vitamin D levels in children, adolescents, and young adults with juvenile idiopathic arthritis.

Deficiency of 25-hydroxyvitamin D [25(OH)D] is reported to be common in patients with rheumatoid arthritis (RA); data in patients with juvenile idiopathic arthritis (JIA) are inconsistent. We assessed serum 25(OH)D in children, adolescents and young adults with JIA, in order to identify the risk factors for vitamin D deficiency in patients with JIA. We evaluated 152 patients with JIA: 115 female, 37 male, mean age 16.2 ± 7.4 yrs; evaluated by onset type, 96 had oligoarticular, 35 polyarticular, 7 systemic, and 14 enthesitis-related arthritis (ERA). Patients were compared with a control group matched for sex and age. All patients and controls underwent laboratory tests of plasma 25(OH)D, parathyroid hormone (PTH), calcium, phosphorus, and bone alkaline phosphatase levels, and dual-energy x-ray absorptiometry examination. Patients with JIA showed significantly reduced 25(OH)D levels compared to controls (p < 0.001), even divided into subtypes (oligoarticular, p < 0.05; polyarticular, p < 0.005; systemic, p < 0.001; ERA, p < 0.005). Patients with active disease and/or frequent relapses had significantly reduced 25(OH)D levels compared to patients with no active disease and no frequent flares (p < 0.005, respectively). Nevertheless, JIA patients had significantly higher PTH levels compared to controls (p < 0.0001). JIA patients with 25(OH)D deficiency showed a significantly lower bone mineral apparent density than those with normal 25(OH)D levels (p < 0.001). JIA patients have reduced 25(OH)D and higher PTH values. This may explain at least in part why JIA patients, despite more effective current drugs, do not achieve bone-normal condition over time. JIA patients with more severe disease could require higher supplementation of vitamin D to maintain normal 25(OH)D serum levels. Longterm studies are needed to investigate the relationship between serum 25(OH)D levels and disease activity in JIA.

AB0884 The Factors Affecting Bone Mineral Content in Patients with Juvenile Idiopathic Arthritis

ObjectivesTo determine the factors influencing bone mineral content in patients with juvenile idiopathic arthritis.MethodsA cross sectional studyin patientswith juvenile idiopathic arthritis (JIA) according to the International League of Association of...

AB0882 To Determine the Factors Influencing the Lean Body Mass in Patients with Juvenile Idiopathic Arthritis

ObjectivesTo determine the factors influencing the lean body mass in patients with juvenile idiopathic arthritis.MethodsA cross sectional study in patients with juvenile idiopathic arthritis (JIA) according to the International League...

Distribution pattern of MRI abnormalities within the knee and wrist of juvenile idiopathic arthritis patients: signature of disease activity.

The aim of this study in clinically active juvenile idiopathic arthritis (JIA) was to assess the frequency and distribution pattern of synovitis as hallmark of disease and additional soft-tissue and bony abnormalities on MRI in the knee and wrist as two target joints. MRI datasets of 153 clinically active JIA patients (110 with knee and 43 with wrist involvement) were evaluated independently by two readers for the presence of literature-based imaging features: "synovial hypertrophy," "bone marrow changes," "bone erosions," "tenosynovitis" (only in the wrist), and "cartilage lesions" (only in the knee) in accordance with validated definitions and scoring locations. Synovial hypertrophy was most frequently observed--both in the knee and in the wrist (61.8-65.1% of cases). For the knee, the most frequently involved locations were the cruciate ligaments (46/183 locations [25.1%] affected with synovial hypertrophy) and medial patella (18/62 locations [29.0%] with bone marrow changes). Cartilage lesions and bone erosions were rare (5.5-7.3% of cases). For the wrist, most frequently involved were the radiocarpal joint (21/64 locations [32.8%] with synovial hypertrophy), lunate (7/46 locations [15.2%] with bone marrow changes), and capitate or triquetrum (6/28 locations [21.4%] with bone erosions). Tenosynovitis was a common wrist-specific feature (46.5% of cases). MRI showed no abnormalities in a subgroup of patients with clinically active knee (23.6%) and wrist (16.3%) involvement. The distribution pattern of MRI abnormalities in the knee and wrist of active JIA patients provides a practical tool to detect a signature of JIA disease activity in target joints.

A17: A Prospective Study Comparing Infectious Risks, Disease Activity, and Cytokine Alterations in Children with Juvenile Idiopathic Arthritis Treated with and without Tumor Necrosis Factor‐alpha Inhibitors

Background/Purpose:Tumor necrosis factor‐alpha (TNF‐α) inhibitors are effective in the treatment of juvenile idiopathic arthritis (JIA), but may increase infection rates due to immunosuppression. However, as JIA results from immune system dysfunction, high disease activity may also render patients vulnerable to infection.To our knowledge, no prior studies have prospectively evaluated whether infection rates in JIA patients vary with changes in treatment or disease activity. This study assesses infection rates in JIA patients treated with and without TNF‐α inhibitors, correlates disease activity with infection risk, and explores cytokine alterations in JIA patients.Methods:This 12 month, prospective cohort study includes JIA subjects ages 1–21 years. TNF subjects are newly initiated on TNF‐α inhibitors. Non‐TNF subjects are treated without TNF‐α inhibitors. At each visit, questionnaires captured mild or severe infections and treatments required. JIA disease activity (by Childhood Health Assessment Questionnaire [CHAQ] and physician joint count/global assessment) was also recorded. TNF‐α, interleukin (IL)‐1β, IL‐6, IL‐8, IL‐10, and IL‐17 cytokine levels were collected at pre‐specified time points. Herein, we report our interim analysis of endpoints. Poisson regression and generalized estimating equations (GEE) were utilized as appropriate.Results:Fifty‐eight subjects have been enrolled, 20 TNF and 38 non‐TNF subjects (mean follow‐up 7.0 and 8.6 months, respectively). We found no difference in infection rates between groups (TNF group 0.078 versus non‐TNF group 0.076 infections/month, p = 0.93). No severe infections or hospitalizations occurred in either group. Numbers of physician sick visits, antimicrobial prescriptions, and missed school days related to infection were similar between groups.Adjusting for study group and other markers of disease activity, higher joint count was associated with increased physician sick visit rates. Higher joint count and higher CHAQ were both associated with higher rates of missed school.Cytokine serum protein analysis showed higher levels of TNF‐α, IL‐6, and IL‐8 in TNF versus non‐TNF subjects at baseline (prior to the initiation of TNF‐α inhibition in TNF subjects). Subsequently, TNF‐α and IL‐10 were higher in TNF versus non‐TNF subjects across 6 months of follow‐up (p&lt;0.05, by GEE model).Conclusion:Our results suggest no difference in infection rates between subjects with JIA treated with and without TNF‐α inhibitors. However, some markers indicating increased disease activity (joint count and CHAQ) were associated with higher risk of secondary infectious outcomes (physician sick visits and missed school). Uncontrolled disease activity may therefore be an independent risk factor for infection that should be considered in the JIA population.Differences in cytokine levels have been noted in our JIA subjects both before and after the initiation of TNF‐α inhibition. Cytokine alterations in JIA patients should be explored further.Ongoing analysis of the relationship between treatment changes, infection rates, disease activity, and cytokine alterations is underway to further delineate potential mechanisms and predictors of infection risk in JIA patients.

Assessment of Disease Activity in Juvenile Idiopathic Arthritis

Juvenile idiopathic arthritis (JIA) is a chronic inflammation of joints in pediatric patients. Assessment of JIA disease activity is very difficult, because children cannot definitely describe their pain by themselves due to development of cognitive function during the pediatric period. Assessment of JIA disease activity is useful for

Serum BLyS and APRIL as possible indicators of disease activity in pediatric systemic lupus erythematosus and juvenile idiopathic arthritis

Aim of the workTo assess serum levels of B lymphocyte stimulator (BLyS) and a proliferation-inducing ligand (APRIL) to determine their correlations with disease activity in pediatric systemic lupus erythematosus (pSLE) and juvenile idiopathic arthritis (JIA) patients. Patients and methodsTwenty-nine pSLE patients and 33 JIA patients were recruited. SLE disease activity was assessed using the systemic lupus erythematosus disease activity index (SLEDAI), while the juvenile arthritis 27 joint disease activity score (JADAS-27) was calculated for JIA patients. Serum samples were assayed for BLyS and APRIL by the enzyme linked immunosorbent assay (ELISA). ResultsSerum BLyS and APRIL were elevated in both pSLE and JIA patients compared to controls. Serum BLyS levels correlated with both SLE and JIA disease activity (p=0.042, p=0.019, respectively) whereas serum APRIL levels correlated positively with JADAS-27 and inversely with SLEDAI (p=0.001, p=0.02, respectively). Elevated serum BLyS and APRIL were significantly associated with a lower incidence of nephritis (p=0.043, p=0.016, respectively), while elevated serum APRIL significantly associated with negative anti-dsDNA in pSLE patients (p=0.017). In JIA patients, both serum BLyS and APRIL were significantly associated with the presence of ANA (p=0.008, p<0.001, respectively), while high serum APRIL associated with the presence of RF (p=0.035). APRIL and BLYS levels correlated with each other positively in JIA but inversely in pSLE patients. ConclusionSerum BLyS showed elevated levels that correlated significantly with pSLE and JIA disease activity, accordingly anti-BLyS therapy might be of great benefit to offset disease flare. The inverse correlations observed between APRIL with both BLyS and disease activity in pSLE patients raises the possibility of being a down regulator of the disease process.

Juvenile Idiopathic Arthritis and Live Virus Vaccines

Juvenile Idiopathic Arthritis and Live Virus Vaccines

Contrast-enhanced MRI compared with the physical examination in the evaluation of disease activity in juvenile idiopathic arthritis

To assess the value of magnetic resonance imaging (MRI) in discriminating between active and inactive juvenile idiopathic arthritis (JIA) patients and to compare physical examination outcomes with MRI outcomes in the assessment of disease status in JIA patients. Consecutive JIA patients with knee involvement were prospectively studied using an open-bore MRI. Imaging findings from 146 JIA patients were analysed (59.6% female; mean age, 12.9 years). Patients were classified as clinically active or inactive. MRI features were evaluated using the JAMRIS system, comprising validated scores for synovial hypertrophy, bone marrow oedema, cartilage lesions and bone erosions. Inter-reader reliability was good for all MRI features (intra-class correlation coefficient [ICC] = 0.87-0.94). No differences were found between the two groups regarding MRI scores of bone marrow oedema, cartilage lesions or bone erosions. Synovial hypertrophy scores differed significantly between groups (P = 0.016). Nonetheless, synovial hypertrophy was also present in 14 JIA patients (35.9%) with clinically inactive disease. Of JIA patients considered clinically active, 48.6% showed no signs of MRI-based synovitis. MRI can discriminate between clinically active and inactive JIA patients. However, physical examination is neither very sensitive nor specific in evaluating JIA disease activity compared with MRI. Subclinical synovitis was present in >35% of presumed clinically inactive patients. • MRI is sensitive for evaluating juvenile idiopathic arthritis (JIA) disease activity. • Contrast-enhanced MRI can distinguish clinically active and inactive JIA patients. • Subclinical synovitis is present in 35.9 % of presumed clinically inactive patients. • Physical examination is neither sensitive nor specific in evaluating JIA disease activity.

Effects of the Live Attenuated Measles-Mumps-Rubella Booster Vaccination on Disease Activity in Patients With Juvenile Idiopathic Arthritis

The immunogenicity and the effects of live attenuated measles-mumps-rubella (MMR) vaccination on disease activity in patients with juvenile idiopathic arthritis (JIA) are matters of concern, especially in patients treated with immunocompromising therapies.To assess whether MMR booster vaccination affects disease activity and to describe MMR booster immunogenicity in patients with JIA.Randomized, multicenter, open-label clinical equivalence trial including 137 patients with JIA aged 4 to 9 years who were recruited from 5 academic hospitals in The Netherlands between May 2008 and July 2011.Patients were randomly assigned to receive MMR booster vaccination (n=68) or no vaccination (control group; n=69). Among patients taking biologics, these treatments were discontinued at 5 times their half-lives prior to vaccination.Disease activity as measured by the Juvenile Arthritis Disease Activity Score (JADAS-27), ranging from 0 (no activity) to 57 (high activity). Disease activity in the year following randomization was compared between revaccinated patients and controls using a linear mixed model. A difference in JADAS-27 of 2.0 was the equivalence margin. Primary immunogenicity outcomes were seroprotection rates and MMR-specific antibody concentrations at 3 and 12 months.Of 137 randomized patients, 131 were analyzed in the modified intention-to-treat analysis, including 60 using methotrexate and 15 using biologics. Disease activity during complete follow-up did not differ between 63 revaccinated patients (JADAS-27, 2.8; 95% CI, 2.1-3.5) and 68 controls (JADAS-27, 2.4; 95% CI, 1.7-3.1), with a difference of 0.4 (95% CI, -0.5 to 1.2), within the equivalence margin of 2.0. At 12 months, seroprotection rates were higher in revaccinated patients vs controls (measles, 100% vs 92% [95% CI, 84%-99%]; mumps, 97% [95% CI, 95%-100%] vs 81% [95% CI, 72%-93%]; and rubella, 100% vs 94% [95% CI, 86%-100%], respectively), as were antibody concentrations against measles (1.63 vs 0.78 IU/mL; P = .03), mumps (168 vs 104 RU/mL; P = .03), and rubella (69 vs 45 IU/mL; P = .01). Methotrexate and biologics did not affect humoral responses, but low patient numbers precluded definite conclusions.Among children with JIA who had undergone primary immunization, MMR booster vaccination compared with no booster did not result in worse JIA disease activity and was immunogenic. Larger studies are needed to assess MMR effects in patients using biologic agents.clinicaltrials.gov Identifier: NCT00731965.

FRI0330 Development of cut-off values for high disease activity in juvenile idiopathic arthritis based on the juvenile arthritis disease activity score (JADAS)

BackgroundIn the last decade, there have been major advances in the management of juvenile idiopathic arthritis (JIA). A reliable documentation of these progresses creates the need for validated criteria that...

SAT0468 Is Early Treatment with Biologics Associated with a Better Long-Term Outcome in Patients with Polyarticular Juvenile Idiopathic Arthritis (JIA)?

BackgroundApproximately one in three children with polyarthritis is currently being treated with a biologic agent in Germany. Biologics are not only increasingly used more frequently in JIA, but also earlier...

SAT0480 High Doses of Infliximab in the Management of Juvenile Idiopathic Arthritis

BackgroundAlthough biologics have revolutionized treatment of juvenile idiopathic arthritis (JIA), many patients have active disease despite therapy [1]. Studies have shown benefit of dose intensification of infliximab in several conditions,...

Association of disease activity and anti-rheumatic treatment in juvenile idiopathic arthritis with serum lipid profiles: A prospective study

Patients with juvenile idiopathic arthritis (JIA) have abnormal serum lipid profiles. This study aimed to explore the association of disease activity and anti-rheumatic treatment with serum lipid profiles in a JIA cohort. Fifty-eight patients newly diagnosed with JIA who had not been treated with corticosteroids or disease-modifying anti-rheumatic drugs were enrolled. We measured their serum lipid profiles at baseline and 18 months later, and determined whether there were differences in lipid levels and atherogenic indices between patients who were in inactive disease and those who were not. For a case-control comparison at 18 months, control subjects from a population-based study cohort (NAHSIT study) were selected. Thirty-one of the 58 patients achieved inactive disease status after 18-month treatment. In these patients, high-density lipoprotein cholesterol (HDL-C) and total cholesterol (TC) levels increased significantly (p = 0.001 and p = 0.044); whereas the ratios of low-density lipoprotein cholesterol (LDL-C) to HDL-C and TC to HDL-C decreased with borderline significance (p = 0.066 and p = 0.080). The overall changes in HDL-C levels, LDL-C/HDL-C and TC/HDL-C ratio between baseline and 18 months were correlated with those in C-reactive protein levels (p = 0.005, p = 0.001, and p = 0.002, respectively). There were also significant differences among inactive, active and control subjects in HDL-C and TC levels (p = 0.021 and p = 0.013) but not in LDL, LDL-C/HDL-C, TC/HDL-C ratio, and triglyceride levels. Abnormal lipid levels and atherogenic indices were associated with disease activity in JIA and improved substantially following effective anti-rheumatic treatment. This improvement may reduce the risk of cardiovascular disease in JIA.

EVIDENCE OF A TRANSIENT NATURE OF THE TH17 PHENOTYPE OF CD4+CD161+ T CELLS IN THE SYNOVIAL FLUID FROM PATIENTS WITH JUVENILE IDIOPATHIC ARTHRITIS.

Event Abstract Back to Event EVIDENCE OF A TRANSIENT NATURE OF THE TH17 PHENOTYPE OF CD4+CD161+ T CELLS IN THE SYNOVIAL FLUID FROM PATIENTS WITH JUVENILE IDIOPATHIC ARTHRITIS. Laura Maggi1*, Lorenzo Cosmi1, Veronica Santarlasci1, Manuela Capone1, Valentina Querci1, Francesco Liotta1, Raffaele De Palma2, Rolando Cimaz3, Enrico Maggi1, Sergio Romagnani1 and Francesco Annunziato1 1 University of Florence, Department of Clinical and Experimental Medicine, Italy 2 Second University of Naples, Italy 3 Anna Meyer Children’s Hospital and University of Florence, Rheumatology unit, Italy OBJECTIVE: To investigate the phenotype and function of CD4+ T cells in synovial fluid (SF) from the affected joints of children with oligoarticular-onset juvenile idiopathic arthritis (JIA) and to establish a possible link with disease activity. METHODS: CD4+ T cells were obtained from the peripheral blood (PB) and SF of 23 children with oligoarticular-onset JIA, as well as from the PB of 15 healthy children and were analyzed for CXCR3, CCR6, CD161 expression and for IFN(interferon)- gamma and interleukin-17A (IL-17A) production. RESULTS: The numbers of CD4+CD161+ cells, showing either the type 1 T helper (Th1) or Th17/Th1 phenotype, were higher in SF than in PB of children with JIA. The few Th17 cells from SF of JIA underwent a spontaneous shift to the Th1 phenotype in vitro, whereas Th17 cells from PB of healthy children shifted only in presence of JIA SF; this effect was neutralized by antibody blocked of IL-12 activity. The frequencies of CD4+CD161+ cells, particularly the Th17/Th1 cells, in the JIA SF positively correlated with levels of erythrocyte sedimentation rate and C-reactive protein. CONCLUSION: These findings suggest that a shifting of CD4+CD161+ T cells from Th17 to the Th17/Th1 or Th1 phenotype can occur in the SF of oligoarticular-onset JIA, and indicate that the accumulation of these cells is correlated with parameters of inflammation. Thus, the results support the hypothesis that these cells may play a role in JIA disease activity. Keywords: Th17, Th1 Cells, CD161, JIA, RORC Conference: 15th International Congress of Immunology (ICI), Milan, Italy, 22 Aug - 27 Aug, 2013. Presentation Type: Abstract Topic: Adaptive Immunity Citation: Maggi L, Cosmi L, Santarlasci V, Capone M, Querci V, Liotta F, De Palma R, Cimaz R, Maggi E, Romagnani S and Annunziato F (2013). EVIDENCE OF A TRANSIENT NATURE OF THE TH17 PHENOTYPE OF CD4+CD161+ T CELLS IN THE SYNOVIAL FLUID FROM PATIENTS WITH JUVENILE IDIOPATHIC ARTHRITIS.. Front. Immunol. Conference Abstract: 15th International Congress of Immunology (ICI). doi: 10.3389/conf.fimmu.2013.02.00958 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 27 Jun 2013; Published Online: 22 Aug 2013. * Correspondence: Dr. Laura Maggi, University of Florence, Department of Clinical and Experimental Medicine, Florence, 50134, Italy, laura.maggi@unifi.it Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Laura Maggi Lorenzo Cosmi Veronica Santarlasci Manuela Capone Valentina Querci Francesco Liotta Raffaele De Palma Rolando Cimaz Enrico Maggi Sergio Romagnani Francesco Annunziato Google Laura Maggi Lorenzo Cosmi Veronica Santarlasci Manuela Capone Valentina Querci Francesco Liotta Raffaele De Palma Rolando Cimaz Enrico Maggi Sergio Romagnani Francesco Annunziato Google Scholar Laura Maggi Lorenzo Cosmi Veronica Santarlasci Manuela Capone Valentina Querci Francesco Liotta Raffaele De Palma Rolando Cimaz Enrico Maggi Sergio Romagnani Francesco Annunziato PubMed Laura Maggi Lorenzo Cosmi Veronica Santarlasci Manuela Capone Valentina Querci Francesco Liotta Raffaele De Palma Rolando Cimaz Enrico Maggi Sergio Romagnani Francesco Annunziato Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.

Altered expression of intestinal human leucocyte antigen D-related and immune signalling molecules in juvenile idiopathic arthritis

We aimed to study intestinal immune activation status in juvenile idiopathic arthritis (JIA) by assessing intestinal human leucocyte antigen (HLA) class II expression and the mRNA expression levels of the pro- and anti-inflammatory mediators and pattern recognition receptors. HLA-D-related (HLA-DR) expression was assessed using immunohistochemical staining of frozen sections in 11 children with JIA and 17 controls. The gene expression levels of the anti- and proinflammatory cytokines, lymphocyte recognition receptors and pattern recognition receptors were studied with reverse transcription-polymerase chain reaction (RT-PCR) in 14 children with JIA and 12 controls. All subjects had various gastrointestinal (GI) symptoms indicating endoscopic examinations, but eventually were not diagnosed with GI disease. In JIA patients, the expression of HLA-DR was increased in the crypt epithelial cells and in the epithelial basement membrane of the ileum when compared with the controls. Positive HLA-DR staining in the ileal mucosa was associated with the presence of high clinical disease activity of JIA and low mRNA expression of anti-inflammatory mediators, such as forkhead box protein P3 (FoxP3), glucocorticoid-induced tumour necrosis factor receptor-related protein (GITR) and transforming growth factor (TGF)-beta. Low ileal expression of interleukin (IL)-10, TGF-β, FoxP3, Toll-like receptor 2 (TLR-2) and TLR-4 transcripts correlated significantly with a high clinical disease activity in the JIA patients. The increased HLA-DR expression suggests enhanced intestinal antigen presentation in JIA. A correlation between clinical disease activity and low gene expression of tolerogenic mediators in the ileum supports the hypothesis that a link exists between the gut immune system and JIA.

Novel automated system for magnetic resonance imaging quantification of the inflamed synovial membrane volume in patients with juvenile idiopathic arthritis

To introduce a novel automated method for the quantification of the inflamed synovial membrane volume (SV) using magnetic resonance imaging (MRI), and to investigate its feasibility and validity in patients with juvenile idiopathic arthritis (JIA). The tool was tested on 58 patients with JIA and wrist involvement. Thirty-six patients had a 1-year MRI followup. MRI of the clinically more affected wrist was performed using a 1.5T scanner and a Flex small coil. An algorithmic approach, based on supervised voxel classification for automatic estimation of SV in a 3-dimensional MRI, was developed. The SV was estimated as the number of positively classified voxels and then normalized by the patient's body surface (NSV). Validation procedures included the analysis of reliability, construct validity, responsiveness to change, discriminant validity, and the predictive value. The agreement between the automated estimation of NSV and the manual measurements was excellent (intraclass correlation coefficient 0.93, 95% confidence interval 0.79-0.98). The automatic NSV demonstrated good construct validity by yielding strong correlations with local signs of disease activity and a moderate correlation with global physician assessment of disease activity and with the Rheumatoid Arthritis Magnetic Resonance Imaging Scoring system synovitis score. NSV showed a strong responsiveness to clinical change (standardized response mean values >1) and satisfactory discriminant validity. High baseline NSV (>4.6) had high predictive value (100%) with respect to erosive progression. The proposed automated method allowed reliable quantification of NSV, which represents a promising imaging biomarker of disease activity in JIA. The automated system has the potential to improve the longitudinal assessment of JIA and to predict progressive joint destruction.

Reliability and responsiveness of the Juvenile Arthritis MRI Scoring (JAMRIS) system for the knee

To assess the reliability and responsiveness of a new Juvenile Arthritis MRI Scoring (JAMRIS) system for evaluating disease activity of the knee. Twenty-five juvenile idiopathic arthritis (JIA) patients with clinical knee involvement were studied using open-bore 1-T MRI. MRI features of synovial hypertrophy, bone marrow changes, cartilage lesions and bone erosions were independently scored by five readers using the JAMRIS system. In addition, the JAMRIS system was determined to be a follow-up parameter by two readers to evaluate the response to therapy in 15 consecutive JIA patients. Inter-reader (ICCs 0.86-0.95) and intra-reader reliability (ICCs 0.92-1.00) for the scoring of JAMRIS features was good. Reliability of the actual scores and changes in scores over time was good for all items: ICCs 0.89-1.00, 0.87-1.00, respectively. Concerning therapy response, the mean synovial hypertrophy scores decreased significantly (mean 1.1 point; P < 0.001, SRM = -0.65). No change was observed with respect to bone marrow change, cartilage lesion and bone erosion scores. The JAMRIS proved to be a simple and highly reliable assessment score in the evaluation of JIA disease activity of the knee. The JAMRIS system may serve as an objective and accurate outcome measure in future research and clinical trials.

Comparison of ultrasonography with Doppler and MRI for assessment of disease activity in juvenile idiopathic arthritis: a pilot study

BackgroundIn juvenile idiopathic arthritis (JIA), the trend towards early therapeutic intervention and the development of new highly effective treatments have increased the need for sensitive and specific imaging. Numerous studies have demonstrated the important role of MRI and US in adult rheumatology. However, investigations of imaging in JIA are rare, and no previous study has been comparing MRI with Doppler ultrasonography (US) for assessment of arthritis. The aim of the present study was to compare the two imaging methods regarding their usefulness for evaluating disease activity in JIA, and to compare the results with those obtained in healthy controls.MethodsIn 10 JIA patients (median age 14 years, range 11–18), 11 joints (six wrists, three knees, two ankles) with arthritis were assessed by color Doppler US and MRI. The same imaging modalities were used to evaluate eight joints (three wrists, three knees, two ankles) in six healthy age- and sex-matched controls. The US examinations of both the patients and controls were compared with the MRI findings.ResultsIn 10 JIA patients, US detected synovial hypertrophy in 22 areas of 11 joints, 86% of which had synovial hyperemia, and MRI revealed synovitis in 36 areas of the same 11 joints. Erosions were identified by US in two areas of two joints and by MRI in six areas of four joints. Effusion was shown by US in nine areas of six joints and by MRI in 17 areas of five joints. MRI detected juxta-articular bone marrow edema in 16 areas of eight joints.ConclusionsThe results of this pilot study indicate that both MRI and US provide valuable imaging information on disease activity in JIA. Importantly, the two techniques seem to complement each other and give partly different information. Although MRI is considered to be the reference standard for advanced imaging in adult rheumatology, US seems to provide useful imaging information that could make it an option in daily clinical practice, in JIA as well as in adult rheumatology. However, the current work represents a pilot study, and thus our results need to be confirmed in a larger prospective clinical investigation.

Validity and predictive ability of the juvenile arthritis disease activity score based on CRP versus ESR in a Nordic population-based setting

ObjectiveTo compare the juvenile arthritis disease activity score (JADAS) based on C reactive protein (CRP) (JADAS-CRP) with JADAS based on erythrocyte sedimentation rate (ESR) (JADAS-ESR) and to validate JADAS in...