Paediatric and Adolescent Rheumatology [143-150]: 143. Knee Joint in JIA: A Prospective Evaluation of Clinical Examination, Ultrasound and Mri Assessment. A Newly Developed Knee MRI Scoring System in JIA

Abstract

Background: Osteoporotic fractures and falls are as heads and tails of a coin. Among the elderly, the greatest risk of fracture comes from falls, rather than osteoporosis, hence, bone mineral density measurement should not be used alone to estimate fracture risk or guide treatment decisions. Evidence shows that at least 15% of falls in older people can be prevented, with individual trials reporting relative reductions of up to 50%. We developed a model that predicts the falls risk among patients referred for bone mineral density using variables that are easily assessed in clinical practice. Methods: As part of the integrated osteoporosis and falls service, patients admitted to the hospital with low trauma fracture had their bone mineral density assessed. In addition to DXA scanning, fracture risk assessment using FRAX (before and after the occurrence of the fracture), as well as falls risk factors were analyzed. The independent predictive value of the different risk factors for the occurrence of falls was assessed using logistic regression analysis. A prediction scoring system was developed using data from a cohort of 106 patients. 102 osteoporotic patients without history of falls or fracture were also assessed as control group. The diagnostic performance of the prediction model was evaluated using the area under the curve (AUC). The developed prediction model was internally validated. Results: Falls risk was significantly higher among the osteoporotic patients who sustained fractures in comparison to the control group (P < 0.01). The risk factors significantly correlated with an increased risk of falls were: history of > 1 fall in the last 12 months (regression coefficient 2.2), slowing of the walking speed/ change of the gait (1.6), impaired vision (1.2), weak grip strength (1.1), loss of balance (1.2). Cut off point of 3.5 achieved the best sensitivity and specificity (0.918 and 0.86 respectively, PPV85.9) and was indicative of high falls risk. A score of 2.0-3.5 was indicative of moderate risk. Conclusions: The findings indicate that evaluation of falls risk based on risk factor profiles of individual patients can help physicians identify high risk osteoporotic patients and assist with decisions concerning falls prevention and patient management. Also, these results emphasize the importance of performing a falls risk assessment for all osteoporotic patients, in parallel with bone mineral density measurement, on regular basis as part of their assessment and management.

EULAR-PReS points to consider for the use of imaging in the diagnosis and management of juvenile idiopathic arthritis in clinical practice

“…Several studies compared US with MRI in the detection of inflammation, particularly at the knee 13 14 33 34. These studies have shown MRI to be better in detecting knee inflammation than US (mean detection rate 1.20-fold, range 0.63–1.56-fold) and in particular MRI was better than US in differentiating pannus from effusion 13.…”