Predictive Value of Magnetic Resonance Imaging in Patients With Juvenile Idiopathic Arthritis in Clinical Remission

Abstract

Objective To define the prevalence of subclinical synovitis on magnetic resonance imaging (MRI) in a large cohort of patients with juvenile idiopathic arthritis (JIA) in clinical remission and to evaluate its predictive value in terms of disease flare and joint deterioration. Methods Ninety patients with clinically inactive JIA who underwent a contrast‐enhanced (CE)–MRI of a previously affected joint were retrospectively included. Each joint was evaluated for synovitis, tenosynovitis, and bone marrow edema. Baseline and follow‐up radiographs were assessed to evaluate structural damage progression. Results CE‐MRI was acquired in 45 wrists, 30 hips, 13 ankles, and 2 knees. Subclinical synovitis was detected in 59 (65.5%) of 90 patients and bone marrow edema in 42 (46.7%) of 90 patients. Fifty‐seven of 90 (63.3%) patients experienced a disease flare during follow‐up. Forty‐four of 59 (74.6%) patients with subclinical synovitis experienced a disease flare versus 13 (41.9%) of 31 patients with no residual synovitis on MRI (P = 0.002). The presence of subclinical synovitis was the best predictor of disease flare on multivariable regression analysis (hazard ratio [HR] 2.45, P = 0.003). Baseline and follow‐up radiographs were available for 54 patients, and 17 (31.5%) of 54 patients experienced radiographic damage progression. The presence of bone marrow edema (HR 4.40, P = 0.045) and being >17 years old (HR 3.51, P = 0.04) were strong predictors of joint damage progression in the multivariable analysis. Conclusion MRI‐detected subclinical inflammation was present in a large proportion of patients with JIA despite clinical remission. Subclinical synovitis and bone marrow edema have been shown to play a role in predicting the risk of disease relapse and joint deterioration, with potential implications for patients' management of the disease.

A novel magnetic resonance imaging scoring system for active and chronic changes in children and adolescents with juvenile idiopathic arthritis of the hip

“…Particularly, it could be used prior to therapy to identify children who need more aggressive treatment and during the pharmacological treatment to monitor its efficacy and to assess more accurately their remission status. Moreover, it has been recently reported that persistent synovitis on hip MRI in children with JIA in clinical remission predicts disease flare [ 34 ]. Therefore, our scoring system could be extremely helpful in children in clinical remission where the depiction of a silent synovitis on MRI might allow prompt treatment with a possible considerable improvement of disease progression.…”

A clinical perspective on imaging in juvenile idiopathic arthritis

“…Nevertheless, its application for treatment monitoring is still limited to clinical trials, as estimates of bone erosion and cartilage loss in children remain inherently imprecise. MRI is known to be constrained by several limitations, including cost, accessibility, and patient acceptance [ 12 , 13 ].…”

“…A recent study by Mazzoni et al [ 12 ] found that subclinical synovitis and bone marrow edema detected on MRI in 65.5% and 46.7% of patients in their cohort, respectively, were the best predictors of disease relapse and joint deterioration, despite clinical remission. These findings have important implications for disease management [ 12 ].…”

“…Emerging issues in MRI surveillance of JIA patients relate to the presence of subclinical synovitis as a predictor of disease flare-up (Fig. 8 ) [ 12 ]. Bone marrow edema is a questionable predictor of an unfavorable outcome, as it can be found in more than 50% of healthy children, as shown by the Norwegian group [ 87 ].…”

Bildgebung bei der juvenilen idiopathischen Arthritis (JIA) – was, wann und warum?

“…Studien konnten für den Nachweis einer subklinischen Aktivität und Hypervaskularisation von Gelenken und Sehnen bei Kindern mit JIA einen prädiktiven Wert für eine erneute Schubsituation nachweisen. Damit gewinnt die Gelenksonografie eine zunehmend wichtige Rolle im Treat-to-target-Konzept [10][11][12][13][14].…”