Quantitative magnetic resonance imaging of the hands and wrists of children with juvenile rheumatoid arthritis

• Published in: Journal of rheumatology Vol. 32; no. 9; pp. 1811 - 1820
• Main Authors: GRAHAM, T. Brent, LAOR, Tal, DARDZINSKI, Bernard J
• Format: Journal Article
• Language: English
• Published: Toronto, ON The Journal of Rheumatology 01-09-2005; Journal of Rheumatology Publishing
• Subjects: Adolescent; Antirheumatic Agents - therapeutic use; Arthritis, Juvenile - diagnosis; Arthritis, Juvenile - drug therapy; Biological and medical sciences; Child; Child, Preschool; Contrast Media; Diseases of the osteoarticular system; Drug Therapy, Combination; Etanercept; Feasibility Studies; Female; Hand - pathology; Humans; Immunoglobulin G - therapeutic use; Immunomodulators; Inflammatory joint diseases; Magnetic Resonance Imaging; Male; Medical sciences; Methotrexate - therapeutic use; Pain Measurement; Pharmacology. Drug treatments; Physical Examination - methods; Prognosis; Prospective Studies; Radiographic Image Enhancement; Receptors, Tumor Necrosis Factor - therapeutic use; Sensitivity and Specificity; Severity of Illness Index; Wrist - pathology; Human; Antineoplastic agent; Diseases of the osteoarticular system; Juvenile rheumatoid arthritis; Inflammatory joint disease; Monoclonal antibody; Nuclear magnetic resonance imaging; Hand; Antifolate; Immunomodulator; Wrist; Chronic; MAGNETIC RESONANCE IMAGING; Antimetabolic; Etanercept; Anticytokine; Medical imagery; Antagonist; Recombinant protein; Fusion protein; Methotrexate; Child; Tumor necrosis factor α; Quantitative analysis
• ISSN: 0315-162X; 1499-2752

OBJECTIVE: To assess feasibility of measuring synovial volume in the hand and wrist in patients with polyarticular course
juvenile rheumatoid arthritis (JRA) by magnetic resonance imaging (MRI). As well, to compare clinical variables with synovial
volume calculated from MRI in patients receiving disease modifying or biologic therapy. METHODS: Ten patients with polyarticular
course JRA starting methotrexate (n = 3) or etanercept (n = 7) therapy had MRI with intravenous contrast performed of one
hand and wrist at baseline and after 6 weeks and 3 months of pharmacotherapy. Synovial volume was determined for the entire
hand and wrist and also for regions. Patients were assessed clinically by the core set of outcome variables for JRA and total
hand swelling score, and assessed for clinical improvement based upon change in these variables. RESULTS: Increased synovial
volume was observed at entry by MRI in all patients (range 2.4-12.5 cc, median 3.7 cc). Correlation of total synovial volume
from MRI with total hand swelling score at each timepoint was good (r = 0.52-0.68). Correlation with other clinical variables
was not consistently strong. Patients who improved clinically did not differ from patients who did not improve clinically
with respect to change in synovial volume. CONCLUSION: Determining synovial volume in the hand and wrist in patients with
JRA by MRI is feasible and correlates with total hand swelling assessed on physical examination. Inconsistent or poor correlation
with other clinical variables and the clinical definition of improvement requires further study.