Patients with juvenile idiopathic arthritis in clinical remission have evidence of persistent inflammation as revealed by 3T MRI
Arthritis Care & Research , 06/29/2012
Brown A et al. – Over half of the patients in clinical remission had magnetic resonance imaging (MRI) evidence of persistent inflammation, as defined by the presence of synovitis, tenosynovitis, or bone marrow lesions (BMLs). A substantial portion of patients with juvenile idiopathic arthritis (JIA) may have subclinical disease despite clinical remission.Methods
- Eleven JIA patients and ten RA patients with arthritis involving the hands and/or wrists were identified by their primary rheumatologist as being in physician–defined clinical remission, having no signs or symptoms of active arthritis and no medication changes for at least 6 months.
- A study rheumatologist performed a joint evaluation for tenderness, swelling, and limitation of motion, and study participants self–reported tender joint counts.
- The participants underwent MRI with intravenous contrast enhancement of one hand and wrist with a history of prior symptoms.
- A pediatric musculoskeletal radiologist, blinded to the clinical data, scored the MRIs for synovitis, tenosynovitis, and/or BMLs.
- Sixty–three percent of the JIA cohort and 70% of the RA cohort had MRI findings of synovitis, BMLs, and/or tenosynovitis.
- All pediatric patients with MRI abnormalities had normal physician tender and swollen joint counts.
- Patients' self–report of painful joint counts did not predict MRI abnormalities.