Paediatric Rheumatology, Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.
Musculoskeletal Research Group, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK.
Pediatr Rheumatol Online J. 2019 Nov 21;17(1):74. doi: 10.1186/s12969-019-0377-7.
Juvenile idiopathic arthritis (JIA), the most common chronic rheumatic disease of childhood, is characterised by synovitis. Clinical assessments of synovitis are imperfect, relying on composite and indirect measures of disease activity including clinician-reported measures, patient-reported measures and blood markers. Contrast-enhanced MRI is a more sensitive synovitis assessment technique but clinical utility is currently limited by availability and inter-observer variation. Improved quantitative MRI techniques may enable future development of more stringent MRI-defined remission criteria. The objective of this study was to determine the utility and feasibility of quantitative MRI measurement of synovial volume and vascularity in JIA before and twelve weeks after intra-articular glucocorticoid injection (IAGI) of the knee and to assess the acceptability of MRI to participating families.
Children and young people with JIA and a new episode of knee synovitis requiring IAGI were recruited from the Great North Children's Hospital in Newcastle upon Tyne. Quantitative contrast-enhanced MRI was performed prior to and twelve weeks after IAGI, in addition to standard clinical assessment tools, including the three-variable clinical juvenile arthritis disease activity score (cJADAS) and active joint count.
Eleven young people (5 male, median age 13 years, range 7-16) with JIA knee flare were recruited and 10 completed follow-up assessment. Following IAGI, the median (interquartile range) cJADAS improved from 8.5 (2.7) to 1.6 (3.9), whilst the median synovial volume improved from 38.5cm (82.1cm) to 0.0cm (0.2cm). Six patients presented with frank synovitis outside normal limits on routine MRI reporting. A further three had baseline MRI reports within normal limits but the quantitative measurements identified measurable synovial uptake. Post-IAGI quantitative measurements highlighted significant improvements in 9 patients.
IAGI led to a marked reduction in synovial volume, with quantitative MRI identifying more patients with an improved synovial volume than routine qualitative clinical reporting. Improvements in cJADAS scores were more variable with the patient/parent global assessment component contributing most to the scores. Further work is indicated, exploring the utility of quantitative MRI in the assessment of less accessible joints and comparing the impact of different treatment modalities.
幼年特发性关节炎（JIA）是儿童中最常见的慢性风湿性疾病，其特征为滑膜炎。滑膜炎的临床评估并不完善，主要依赖于包括临床医生报告、患者报告和血液标志物在内的复合且间接的疾病活动指标。对比增强 MRI 是一种更敏感的滑膜炎评估技术，但由于可用性和观察者间差异，其临床应用目前受到限制。改进的定量 MRI 技术可能会为未来制定更严格的 MRI 定义缓解标准提供帮助。本研究的目的是确定在膝关节内注射糖皮质激素（IAGI）前后定量 MRI 测量 JIA 患者滑膜体积和血管性的实用性和可行性，并评估 MRI 在参与家庭中的可接受性。
从泰恩河畔纽卡斯尔的大北方儿童医院招募了患有 JIA 和新发作膝关节滑膜炎需要 IAGI 的儿童和年轻人。除了标准的临床评估工具（包括三变量临床幼年特发性关节炎疾病活动评分[cJADAS]和活跃关节计数）外，还在 IAGI 前和 IAGI 后 12 周进行定量对比增强 MRI。
共招募了 11 名 JIA 膝关节发作的年轻人（5 名男性，中位年龄 13 岁，范围 7-16 岁），其中 10 名完成了随访评估。IAGI 后，cJADAS 的中位数（四分位距）从 8.5（2.7）改善至 1.6（3.9），而滑膜体积中位数从 38.5cm（82.1cm）改善至 0.0cm（0.2cm）。6 名患者在常规 MRI 报告中出现明显的滑膜外滑膜炎。另有 3 名患者基线 MRI 报告在正常范围内，但定量测量发现可测量的滑膜摄取。IAGI 后定量测量显示 9 名患者有显著改善。
IAGI 导致滑膜体积明显减少，定量 MRI 比常规定性临床报告更能识别出更多滑膜体积改善的患者。cJADAS 评分的改善更为多变，其中患者/家长总体评估成分对评分的贡献最大。需要进一步研究，探索定量 MRI 在评估较难触及关节中的应用，并比较不同治疗方式的影响。
