Radiologic features in juvenile idiopathic arthritis: A first step in the development of a standardized assessment method

Abstract

Objective. To describe radiologic features of patients with juvenile idiopathic arthritis (JIA) in a standardized manner, to test the reliability and feasibility of this description, and to correlate these features with clinical signs as a first step in the development of a standardized assessment method.Methods. The placebo-controlled study of sulfasalazine in patients with oligoarticular, extended oligoarticular, and polyarticular JIA performed by the Dutch Juvenile Idiopathic Arthritis Study Group yielded the data for this study. All trial entry radiographs (clinically involved joints and contralateral joints) were scored (in consensus by a skeletal radiologist and pediatric rheumatologist) for the presence of swelling, osteopenia, joint space narrowing, growth abnormalities, subchondral bone cysts, erosions, and malalignment.Results. Data on 67 of 69 patients were analyzed. The mean age was 9.1 years (range 2.5-17.6 years), and the median disease duration was 24 months (range 5-176 months). Thirteen percent of the patients were IgM rheumatoid factor (IgM-RF) positive, and 16% were HLA-B27 positive. All 68 clinically evaluated joints were included in the maximum of 19 radiographed joints (or joint groups) per patient. The mean number of radiographed joints per patient was 7 (range 2-15); knees, hands, ankles, and feet were most frequently affected. Fifty-eight patients (87%) had radiologic abnormalities in at least one joint (soft-tissue swelling in 63% of patients, growth disturbances in 48%, joint space narrowing in 28%, and erosions in 15%). In total, half of the radiographs of the clinically involved joints showed radiologic abnormalities, including two-thirds of the radiographs of the clinically affected hands and knees.

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

“…), and 3) feasibility (Can the instrument be feasibly applied in the intended setting?). We confirmed, to some degree, the truth and feasibility of the Dijkstra score in a clinical trial setting in our previous study (9). In the current study, we focus on the discrimination criterion as it applies to the Dijkstra score.…”

“…In our previous study, we demonstrated that scores for swelling and osteopenia were only moderately reliable (9). Despite detectable change, we still believe that both swelling and osteopenia are of limited value in a scoring system.…”

“…The radiographs were scored in accordance with a standardized assessment method as described previously (9); this is referred to as the Dijkstra score. In summary, a maximum of 19 joints or joint groups were evaluated on radiographs: the cervical spine (1 joint), 2 mandibles, 2 shoulders, 2 elbows, 2 hands (for each hand, the joint group includes all finger, metacarpal, and wrist joints), 2 sacroiliac joints, 2 hips, 2 knees, 2 ankles, and 2 feet (for each foot, the joint group includes all tarsal, metatarsal, and toe joints).…”

“…The DI and DG scores (inflammation and growth abnormalities) changed most often in the knees, while the DD scores (joint damage) changed most often in the hands and feet. Patients with different prognostic profiles (HLA-B27 positive or IgM rheumatoid factor positive [9]) and patients with availability of films from the standard set (hands, feet, and knees) showed com- …”

“…Recently, we introduced the Dijkstra score as a standardized method to evaluate the radiographs of patients with oligoarticular-and polyarticular-onset JIA. Data were obtained from the data set of a placebocontrolled sulfasalazine (SSZ) trial performed in The Netherlands (9). All radiographs were assessed for the presence of a comprehensive spectrum of JIA radiologic features.…”