[Show abstract][Hide abstract] ABSTRACT: Approximately 30 % of juvenile idiopathic arthritis (JIA) patients fail to respond to anti-TNF treatment. When clinical remission is induced, some patients relapse after treatment has been stopped. We tested the predictive value of MRP8/14 serum levels to identify responders to treatment and relapse after discontinuation of therapy.
Samples from 88 non-systemic JIA patients who started and 26 patients who discontinued TNF-blockers were analyzed. MRP8/14 serum levels were measured by in-house MRP8/14 ELISA and by Bühlmann Calprotectin ELISA at start of anti-TNF treatment, within 6 months after start and at discontinuation of etanercept in clinical remission. Patients were categorized into responders (ACRpedi ≥ 50 and/or inactive disease) and non-responders (ACRpedi < 50) within six months after start, response was evaluated by change in JADAS-10. Disease activity was assessed within six months after discontinuation.
Baseline MRP8/14 levels were higher in responders (median MRP8/14 of 1466 ng/ml (IQR 1045-3170)) compared to non-responders (median MRP8/14 of 812 (IQR 570-1178), p < 0.001). Levels decreased after start of treatment only in responders (p < 0.001). Change in JADAS-10 was correlated with baseline MRP8/14 levels (Spearman's rho 0.361, p = 0.001). Patients who flared within 6 months after treatment discontinuation had higher MRP8/14 levels (p = 0.031, median 1025 ng/ml (IQR 588-1288)) compared to patients with stable remission (505 ng/ml (IQR 346-778)). Results were confirmed by Bühlmann ELISA with high reproducibility but different overall levels.
High levels of baseline MRP8/14 are associated with good response to anti-TNF treatment, whereas elevated MRP8/14 levels at discontinuation of etanercept are associated with higher chance to flare.
Full-text · Article · Aug 2015 · Arthritis research & therapy
[Show abstract][Hide abstract] ABSTRACT: Depression is common in pregnancy and associated with increased risk of adverse effects for the neonate. Treatment and prevention options include antidepressant therapy. The aim of this paper was to review the literature on safety of mirtazapine during pregnancy and lactation. In 31 papers a total of 390 cases of neonates exposed to mirtazapine during pregnancy or lactation have been described. There might be an association between mirtazapine and spontaneous abortion, however, this might be attributable to underlying psychiatric disease. An increased risk of major neonatal malformations associated with mirtazapine in pregnancy has not been reported. Although one study showed a nearly significant increase in occurrence of respiratory problems and hypoglycaemia, no indication of causality could be given. No other significant adverse effects on neonates were reported. Limited available data, four papers on 11 exposed neonates, suggest that use of mirtazapine during breastfeeding is safe due to a low relative infant dose. High plasma levels might be associated with increased body weight and sleep. However, the reported data are too scarce to come to a clear assessment of the risk of mirtazapine in lactation. No information is available on the use of mirtazapine in pregnancy and Poor Neonatal Adaptation Syndrome (PNAS) or neurobehavioral development at an age over one year. In conclusion, mirtazapine seems to be safe in pregnancy, especially regarding incidence of congenital malformations. There are not enough data available to come to a conclusion on the safety of mirtazapine during lactation.
No preview · Article · Jun 2015 · European neuropsychopharmacology: the journal of the European College of Neuropsychopharmacology
[Show abstract][Hide abstract] ABSTRACT: To determine whether clinical, laboratory or Magnetic Resonance Imaging (MRI) measures differentiate Juvenile Idiopathic Arthritis (JIA) from other forms of active childhood arthritis.
We prospectively collected data of 80 treatment-naïve patients clinically suspected of JIA with active non-infectious arthritis of (at least) one knee for <12 months duration. Upon presentation patients underwent clinical and laboratory assessments and contrast-enhanced MRI. MRI was not used as a diagnostic criterion.
Forty-four (55 %) patients were clinically diagnosed with JIA, whereas in 36 (45 %) patients the diagnosis of JIA was discarded on clinical or laboratory findings. MRI-based synovitis was present in 27 (61.4 %) JIA patients and in 7 (19.4 %) non-JIA patients (P < 0.001). Five factors (male gender, physician's global assessment of overall disease activity, joints with limited range of motion, HLA-B27, MRI-based synovitis) were associated with the onset of JIA. In multivariate analysis MRI-based synovitis proved to be independently associated with JIA (OR 6.58, 95 % CI 2.36-18.33). In patients with MRI-based synovitis, the RR of having JIA was 3.16 (95 % CI 1.6-6.4).
The presence of MRI-based synovitis is associated with the clinical onset of JIA. Physical examination could be supported by MRI, particularly to contribute in the early differentiation of different forms of non-infectious childhood arthritis.
• Juvenile Idiopathic Arthritis (JIA) is a diagnosis of exclusion. • Differentiating JIA and other forms of childhood arthritis can be difficult. • MRI-techniques have substantially improved evaluation of joint abnormalities in JIA patients. • MRI-based synovitis is significantly associated with the clinical onset of JIA. • MRI could support physical examination in the early differentiation of childhood arthritis.
Full-text · Article · May 2015 · European Radiology
[Show abstract][Hide abstract] ABSTRACT: Depression is a common disorder in pregnancy and associated with adverse effects for both mother and neonate. Pharmacological treatment and prevention options include mirtazapine. In a series of 56 cases, we investigated neonatal outcome after intrauterine exposure to mirtazapine and exposure through lactation in the first days postpartum.No increase in any neonatal complication was observed. None of the infants exposed to mirtazapine in the first trimester were born with a major malformation. Of the 54 infants exposed to mirtazapine in the third trimester, 14 were diagnosed with poor neonatal adaptation syndrome (PNAS). This incidence (25.9%) is similar to the incidence of PNAS after intrauterine exposure to other antidepressants. The incidence of PNAS after exposure to mirtazapine was significantly diminished in children who were partially or fully breastfed (18.6% versus 54.5%, P = 0.024).
No preview · Article · Feb 2015 · Journal of Clinical Psychopharmacology
[Show abstract][Hide abstract] ABSTRACT: AimInfants exposed to antidepressants in utero are at risk of developing poor neonatal adaptation (PNA). This study identified risk factors for PNA.Methods
In this cohort study, data on mothers and infants admitted to the maternity ward of a generalhospital between 2007 and 2012 were analysed. All infants were exposed to an antidepressantduring the last trimester of fetal life. The main outcome measure was PNA, defined as at least one Finnegan scores of four or more during admission. Risk factors analysed for their possible association with PNA included type of feeding, type and dosage of antidepressant, prematurity and maternal smoking, anxiety and depression.ResultsWe included 247 infants in the study and 157 (64%) developed PNA. Formula feeding was associated with an increased risk of PNA compared to breastfeeding or mixed feeding (OR3.16 95%CI 1.40-7.13 p0.003). Selective serotonin reuptake inhibitors (SSRIs) were associated with an increased risk of PNA compared to serotonin and norepinephrine reuptake inhibitors (OR2.52 95%CI 1.07-5.95 p0.04). Dosage did not influence the risk of PNA (OR 1.50 95%CI 0.89-2.52 p0.13).Conclusion
Formula feeding and exposure to SSRIs were associated with development of PNA, but dosage was not.This article is protected by copyright. All rights reserved.
No preview · Article · Jan 2015 · Acta Paediatrica
[Show abstract][Hide abstract] ABSTRACT: Abstract Objective The Finnegan scoring list (FSL) is widely used to screen for Poor Neonatal Adaptation in infants exposed to antidepressants in utero. However, the large number of FSL-items and differential weighing of each item is time consuming. The aim of this study was to shorten and simplify the FSL yet preserving its clinimetric properties. Methods This observational study examined infants exposed to an antidepressant during pregnancy admitted for at least 72 hours on a maternity ward. Trained nurses completed the FSL three times daily. Items for the adapted FSL were selected through forward analysis whereby the number of selected items was based on the Area Under the Curve (AUC). Internal validity was assessed by cross-validation. Results 183 infants met the inclusion criteria. By forward analysis 8 equally-weighed items resulted in an AUC of 0.91. In cross-validation, the mean AUC was 0.89 for 8 items. This adapted FSL had a sensitivity of 97.7% and specificity of 37.0% and a sensitivity of 41.9% and specificity of 86.2% regarding a cut off of respectively 1 and 2. Conclusions An adapted FSL with 8 equally-weighed items has acceptable clinimetric properties and can serve as an easy to apply screening tool in infants exposed to antidepressants during pregnancy.
No preview · Article · Oct 2014 · Journal of Maternal-Fetal and Neonatal Medicine
[Show abstract][Hide abstract] ABSTRACT: Objective:
To determine the prevalence of hand- and wrist-related symptoms and impairments, with resulting activity limitations and participation restrictions in children being treated for juvenile idiopathic arthritis.
Design and patients:
Cohort study of children, diagnosed in our hospitals between 2003 and 2008 with juvenile idiopathic arthritis, who received standard treatment with regular follow-ups in the same institutions. Patients were asked about hand and wrist symptoms, and underwent a standardized physical examination. For activity limitations, they were asked to complete the Dutch version of the Childhood Health Assessment Questionnaire (CHAQ). Concerning participation restrictions, children were asked about any hand- and/or wrist-related difficulties during daily activities.
Of all 152 eligible patients, 121 (80%) participated in the study; 34 boys and 87 girls, mean age 13.7 years (standard deviation (SD) 4.2), mean disease duration 2.6 years (SD 1.4), mean Juvenile Arthritis Disease Activity Score in 71 joints (JADAS-71) score 8 (SD 8), indicating low disease activity. Of these 121, 84 (69%) had at least 1 symptom and 40% had at least 1 impairment. The median CHAQ-total score was 0.5 (mean 0.75 (SD 0.77)), indicating mild-to-moderate activity limitations; and 54% reported having hand- and/or wrist-related problems at school.
Despite low disease activity, many children appeared to have hand- and/or wrist-related symptoms and impairments, with resulting moderate to severe levels of activity limitations and participation restrictions at school.
Full-text · Article · Sep 2014 · Journal of Rehabilitation Medicine
[Show abstract][Hide abstract] ABSTRACT: Objective:
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.
Materials and methods:
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.
No preview · Article · May 2014 · American Journal of Roentgenology
[Show abstract][Hide abstract] ABSTRACT: To compare DCE-MRI parameters and the relative number of time-intensity curve (TIC) shapes as derived from pixel-by-pixel DCE-MRI TIC shape analysis between knees of clinically active and inactive juvenile idiopathic arthritis (JIA) patients.
DCE-MRI data sets were prospectively obtained. Patients were classified into two clinical groups: active disease (n = 43) and inactive disease (n = 34). Parametric maps, showing seven different TIC shape types, were created per slice. Statistical measures of different TIC shapes, maximal enhancement (ME), maximal initial slope (MIS), initial area under the curve (iAUC), time-to-peak (TTP), enhancing volume (EV), volume transfer constant (K (trans)), extravascular space fractional volume (V e) and reverse volume transfer constant (k ep) of each voxel were calculated in a three-dimensional volume-of-interest of the synovial membrane.
Imaging findings from 77 JIA patients were analysed. Significantly higher numbers of TIC shape 4 (P = 0.008), median ME (P = 0.015), MIS (P = 0.001) and iAUC (P = 0.002) were observed in clinically active compared with inactive patients. TIC shape 5 showed higher presence in the clinically inactive patients (P = 0.036).
The pixel-by-pixel DCE-MRI TIC shape analysis method proved capable of differentiating clinically active from inactive JIA patients by the difference in the number of TIC shapes, as well as the descriptive parameters ME, MIS and iAUC.
• The pixel-by-pixel TIC shape method differentiates clinically active and inactive JIA patients • Significantly higher numbers of TIC shape 4 were observed in clinically active patients • DCE-MRI parameters ME, MIS and iAUC differ between active and inactive patients • The pixel-by-pixel analysis method allows direct visualization of the heterogeneously distributed disease • The DCE-MRI TIC shape method may serve as a quantitative outcome measure.
No preview · Article · Apr 2014 · European Radiology
[Show abstract][Hide abstract] ABSTRACT: Treatment of juvenile idiopathic arthritis (JIA) has changed dramatically since the introduction of biological agents in 1999.
To evaluate trends in prescription patterns of biological agents and the subsequent outcome of JIA.
The Arthritis and Biologics in Children register (multicentre prospective observational study) aimed to include all consecutive patients with JIA in the Netherlands who had started biological agents since 1999. Patients were divided according to year of introduction of first biological agent. Patient characteristics at introduction of the first biological agent and its effectiveness were analysed over 12 years.
335 patients with non-systemic JIA and 86 patients with systemic JIA started a biological agent between 1999 and 2010. Etanercept remained the most often prescribed biological agent for non-systemic JIA; anakinra became first choice for systemic JIA. The use of systemic glucocorticoids and synthetic disease-modifying antirheumatic drugs before biological agents decreased. During these 12 years of observation, biological agents were prescribed earlier in the disease course and to patients with lower baseline JADAS (Juvenile Arthritis Disease Activity Score) disease activity. All baseline disease activity parameters were lowered in patients with non-systemic JIA. In systemic JIA, prescription patterns changed towards very early introduction of biological agents (median 0.4 years of disease duration) in patients with a low number of joints with active arthritis and high erythrocyte sedimentation rates. These changes for both systemic and non-systemic JIA resulted in more patients with inactive disease after 3 and 15 months of treatment.
Biological agents are increasingly prescribed, earlier in the disease and in patients with JIA with lower disease activity. These changes are accompanied by better short-term disease outcomes.
No preview · Article · Mar 2014 · Annals of the rheumatic diseases
[Show abstract][Hide abstract] ABSTRACT: Background MRI plays an increasingly important role in the assessment and monitoring of disease activity in juvenile idiopathic arthritis (JIA). Awareness of the incidence and distribution pattern of MRI abnormalities in JIA is a valuable tool in the daily practice of the reading radiologist and the treating clinician. Preferred locations for pathology within target joints are facilitated by knowledge on common distribution patterns of MRI abnormalities, enabling rapid differentiation between JIA abnormalities and normal variants.
Objectives To determine (1) incidence and (2) distribution pattern of soft-tissue- and osseous abnormalities upon MRI of the two of the most affected joints in JIA (i.e. the knee and wrist)
Methods MRI datasets of 166 active JIA patients (123 with knee and 43 with wrist involvement) were analyzed. Two readers evaluated presence of 4 literature-based items per joint. Common items included synovial hypertrophy (SH), bone marrow changes (BMC), and bone erosions (BE). Joint-specific features were additionally evaluated: cartilage lesions (CL) for the knee and tenosynovits (TS) for the wrist. Scoring locations in these two joints were also literature-based. Incidence of each scored item was defined separately. Involvement per location, analyzed as percentage of the total amount of affected locations, was determined.
Results SH showed the highest incidence in both the knee and wrist (56.9-65.1% of the patients). Besides BMC (34.1%), the incidence of osteochondral features was low in the knee (CL 6.5%; BE 4.9%). In contrast, the incidence of these features in the wrist were relatively high (BMC 37.2% and BE 30.2%) and TS was present in 46.5% of the patients with wrist involvement.
In order to make MRI easy, ‘top-3-location’ per feature was constituted. Below, the ‘number 1’ or most frequently affected location per feature is mentioned. In the knee these locations consisted of cruciate ligaments (25.1% in SH), medial patella (28.1% in BMC, 33.3% in CL) and lateral femur trochlea (50% in BE).
In the wrist, the radiocarpal joint (32.8% in SH), extensor-tendon-group (83.3% in TS), lunate (15.2% in BMC) and capitate/triquetrum (21.4% in BE) were mostly affected. Being the most important feature in JIA, SH in the knee showed preferred presence in the central locations, which accounted for >85% of the total affected locations. Less obvious demarcation for SH was found in the wrist. Both in the knee and wrist the three least affected locations of SH were never found to be involved without the presence of at least one of the three other most frequently affected locations.
Conclusions This study provides an overview of incidence and distribution of a well-defined spectrum of MRI abnormalities within the knee or wrist of clinically active JIA patients. SH has highest incidence in both joints. In daily practice, a top-3-location per feature suggestive for pathology is helpful in navigation through the MRI of the knee or wrist in JIA patients.
Disclosure of Interest None Declared
[Show abstract][Hide abstract] ABSTRACT: Background Juvenile Idiopathic Arthritis (JIA) is the most frequent form of arthritis in children. There are 7 subtypes of JIA in all of which the hand and wrist can be affected (1,2). The consequences of inflammation in the hand and wrist can be far-reaching and may lead to serious impairments and deformities. General problems of hand and wrist are described in 80% of all children with JIA (2) without further specification of the impairments. These impairments need to be further investigated, in order to develop nonpharmacological preventive treatment.
Objectives To investigate the prevalence of specific hand and wrist impairments in children with JIA
Methods Cross-sectional design, in which all children and adolescents (0-21 years) were included, who were diagnosed between January 2003 and January 2008 for JIA at the Departments of Pediatric Rheumatology of the Jan van Breemen Institute and Emma Childrens’ Hospital AMC in Amsterdam, and who have been treated in these clinics since then. During control visits at the outpatient clinic, assessment of complaints such as pain and stiffness and the use of devices, was performed, together with a specialized standardized physical examination of the hand and wrist including scores for tenosynovitis, arthritis and joint deformities.
Results Between October 2006 and March 2010, 169 children met the inclusion criteria, of which 122 (72% of the total cohort) were assessed according to the protocol: mean disease duration 2.4 year (range 0.3-4.5 years), 71% female, mean age 13.7 years (range 3-20 years) and JIA subtypes: Rf-polyarthritis (52%), oligoarthritis (29%), Rf+polyarthritis (7%), psoriatic arthritis (6%), enthesitis related arthritis (6%), systemic (0%) and undifferentiated JIA (0%). The prevalence of any hand and wrist complaint was 56% and 49%, respectively. In 54% the children experienced complaints at school, and in 17% during hobbies. In only 15% and 23% of the children there were signs of active arthritis in hand and wrist joints respectively, and in 3% stenosing tenosynovitis. The prevalence of any hand or wrist impairment was 34%. Most frequent impairments were: limited range of motion of wrist (22%), PIP (18%), and MCP joints (8%). Only 2 children showed Boutonniere deformities; there were no Swanneck deformities, no radiar or ulnar deviations of wrist and finger joints, and no tendon ruptures. Five children showed diminished grip force in both hands. In 18% and 9%, the children were using wrist braces and finger splints respectively, while 43% applied other devices like a laptop (20%) or an adapted pencil (26%) at school.
Conclusions In 122 children with JIA (72% of the total cohort), there was a high prevalence of hand and wrist impairments, also without the presence of active clinical arthritis.
Disclosure of Interest None Declared
[Show abstract][Hide abstract] ABSTRACT: Background Anti-citrullinated protein antibodies (ACPA) have a low prevalence in Juvenile Idiopathic Arthritis (JIA). Autoantibodies recognizing carbamylated protein (anti-CarP) are a promising new serological marker for ACPA negative Rheumatoid Arthritis and are associated with a more severe clinical course (Shi et al, 2011).
Objectives To determine the presence of anti-CarP antibodies in sera of JIA patients and to investigate their prognostic value.
Methods Samples of 249 patients with all subgroups of JIA, taken at different time points in their disease course and 107 healthy partially age matched controls were analyzed for the presence of anti-CarP antibodies as well as ACPA (commercial CCP2 ELISA). Cut-off for positivity was determined in the sera of the healthy controls as the mean plus two times standard deviation.
Results The serum samples came from patients with all different subtypes of JIA (median age 12,1 years, IQR 8,1-15,7 median disease duration 2,2 years IQR 0,7-6,4) including 19 polyarticular rheumatoid factor positive patients. IgG antibodies recognizing carbamylated antigens were present in sera of 12,9% (32/249) of all JIA patients vs 2,8% (3/107) in the controls (p=0,002). Anti-CarP antibodies were detected in 58% (11/19) of the rheumatoid factor positive polyarticular JIA patients (p<0,001) vs 10% (9/90) in the rheumatoid factor negative polyarticular JIA patients.
Conclusions Anti-CarP antibodies can be detected in sera of patients with JIA, mainly in the rheumatoid factor positive polyarticular subgroup, which is the JIA subtype that shows the most resemblance with RA in adults. Correlations between anti-CarP antibodies and disease characteristics are currently under investigation.
Disclosure of Interest P. Hissink Muller Grant/Research support from: Pfizer and the Dutch League against Rheumatism, J. Anink: None Declared, J. Shi: None Declared, N. Levarht: None Declared, T. Reinards: None Declared, M. Otten: None Declared, M. van Tol: None Declared, C. Jol-van der Zijde: None Declared, C. Allaart: None Declared, E. Hoppenreijs: None Declared, Y. Koopman-Keemink: None Declared, K. Dolman: None Declared, J. van den Berg: None Declared, M. van Rossum: None Declared, L. van Suijlekom-Smit: None Declared, M. Schilham: None Declared, R. ten Cate: None Declared, R. Toes: None Declared, L. Trouw: None Declared
No preview · Article · Jan 2014 · Annals of the Rheumatic Diseases
[Show abstract][Hide abstract] ABSTRACT: Background Treatment of juvenile idiopathic arthritis (JIA) has changed dramatically since the introduction of biologics in 1999. Because of more insight in the immunological and biological pathways involved in the development of JIA the number of available biologic agents increased. Together with the introduction of these new drugs, also new insights in the optimal treatment of JIA indicate that earlier and more aggressive therapy is associated with better outcomes. Whether these new insights with regard to biologic treatment have been adopted in daily practice and resulted in better patients’ outcomes is not yet reported.
Objectives o evaluate trends in prescription of biologics and influence on outcomes of Dutch JIA patients that started their first biologic between 1999 and 2010.
Methods The Arthritis and Biologicals in Children register (a multicenter prospective observational study) aims to include all JIA patients in the Netherlands who use or used biologic agents since 1999. Patients were divided in time periods according to the year of introduction of first biologic agent. Trends in characteristics of patients before introduction of first biologic and effectiveness of the first biologic were analyzed over a 12 year period.
Results 343 non-systemic and 86 systemic JIA patients started at least 1 biologic agent between 1999 and 2010. Etanercept remained biologic of first choice for non-systemic JIA and anakinra has become first choice for systemic JIA. The use of systemic prednisone and synthetic disease-modifying anti-rheumatic drugs (besides methotrexate) prior to biologics decreased. During these 12 years of observation, biologics were prescribed after shorter disease durations; the proportion of patients with less than 1.5 years of disease duration before start of the first biologic agent increased from zero in the years 1999-2001 to 31% in 2008-2010. Disease activity and acquired sequelae at baseline decreased with regard to number of joints with arthritis (median of 18 active joints in 1999-2001 to 5 in 2008-2010), number of joints with limited motion (median of 12 limited joints in 1999-2001 decreased to 3 in 2008-2010) and functional disability scores (median CHAQ score of 1.8 in 1999-2001 decreased to 1.1 in 2008-2010). For systemic JIA, prescription patterns changed towards introduction in patients with higher ESR values. These changes for both systemic and non-systemic JIA resulted in more patients with inactive disease and less joints with limited motion after 3 and 15 months of treatment.
Conclusions Biologics are prescribed increasingly, are introduced earlier during the disease course and in JIA patients with lower disease activity. These changes are subsequently accompanied by better short-term disease outcomes. Etanercept remains biologic of first choice for non-systemic JIA and anakinra has become first choice for systemic JIA.
Disclosure of Interest M. Otten Grant/research support from: Abbott, Novartis, Roche, Pfizer, Consultant for: Roche, J. Anink: None Declared, F. Prince Grant/research support from: Abbott, Bristol-Myers Squibb, Novartis, Tevapharma, and Pfizer, Consultant for: Roche, M. Twilt: None Declared, S. Vastert: None Declared, R. ten Cate Grant/research support from: Pfizer, Consultant for: Pfizer, E. Hoppenreijs: None Declared, W. Armbrust: None Declared, S. Gorter: None Declared, P. van Pelt: None Declared, S. Kamphuis Grant/research support from: Pfizer, K. Dolman: None Declared, J. Swart: None Declared, J. van den Berg: None Declared, Y. Koopman-Keemink: None Declared, M. van Rossum: None Declared, N. Wulffraat Grant/research support from: Pfizer, Novartis and Roche, L. van Suijlekom-Smit Grant/research support from: Dutch Board of Health Insurances, Dutch Arthritis Association, Pfizer, Abbott, Consultant for: Roche, Novartis
Full-text · Article · Jan 2014 · Annals of the Rheumatic Diseases
[Show abstract][Hide abstract] ABSTRACT: To evaluate whether clinical disease activity findings during 1-year followup of patients with juvenile idiopathic arthritis (JIA) is associated with changes of magnetic resonance imaging (MRI)-based disease activity scores.
Patients with JIA who had active knee involvement were studied using an open-bore MRI. After followup of a median of 1.3 years, patients were re-evaluated and classified as improved or unimproved according to the American College of Rheumatology Pediatric-50 (ACR-Ped50) criteria. Baseline and followup MRI features were scored by 2 readers using the Juvenile Arthritis MRI Scoring (JAMRIS) system, comprising validated scores for synovial hypertrophy, bone marrow changes, cartilage lesions, and bone erosions.
Data of 40 patients were analyzed (62.5% female, mean age 12.2 yrs). After followup, 27 patients (67.5%) were classified as clinically improved, whereas 13 patients (32.5%) showed no clinical improvement. The clinically improved patients showed a significant reduction in synovial hypertrophy scores during followup (p < 0.001), with substantial effects (standardized response mean -0.70). No such changes were observed for any of the other MRI features. Significant differences were detected regarding a change in synovial hypertrophy scores comparing clinically improved and unimproved patients (p = 0.004), without statistically significant differences for changes in scores for bone marrow changes (p = 0.079), cartilage lesions (p = 0.165), and bone erosions (p = 0.078).
This is one of the first studies to provide evidence for MRI-based improvement upon followup in JIA patients with knee involvement. There is a strong association with clinical improvement according to the ACR-Ped50 criteria and changes in MRI-based synovial hypertrophy scores, supporting the role of MRI as a responsive outcome measure to evaluate disease activity with antiinflammatory treatment strategies.
No preview · Article · Dec 2013 · The Journal of Rheumatology