Feasibility and reliability of the Spondyloarthritis Research Consortium of Canada sacroiliac joint inflammation score in children

Weiss, Pamela F.; Maksymowych, Walter P.; Lambert, Robert G.; Jaremko, Jacob L.; Biko, David M.; Paschke, Joel; Brandon, Timothy G.; Xiao, Rui; Chauvin, Nancy A.

doi:10.1186/s13075-018-1543-x

Cited by 27 publications

(20 citation statements)

References 16 publications

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“…Two of the 3 raters (MLF and NAC) participated in a study that included review of SI imaging of 70 healthy children ages 7–18 years (2). All 3 central raters have been extensively calibrated to review inflammatory and structural lesions at the SI joint (5–8). Digital Imaging and Communications in Medicine–based anonymized cases were scored in randomized order, and study data were collected and managed using REDCap electronic data capture tools hosted at the Children’s Hospital of Philadelphia (9).…”

Section: Methodsmentioning

confidence: 99%

Variability in Interpretation of Magnetic Resonance Imaging of the Pediatric Sacroiliac Joint

Weiss

Brandon

Bohnsack

et al. 2021

Arthritis Care & Research

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Objective Magnetic resonance imaging (MRI) is pivotal in the assessment of early sacroiliitis in children. We aimed to evaluate the agreement between local radiology reports and central imaging reviewers for active inflammation and structural damage at the sacroiliac (SI) joints. Methods Eight hospitals each contributed up to 20 cases of consecutively imaged children and adolescents with juvenile idiopathic arthritis and suspected sacroiliitis. Studies were independently reviewed by 3 experienced musculoskeletal pediatric radiologists. Local assessments of global impression and lesions were coded from the local radiology reports by 2 study team members. Test properties of local reports were calculated using the central imaging team’s majority as the reference standard. Results For 120 evaluable subjects, the median age was 14 years, half of the cases were male, and median disease duration at the time of imaging was 0.8 years (interquartile range 0–2). Sensitivity of local reports for inflammation was high, 93.5% (95% confidence interval [95% CI] 78.6–99.2), and specificity was moderate, 69.7% (95% CI 59.0–79.0), but positive predictive value (PPV) was low, 51.8% (95% CI 38.0–65.3). Twenty‐seven cases (23%) had active inflammation reported locally but rated normal at the central reading, 19 (70%) with subsequent medication changes. The sensitivity of local reports detecting structural damage was low, 45.7% (95% CI 28.8–63.4), and specificity was high, 88.2% (95% CI 79.4–94.2); PPV was low, 61.5% (95% CI 40.6–79.8). Conclusion Substantial variation exists in the interpretation of inflammatory and structural lesions at the SI joints in children. To reliably identify pathology, additional training in the MRI appearance of the maturing SI joint is greatly needed.

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Section: Methodsmentioning

confidence: 99%

Variability in Interpretation of Magnetic Resonance Imaging of the Pediatric Sacroiliac Joint

Weiss

Brandon

Bohnsack

et al. 2021

Arthritis Care & Research

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“…Another important modality to assess disease extent in ERA is the use of MRI, especially to detect the presence of sacroiliitis. This is generally defined as either the presence of erosions or synovial thickening in the lower, synovial portion of the sacroiliac joint, or the presence of associated bone marrow edema around the sacroiliac joint, which can then be graded for its intensity and the depth at which this is present 49. Recent literature suggests that noncontrast MRI of the sacroiliac joints using fluid-sensitive sequences has similar sensitivity and specificity to contrast-enhanced MRI in children 50.…”

Section: Diagnosismentioning

confidence: 99%

<p>Enthesitis-related arthritis: current perspectives</p>

Mistry¹,

Patro²,

Agarwal³

et al. 2019

OARRR

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In this narrative review, we overview the recent literature on enthesitis-related arthritis (ERA). For the purpose of our review, we searched Scopus for recent articles on this subject from 2013 onward, including some classic older articles for perspective. ERA is a juvenile idiopathic arthritis (JIA) subtype more common in males, associated in a majority with human leucocyte antigen B27. Such children generally present with asymmetric oligoarthritis or polyarthritis, predominantly of lower limb joints, associated with enthesitis or sacroiliitis. While diagnosis remains clinical, ultrasound is being increasingly used to detect subclinical enthesitis and for guiding entheseal site injections. Spine MRI can help detect sacroiliitis, inflammatory spinal changes, and pelvic sites of enthesitis in such patients. The recent juvenile spondyloarthropathy disease activity index recognizes the key clinical features of ERA, viz enthesitis and inflammatory back pain, which other disease activity indices used in JIA did not include. Management includes NSAIDs with physical therapy. Conventional disease-modifying agents like sulfasalazine and methotrexate may be used to minimize duration of NSAID use and in those with high inflammatory burden. In patients refractory to these drugs, biologics such as antitumor necrosis factor alpha agents have proven useful, based on evidences from randomized controlled trials and retrospective registry analyses. Factors predicting a poorer outcome in such children include hip or ankle involvement or restricted spinal mobility. Considering that children with ERA have overall poorer long-term outcomes than other subtypes of JIA, there is a need to further optimize therapeutic strategies for such patients.

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“…In adults, there are scoring systems, of which the Spondyloarthritis Research Consortium of Canada (SPARCC) scoring system is most widely accepted. The early studies in children are promising and describe good feasibility and reliability of the SPARCC scoring systems; however, these are not yet widely used and some adaptations may be necessary [ 43 – 45 ] (Table 2 ). Developing reliable paediatric-specific definition for sacroiliitis is a difficult task currently undergoing active study [ 44 , 68 ].…”

Section: Paediatric-specific Items Per Jointmentioning

confidence: 99%

Imaging assessment of children presenting with suspected or known juvenile idiopathic arthritis: ESSR-ESPR points to consider

et al. 2020

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Juvenile idiopathic arthritis (JIA) is the most common paediatric rheumatic disease. It represents a group of heterogenous inflammatory disorders with unknown origin and is a diagnosis of exclusion in which imaging plays an important role. JIA is defined as arthritis of one or more joints that begins before the age of 16 years, persists for more than 6 weeks and is of unknown aetiology and pathophysiology. The clinical goal is early suppression of inflammation to prevent irreversible joint damage which has shifted the emphasis from detecting established joint damage to proactively detecting inflammatory change. This drives the need for imaging techniques that are more sensitive than conventional radiography in the evaluation of inflammatory processes as well as early osteochondral change. Physical examination has limited reliability, even if performed by an experienced clinician, emphasising the importance of imaging to aid in clinical decision-making. On behalf of the European Society of Musculoskeletal Radiology (ESSR) arthritis subcommittee and the European Society of Paediatric Radiology (ESPR) musculoskeletal imaging taskforce, based on literature review and/or expert opinion, we discuss paediatric-specific imaging characteristics of the most commonly involved, in literature best documented and clinically important joints in JIA, namely the temporomandibular joints (TMJs), spine, sacroiliac (SI) joints, wrists, hips and knees, followed by a clinically applicable point to consider for each joint. We will also touch upon controversies in the current literature that remain to be resolved with ongoing research. Key Points • Juvenile idiopathic arthritis (JIA) is the most common chronic paediatric rheumatic disease and, in JIA imaging, is increasingly important to aid in clinical decision-making. • Conventional radiographs have a lower sensitivity and specificity for detection of disease activity and early destructive change, as compared to MRI or ultrasound. Nonetheless, radiography remains important, particularly in narrowing the differential diagnosis and evaluating growth disturbances. • Mainly in peripheral joints, ultrasound can be helpful for assessment of inflammation and guiding joint injections. In JIA, MRI is the most validated technique. MRI should be considered as the modality of choice to assess the axial skeleton or where the clinical presentation overlaps with JIA.

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Feasibility and reliability of the Spondyloarthritis Research Consortium of Canada sacroiliac joint inflammation score in children

Cited by 27 publications

References 16 publications

Variability in Interpretation of Magnetic Resonance Imaging of the Pediatric Sacroiliac Joint

Variability in Interpretation of Magnetic Resonance Imaging of the Pediatric Sacroiliac Joint

<p>Enthesitis-related arthritis: current perspectives</p>

Imaging assessment of children presenting with suspected or known juvenile idiopathic arthritis: ESSR-ESPR points to consider

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