MAGNETIC RESONANCE IMAGING IN THE DIAGNOSIS OF JUVENILE IDIOPATHIC ARTHRITIS

Juvenile idiopathic arthritis (JIA) are a group of socially significant diseases of childhood because of the high prevalence of a chronic nature, as well as a large percentage of early disability. JIA is a collection of diseases that have different start, course and outcome, as well as various etiologies, which emphasizes the difficulties in the diagnosis process in children. When this disease is progressive in nature, leads to loss of function of the musculoskeletal system, severe disability at an early age and, therefore, needs early diagnosis and adequate therapy appointment.
Significant role in identifying pathology osteoarticular system belongs radiological methods and routine radiography remains the most widely used technique included in the classification criteria of the majority of rheumatic diseases. However, it is well known that secondary structural changes in the bones precedes roentgen period, and therefore the X-rays can not be regarded as a method of early diagnosis with articular syndrome. Widely introduced in recent years, magnetic resonance imaging (MRI) has more say in the assessment of capabilities of the joints, as in addition to assessment of bone allows quantitatively and qualitatively assess changes in the synovial membrane, articular cartilage, the presence and severity of inflammatory changes in the periarticular soft tissue and bone tissue. The data obtained using MRI may be used for diagnosis, prognosis, and monitoring response to treatment, including early stage disease.
Nevertheless, despite the obvious opportunities MRI, this technique is not widely used, including the lack of clear diagnostic criteria for the disease, the lack of centralized research validated, standardized protocols for conducting MRI studies of children with articular syndrome. Thus, research is warranted to address a number of clinical and diagnostic aspects in JIA, in particular the development of the scoring system assessing the severity and progression of the disease.

1. Ravelli A., Martini A. Juvenile idiopathic arthritis. Lancet, 2007, vol. 369, no. 9563, pp. 767–778.

2. Petty R.E., Southwood T.R., Manners P. et al. International league of associations for rheumatology classification of juvenile idiopathic arthritis: second revision. J. Rheumatol., 2004, vol. 31, no. 2, pp. 390–392.

3. Martini A., Lovell D.J. Juvenile idiopathic arthritis: state of the art and future perspectives. Ann. Rheum. Dis., 2010, vol. 69, no. 7, pp. 1260–1263.

4. Jing-Long Huang. New Advances in Juvenile Idiopathic Arthritis. Chang. Gung. Med. J., 2012, vol. 35, no. 1, pp. 1–14.

5. Huang J.L., Kuo M.L., Hung I.J., Wu C.J., Ou L.H., Cheng J.H. Lowered IL-4-producing T cells and decreased IL-4 secretion in peripheral blood from subjects with juvenile rheumatoid arthritis. Chang. Gung. Med. J., 2001, vol. 24, pp. 77–83.

6. Ravelli A., Grom A.A., Behrens E.M. et al. Macrophage activation syndrome as part of systemic juvenile idiopathic arthritis: diagnosis, genetics, pathophysiology and treatment. J. Genes Immun., 2012, vol. 13 (4), pp. 289–298.

7. McInnes I.B., Schett G. Cytokines in the pathogenesis ofrheumatoid arthritis. Nat. Rev. Immunol., 2007, vol. 7, no. 7, pp. 429–442.

8. Hayward K., Wallace C.A. Recent developments in antirheumatic drugs in pediatrics: treatment of juvenile idiopathic arthritis. Arthritis Res. Ther., 2009, vol. 11, no. 1, pp. 216.

9. Lovell D.J., Giannini E.H., Reiff A. et al. Etanercept in children with polyarticular juvenile rheumatoid arthritis. Pediatric Rheumatology Collaborative Study Group. N. Engl. J. Med., 2000, vol. 342, no. 11, pp. 763–769.

10. Lovell D.J., Ruperto N., Goodman S. et al. Adalimumab with or without methotrexate in juvenile rheumatoid arthritis. N. Engl. J. Med., 2008, vol. 359, no. 8, pp. 810–820.

11. Boutry N., Larde A., Lapegue F., et al. Magnetic resonance imaging appearance of the hands and feet in patients with early rheumatoid arthritis. J. Rheumatol., 2003, vol. 30, no. 4, pp. 671–679.

12. Klauser A., Frauscher F., Schirmer M. et al. The value of contrast-enhanced color Doppler ultrasound in the detection of vascularization of finger joints in patients with rheumatoid arthritis. Arthritis Rheum., 2002, vol. 46, pp. 647–653.

13. Guzma´n J., Burgos-Vargas R., Duarte-Salazar C. et al. Reliability of the articular examination in children with juvenile rheumatoid arthritis: interobserver agreement and sources of disagreement. J. Rheumatol., 1995, vol. 22, pp. 2331–2336.

14. Forslind K., Larsson E.M., Johansson A. et al. Detection of joint pathology by magnetic resonance imaging in patients with early rheumatoid arthritis. Br. J. Rheumatol., 1997, vol. 36, pp. 683–688.

15. Javadi S., Kan J.H., Orth R.C., DeGuzman M. Wrist and ankle MRI of patients with juvenile idiopathic arthritis: identification of unsuspected multicompartmental tenosynovitis and arthritis. AJR Am. J. Roentgenol., 2014, vol. 202 (2), pp. 413–417. doi: 10.2214/AJR.13.10671.

16. Nielsen H.E., Strandberg C., Andersen S., Kinnander C., Erichsen G. Ultrasonographic examination in juvenile idiopathic arthritis is better than clinical examination for identification of intraarticular disease. Dan. Med. J., 2013, vol. 60 (8), A4669.

17. Malattia C., Damasio M.B., Magnaguagno F. et al. Magnetic resonance imaging, ultrasonography, and conventional radiography in the assessment of bone erosions in juvenile idiopathic arthritis. Arthritis Rheum., 2008, vol. 59, no. 6, pp. 1764–1772.

18. Wakefield R.J., O’Connor P.J., Conaghan P.G. et al. Finger tendon disease in untreated early rheumatoid arthritis: a comparison of ultrasound and magnetic resonance imaging. Arthritis Rheum., 2007, vol. 57, no. 4, pp. 1158–1164.

19. Buchmann R.F., Jaramillo D. Imaging of articular disorders in children. Radiol. Clin. North. Am., 2004, vol. 42, no. 1, pp. 151–168.

20. Døhn U.M., Ejbjerg B.J., Court-Payen M. et al. Are bone erosions detected by magnetic resonance imaging and ultrasonography true erosions? A comparison with computed tomography in rheumatoid arthritis metacarpophalangeal joints. Arthritis Research & Therapy, 2006, vol. 8, no. 4. R110. doi: 10.1186/ar1995.

21. McQueen F., Benton N., Perry D. et al. Bone edema scored on magnetic resonance imaging scans of the dominant carpus at presentation predicts radiographic joint damage of the hands and feet six years later in patients with rheumatoid arthritis. Arthritis Rheum., 2003, vol. 48, no. 7, pp. 1814–1827.

22. Benton N., Stewart N., Crabbe J. et al. MRI of the wrist in early rheumatoid arthritis can be used to predict functional outcome at 6 years. Ann. Rheum. Dis., 2004, vol. 63, no. 5, pp. 555–561.

23. Østergaard M., Peterfy C., Conaghan P. et al. OMERACT Rheumatoid Arthritis Magnetic Resonance Imaging Studies. Core set of MRI acquisitions, joint pathology definitions, and the OMERACT RA-MRI scoring system. J. Rheumatol., 2003, vol. 30, no. 6, pp. 1385–1386.

24. Lamer S., Sebag G.H. MRI and ultrasound in children with juvenile chronic arthritis. Eur. J. Radiol., 2000, vol. 33, no. 2, pp. 85–93.

25. Peterfy C.G., Genant H.K. Emerging applications of magnetic resonance imaging in the evaluation of articular cartilage. Radiol. Clin. North. Am., 1996, vol. 34, no. 1, pp. 195–213.

26. Thapa M.M., Chaturvedi A., Iyer R.S., Darling S.E., Khanna P.C., Ishak G., Chew F.S. MRI of pediatric patients: Part 2, normal variants and abnormalities of the knee. AJR Am. J. Roentgenol., 2012, vol. 198 (5), pp. 456–465. doi: 10.2214/AJR.10.7317.

27. Doria A.S., Babyn P.S., Feldman B. A critical appraisal of radiographic scoring systems for assessment of juvenile idiopathic arthritis. Pediatr. Radiol., 2006, vol. 36, no. 8, pp. 759–772.

28. Conaghan P.G., O’Connor P., McGonagle D. et al. Elucidation of the relationship between synovitis and bone damage: A randomized magnetic resonance imaging study of individual joints in patients with early rheumatoid arthritis. Arthritis Rheum., 2003, vol. 48, no. 1, pp. 64–71.

29. Ostergaard M., Stoltenberg M., Lovgreen-Nielsen P. et al. Quantification of synovitis by MRI: correlation between dynamic and static gadolinium-enhanced MRI and microscopic and macroscopic signs of synovial inflammation. Magn. Reson. Imaging, 1998, vol. 16, pp. 743–54.

30. Magni-Manzoni S., Malattia C., Lanni S., Ravelli A. Advances and challenges in imaging in juvenile idiopathic arthritis. Nat. Rev. Rheumatol., 2012, vol. 8 (6), pp. 329–336. doi: 10.1038.

31. Cimmino M.A., Bountis C., Silvestri E. et al. An appraisal of magnetic resonance imaging of the wrist in rheumatoid arthritis. Semin. Arthritis Rheum., 2000, vol. 30, pp. 180–195.

32. Sugimoto H., Takeda A., Kano S. Assessment of disease ac tivity in rheumatoid arthritis using magnetic resonance imaging: quantification of pannus volume in the hands. Br. J. Rheumatol., 1998, vol. 37, pp. 854–861.

33. Nusman C.M., Hemke R., Schonenberg D., Dolman K.M., van Rossum M.A., van den Berg J.M., Kuijpers T.W., Maas M. Distribution pattern of MRI abnormalities within the knee and wrist of juvenile idiopathic arthritis patients: signature of disease activity. AJR Am. J. Roentgenol., 2014, vol. 202 (5), pp. 439–446. doi: 10.2214/AJR.13.11314.

34. Bird P., Lassere M., Shnier R. et al. Computerized measurement of magnetic resonance imaging erosion volumes in patients with rheumatoid arthritis: a comparison with existing magnetic resonance imaging scoring systems and standard clinical outcome measures. Arthritis Rheum., 2003, vol. 48, no. 3, pp. 614–624.

35. Zikou A.K., Argyropoulou M.I., Voulgari P.V. et al. Magnetic resonance imaging quantification of hand synovitis in patients with rheumatoid arthritis treated with adalimumab. J. Rheumatol., 2006, vol. 33, no. 2, pp. 219–223.

36. Graham T.B., Laor T., Dardzinski B.J. Quantitative magnetic resonance imaging of the hands and wrists of children with juvenile rheumatoid arthritis. J. Rheumatol., 2005, vol. 32, no. 9, pp. 1811–1820.

37. Gylys-Morin V.M., Graham T.B., Blebea J.S. et al. Knee in early juvenile rheumatoid arthritis: MR imaging findings. Radiology, 2001, vol. 220, no. 3, pp. 696–706.

38. Nistala K., Babar J., Johnson K. et al. Clinical assessment and core outcome variables are poor predictors of hip arthritis diagnosed by MRI in juvenile idiopathic arthritis. Rheumatology, 2007, vol. 46, no. 4, pp. 699–702.

39. Brown A.K., Quinn M.A., Karim Z. et al. Presence of significant synovitis in rheumatoid arthritis patients with diseasemodifying antirheumatic drug-induced clinical remission: Evidence from an imaging study may explain structural progression. Arthritis Rheum., 2006, vol. 54, no. 12, pp. 3761–3773.

40. Soden M., Rooney M., Cullen A. et al. Immunohistological features in the synovium obtained from clinically uninvolved knee joints of patients with rheumatoid arthritis. Br. J. Rheumatol., 1989, vol. 28, pp. 287–292.

41. Konig H., Sieper J., Wolf K.J. et al. Rheumatoid arthritis: evaluation of hypervascular and fibrous pannus with dynamic MR imaging enhanced with Gd-DTPA. Radiology, 1990, vol. 176, no. 2, pp. 473–477.

42. Malattia C., Damasio M.B., Basso C. et al. Dynamic contrastenhanced magnetic resonance imaging in the assessment of disease activity in patients with juvenile idiopathic arthritis. Rheumatology (Oxford), 2010, vol. 49, pp. 178–185.

43. Gaffney K., Cookson J., Blades S. et al. Quantitative assessment of the rheumatoid synovial microvascular bed by gadolinium-DTPA enhanced magnetic resonance imaging. Ann. Rheum. Dis., 1998, vol. 57, no. 3, pp. 152–157.

44. Tamai K., Yamato M., Yamaguchi T., Ohno W. Dynamic magnetic resonance imaging for the evaluation of synovitis in patients with rheumatoid arthritis. Arthritis Rheum., 1994, vol. 37, pp. 1151–1157.

45. Malattia C., Consolaro A., Pederzoli S. et al. MRI versus conventional measures of disease activity and structural damage in evaluating treatment efficacy in juvenile idiopathic arthritis. Ann. Rheum. Dis., 2013, vol. 72, pp. 363–368.

46. Hodgson R.J., O’Connor P., Moots R. MRI of rheumatoid arthritis–image quantitation for the assessment of disease activity, progression and response to therapy. Rheumatology, 2008, vol. 47, no. 1, pp. 13–21.

47. Østergaard M., Stoltenberg M., Løvgreen-Nielsen P. et al. Magnetic resonance imaging-determined synovial membrane and joint effusion volumes in rheumatoid arthritis and osteoarthritis: comparison with the macroscopic and microscopic appearance of the synovium. Arthritis Rheum., 1997, vol. 40, pp. 1856–1867.

48. Huang J., Stewart N., Crabbe J. et al. A 1 year follow up study of dynamic magnetic resonance imaging in early rheumatoid arthritis reveals synovitis to be increased in shared epitope positive patients and predicts erosions at 1 year. Rheumatology Oxford, 2000, vol. 39, no. 4, pp. 407–416.

49. Palosaari K., Vuotila J., Takalo R. et al. Bone oedema predicts erosive progression on wrist MRI in early RA–a 2-yr observational MRI and NC scintigraphy study. Rheumatology, 2006, vol. 45, no. 12, pp. 1542–1548.

50. Ostergaard M., Hansen M., Stoltenberg M. et al. New radiographic bone erosions in the wrists of patients with rheumatoid arthritis are detectable with magnetic resonance imaging a median of two years earlier. Arthritis Rheum., 2003, vol. 48, no. 8, pp. 2128–2131.

51. Hemke R., Maas M., van Veenendaal M. et al. Contrastenhanced MRI compared with the physical examination in the evaluation of disease activity in juvenile idiopathic arthritis. Eur. Radiol., 2014, vol. 24, pp. 327–334.

52. Argyropoulou M.I., Fanis S.L., Xenakis T. et al. The role of MRI in the evaluation of hip joint disease in clinical subtypes of juvenile idiopathic arthritis. Br. J. Radiol., 2002, vol. 75, pp. 229–233.

53. Jans L.B., Jaremko J.L., Ditchfield M., Verstraete K.L. Evolution of femoral condylar ossification at MR imaging: frequency and patient age distribution. Radiology, 2011, vol. 258, no. 3, pp. 880–888.

54. Müller L.S., Avenarius D., Damasio B. et al. The paediatric wrist revisited: redefining MR findings in healthy children. Ann. Rheum. Dis., 2011, vol. 70, no. 4, pp. 605–610.