A radiographic classification system in juvenile rheumatoid arthritis applied to the knee

104

Objective. To explore early changes and predictors of bone mass in children with juvenile idiopathic arthritis (JIA) in order to identify patients who will develop bone mass reductions.Methods. We conducted a prospective cohort study of 108 children with early JIA (ages 6-18 years; mean disease duration 19.3 months) who were individually matched with 108 healthy children for age, sex, race, and county of residence. Bone mass and changes in total body, spine, femur, and forearm bone mineral density and bone mineral content (BMC), body composition, growth, and biochemical parameters of bone turnover were examined at baseline and at followup a mean of 24 months later. Low bone mass was defined as a Z score >1 SD below the reference population.Results. Of the 200 children evaluated at followup, the 100 healthy children had greater gains in total body BMC (P ‫؍‬ 0.035), distal radius BMC (P < 0.001), and total body lean mass (P < 0.001) than did the 100 JIA patients. Low or very low total body BMC was observed in 24% of the patients and 12% of the healthy children. Bone formation, bone resorption, and weight-bearing activities were reduced in the patients compared with the healthy children. Multiple regression analysis showed that in patients with JIA, serum bonespecific alkaline phosphatase, serum C-telopeptide of type I collagen, and weight-bearing activities were independent predictors of changes in total body BMC. Total body BMC was lower in patients with polyarticular onset than in those with oligoarticular disease onset.Conclusion. Patients with JIA have moderate reductions in bone mass gains, bone turnover, and total body lean mass early in the disease course.

Section: Methodsmentioning

confidence: 99%

A two‐year prospective controlled study of bone mass and bone turnover in children with early juvenile idiopathic arthritis

Lien¹,

Selvaag²,

Flatø³

et al. 2005

104

“…During followup, the following data were collected: 1) onset of a polyarticular disease course (arthritis in a cumulative total of more than 4 joints), 2) occurrence of joint destruction (first radiograph showing joint space narrowing with or without erosion up to ankylosis, corresponding to a Steinbrocker stage of at least 2 or a Dale staging grade of 3 [19]; radiographs were available for 183 patients and were assessed by both radiologists and rheumatologists; they were performed systematically before each intraarticular injection of corticosteroids or when articular stiffness persisted despite adapted physiotherapy and/or oral nonsteroidal antiinflammatory drug [NSAID] treatment for 3 months), 3) occurrence of asymptomatic chronic anterior uveitis (detected by systematic slit lamp examination every 3 months), 4) remission, defined by absence of joint swelling or painful stiffness and/or any sign of uveitis on slit lamp examination, and by an ESR Ͻ15 mm/first hour without any treatment for at least 2 years, 5) treatment regimens (NSAIDs, corticosteroids, and disease-modifying antirheumatic drugs [DMARDs] (20) and illustrated with eventfree survival curves.…”

Section: Methodsmentioning

confidence: 99%

Long-term outcome and prognosis in oligoarticular-onset juvenile idiopathic arthritis

Guillaume¹,

Prieur²,

Coste³

et al. 2000

181

Objective. To describe the long-term outcome and determine predictors of severity among patients with oligoarticular-onset juvenile idiopathic arthritis (JIA).Methods. In a longitudinal study, 207 patients with oligoarticular-onset JIA who were referred between 1988 and 1998 were evaluated. At disease onset, selected clinical and laboratory data were collected as independent variables. A polyarticular disease course, joint erosion, uveitis, and remission were assessed as dependent variables. Longitudinal analyses were performed with the Kaplan-Meier method, and multivariate analysis with the Cox model.Results. After 6 years of followup, the probability of a polyarticular course of disease was 50%, joint erosion was 35%, uveitis was 30%, and remission was 23% in these patients. Joint erosion was strongly associated with a polyarticular course. A high erythrocyte sedimentation rate (ESR) as well as involvement of more than 1 joint or involvement of an upper limb at disease onset were predictors of disease extension. A high ESR was also a strong predictor of a destructive course, and a family history of psoriasis was predictive of uveitis occurrence. No predictive factor for remission could be identified.Conclusion. Oligoarticular-onset JIA is a severe disease with frequent complications. Factors predictive of severity in oligoarticular-onset JIA were identified. This could allow early identification of high-risk patient subgroups, warranting a more aggressive therapeutic approach.

“…A number of scoring systems are available to quantify radiographic changes in adults with rheumatoid arthritis (3,4). However, little information exists on standardized measurement of radiographic damage in the investigation of disease outcome in children with juvenile idiopathic arthritis (JIA) (5)(6)(7)(8)(9)(10)(11). Furthermore, the assessment of radiographic progression has never been included in controlled trials of second-line agents in JIA.…”

Section: Introductionmentioning

confidence: 99%

Use of the sharp and larsen scoring methods in the assessment of radiographic progression in juvenile idiopathic arthritis

Rossi¹,

Dia²,

Galipò³

et al. 2006

Objective. To investigate the applicability of the Sharp and Larsen scoring methods for radiographic damage in juvenile idiopathic arthritis (JIA). Methods. Wrist/hand radiographs of 25 patients with polyarthritis obtained at first observation and then yearly for 4 -5 years were assessed independently by 2 pediatric rheumatologists according to the Sharp and Larsen methods. To facilitate score assignment, each patient radiograph was compared with a bone age-related standard. A third pediatric rheumatologist measured the Poznanski score, and a pediatric radiologist provided a semiquantitative assessment of radiographic damage severity.