Prognostic factors for radiographic progression, radiographic damage, and disability in juvenile idiopathic arthritis

Abstract

Objective. To investigate the rate of radiographic progression and identify prognostic factors of radiographic progression, radiographic damage, and physical disability in juvenile idiopathic arthritis (JIA).Methods. Ninety-four JIA patients with a median disease duration of 1.1 years were followed up prospectively for a median of 4.5 years. Bilateral wrist radiographs were obtained at baseline, at 1 year, and at the last followup visit. Radiographic damage was assessed by the carpal length (Poznanski score), and physical disability by the Childhood Health Assessment Questionnaire (C-HAQ). Yearly radiographic progression, the Poznanski score at the final visit, and the C-HAQ score at the final visit were used as outcome measures. Baseline parameters included demographic, clinical, laboratory, and radiographic data.Results. The mean ؎ SD Poznanski score was -1.2 ؎ 1.3 at baseline, -1.7 ؎ 1.8 at the 1-year visit, and -1.9 ؎ 2.2 at the final visit (P < 0.0001). Radiographic progression was greater during the first year (mean ؎ SD -0.5 ؎ 1.1) than between the 1-year visit and the final visit (-0.2 ؎ 1.3). The mean yearly radiographic progression during the entire study period was -0.1 ؎ 0.4. Logistic regression analysis revealed that radiographic progression during the first year was the only baseline parameter that was predictive of all 3 study outcomes. The final Poznanski score was also predicted by the baseline Poznanski score, whereas female sex was protective against radiographic progression.Conclusion. We identified the prognostic factors for poorer outcome in polyarticular-course JIA. The changes in the early Poznanski score can be used to predict long-term joint damage and physical disability.

Development of a standardized method of assessment of radiographs and radiographic change in juvenile idiopathic arthritis: Introduction of the Dijkstra composite score

“…This sign is considered a key manifestation of JIA (8,11,12), but in our investigations, its reproducibility was moderate (9). Definitions of growth disturbance therefore need further refinement (e.g., an atlas of reference films) to improve the value in a scoring system.…”

“…Because one of the aims of JIA treatment is to prevent or retard joint damage, and radiographs are able to document this damage, a standardized tool for the radiologic evaluation of the lesions of the joints over time is needed. Several methods have been proposed to assess radiographs in JIA (5)(6)(7)(8), but none have been tested for sensitivity to change or discrimination between treatment groups in a trial. Recently, we introduced the Dijkstra score as a standardized method to evaluate the radiographs of patients with oligoarticular-and polyarticular-onset JIA.…”

Development and validation of a clinical index for assessment of long‐term damage in juvenile idiopathic arthritis

“…In patients with wrist involvement, standard radiographs of both wrists in the posteroanterior view were obtained. Radiographic damage was scored according to the method described by Poznanski et al (12), as previously reported (13). Briefly, this method is based on the measurement of the radiometacarpal (RM) length, which is the distance from the base of the third metacarpal bone to the midpoint of the distal growth plate of the radius, and of the maximal length of the second metacarpal bone (M2).…”

“…In addition, radiographs do not measure damage in extraarticular systems or visceral organs. Second, the few available methods for scoring radiographic damage in JIA patients concentrate on the wrists or knees (12)(13)(14), whereas damage in other joints may be of equal importance for a patient's functional ability. Third, the cost of measuring radiographic damage and the related radiation exposure make these methods less suitable for studying large numbers of patients or for use in developing countries.…”

Paediatric musculoskeletal US beyond the hip joint

“…Juvenile idiopathic arthritis US is an accurate test for intraarticular signs of disease, such as joint effusion, synovial hypertrophy and hyperaemia, and is able to detect subclinical synovitis in children with juvenile idiopathic arthritis [26,27]. The ability of US to assess multiple joints in one sitting, and to detect subclinical synovitis, seems to be particularly useful in juvenile idiopathic arthritis, since the differentiation of oligoarthritis and polyarthritis is based on the number of inflamed joints.…”