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Sorokina L, Kaneva M, Artamonov A, Gordeeva N, Chikova I, Kostik M. Clinical and laboratory features of juvenile idiopathic arthritis with wrist involvement: Results of a retrospective cohort study. World J Clin Pediatr 2024; 13:91656. [PMID: 39350901 PMCID: PMC11438928 DOI: 10.5409/wjcp.v13.i3.91656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 06/16/2024] [Accepted: 06/26/2024] [Indexed: 08/30/2024] Open
Abstract
BACKGROUND Previous studies in the pre-biological era showed an association of wrist inflammation in juvenile idiopathic arthritis (JIA) with progressive disease course, polyarticular involvement and failure of methotrexate treatment. AIM To describe features of JIA, associated with wrist arthritis. METHODS Data from about 753 JIA patients were included in this retrospective cohort study. The clinical and laboratory features of patients with and without wrist involvement were analyzed. RESULTS Wrist involvement was found in oligoarthritis (5.8%), RF(-)/RF(+) polyarthritis (44.9%/15.0%), enthesitis-related arthritis (17.7%), and systemic (58.6%) JIA categories. Unilateral wrist involvement was typical for oligoarthritis patients, bilateral involvement was either equal to that of unilateral involvement or was more frequent in other categories. Wrist arthritis was found to be associated with female sex, a low incidence of uveitis, and more indications of systemic inflammation, including elevated levels of C-reactive protein, erythrocyte sedimentation rate, and platelets, as well as involvement of the cervical spine, temporomandibular, shoulder, elbow, metacarpophalangeal, proximal interphalangeal, distal interphalangeal, hip, ankle, and tarsus arthritis. The number of patients with hip osteoarthritis and hip replacement was also higher. Wrist arthritis was associated with a lower probability of achieving remission [hazard ratio (HR) = 1.3 (95%CI: 1.0-1.7), P = 0.055], and a higher probability of being treated with biologics [HR = 1.7 (95%CI: 1.3-2.10, P = 0.00009)]. CONCLUSION Wrist arthritis in JIA patients is a marker of a severe disease course, characterized by more intensive inflammation, unfavorable outcomes, and. requiring more intensive treatment with early administration of biologics. Close monitoring of wrist inflammation with ultrasound and MR assessment with early biological treatment might improve the outcomes.
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Affiliation(s)
- Lyubov Sorokina
- Hospital Pediatry, Saint Petersburg State Pediatric Medical University, Saint Petersburg 194100, Russia
| | - Maria Kaneva
- Hospital Pediatry, Saint Petersburg State Pediatric Medical University, Saint Petersburg 194100, Russia
| | - Artem Artamonov
- Hospital Pediatry, Saint Petersburg State Pediatric Medical University, Saint Petersburg 194100, Russia
| | - Natalia Gordeeva
- Department of Consulting and Diagnostic, Saint-Petersburg Children’s Hospital #2, n.a. Saint Mary Magdalene, Saint Petersburg 199004, Russia
| | - Irina Chikova
- Hospital Pediatry, Saint Petersburg State Pediatric Medical University, Saint Petersburg 194100, Russia
| | - Mikhail Kostik
- Hospital Pediatry, Saint Petersburg State Pediatric Medical University, Saint Petersburg 194100, Russia
- Research Laboratory of Autoimmune and Autoinflammatory Diseases, Almazov National Medical Research Center, Saint-Petersburg 197341, Russia
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Ar Altamimi A, Gharaibeh MA, Shokor MA, Dawod MS, Alswerki MN, Al-Odat OM, Elkhaldi RH. Association between carpal height ratio and ulnar variance in normal wrist radiography. BMC Musculoskelet Disord 2024; 25:524. [PMID: 38982384 PMCID: PMC11232295 DOI: 10.1186/s12891-024-07647-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2024] [Accepted: 07/01/2024] [Indexed: 07/11/2024] Open
Abstract
INTRODUCTION The wrist joint is a complex anatomical structure, and various radiographic parameters are utilized to assess its normal alignment and orientation. Among these parameters are carpal height ratio (CHR) and ulnar variance (UV). Previous literature has indicated that factors such as age and gender may influence these parameters; However, there is a lack of studies investigating these differences specifically in the Middle East or Jordan. Additionally, no prior research has explored the relationship between UV and CHR. Therefore, the objective of this study is to investigate these critical radiological parameters and their associations. METHODOLOGY A cross-sectional study design was employed, wherein a total of 385 normal wrist X-rays were reviewed, and CHR and UV were measured. Intra-observer and inter-observer reliability assessments were conducted to ensure the consistency and accuracy of measurements. Additionally, the association between UV and CHR was measured and plotted for further analysis. RESULTS In our study, the mean CHR was 0.5 (range: 0.4 to 1.5), and the mean UV was - 0.3 mm (range: -5.8 mm to 4.1 mm). We found a significant negative correlation between CHR and age (p < 0.05). No significant gender differences were observed in UV and CHR. Additionally, a weak positive correlation was found between UV and CHR (Pearson correlation coefficient = 0.13, p = 0.01; adjusted R2 = 0.014, p = 0.02). CONCLUSION Age correlated significantly with a decline in carpal height ratio. Additionally, ulnar variance had a week positive yet significant correlation with carpal height ratio. LEVEL OF EVIDENCE Cross-sectional study, Level III.
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Affiliation(s)
- Anas Ar Altamimi
- Orthopedic & Hand Surgery Consultant, Head of special surgery department, Hashemite University, Amman, Jordan
| | - Monther A Gharaibeh
- Orthopedic surgery Consultant, Department of Special Surgery, Faculty of Medicine, The Hashemite University, Zarqa, 13133, Jordan
| | | | - Moh'd S Dawod
- Faculty of Medicine, Mutah University, Al- karak, Jordan
| | - Mohammad N Alswerki
- Orthopedic Surgery Resident, Department of Orthopedics, Jordan University Hospital, Amman, Jordan.
- Department of Orthopedic Surgery, Jordan University Hospital, P.O. Box: (13046), Amman, Jordan.
| | - Omar M Al-Odat
- Orthopedic Surgery Resident, Jordan Hospital, Amman, Jordan
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Balay-Dustrude E, Shenoi S. Current Validated Clinical and Patient Reported Disease Outcome Measures in Juvenile Idiopathic Arthritis. Open Access Rheumatol 2023; 15:189-206. [PMID: 37841510 PMCID: PMC10574249 DOI: 10.2147/oarrr.s261773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 09/29/2023] [Indexed: 10/17/2023] Open
Abstract
Juvenile idiopathic arthritis (JIA) is a common chronic illness in childhood and comprises seven categories based on the International League of Associations for Rheumatology (ILAR) criteria. Accurate assessment and measurement of the clinical, functional, and quality of life outcomes of patients with JIA are paramount for understanding the disease course and formulating effective treatment strategies. Interest in the development and use of outcome measurements specifically focused on rheumatologic conditions has greatly expanded over the last two decades, adding to and improving upon the established disease measures. Furthermore, many of these measures have been validated using the widely accepted Outcome Measures in Rheumatology (OMERACT) core principles of instrument validation, allowing researchers and clinicians to gain confidence in these tools. This review summarizes the current validated disease outcome measures in JIA, including clinical, imaging, patient-reported, and functional outcome measurement tools, and highlights ongoing work that continues to refine and improve upon the available tools. The clinical disease outcome measures discussed in this review include physician global assessment (PhGA), American College of Rheumatology (ACR, Wallace) criteria for clinical inactive disease and clinical remission, juvenile arthritis disease activity scores (JADAS), juvenile spondyloarthritis disease activity index (JSPaDA), juvenile arthritis damage index (JADAI), and the ACR pediatric response scores. The imaging outcome measures discussed include the Dijkstra composite scores, childhood arthritis radiographic score of the hip (CARSH), and Poznanski Score. The patient-reported disease outcome measures discussed include patient global assessment (PtGA), patient-reported outcome measurement information system for JIA (PROMIS), juvenile arthritis parent/child centered disease assessment index (JAPAI, JACAI), juvenile arthritis multidimensional assessment report (JAMAR), and the Pediatric quality of life inventory rheumatology module (PedsQL). The functional outcome tools discussed include the Childhood Health Assessment Questionnaire (CHAQ), juvenile arthritis functionality scale and index (JAFS and JASI), and Juvenile Arthritis Functional Assessment Report and Scale (JAFAS and JAFAR).
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Affiliation(s)
- Erin Balay-Dustrude
- Department of Pediatrics, Division of Rheumatology, University of Washington, Seattle, WA, USA
- Department of Pediatric Rheumatology, Seattle Children’s Hospital and Research Center, Seattle, WA, USA
| | - Susan Shenoi
- Department of Pediatrics, Division of Rheumatology, University of Washington, Seattle, WA, USA
- Department of Pediatric Rheumatology, Seattle Children’s Hospital and Research Center, Seattle, WA, USA
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Li Z, Chen W, Ju Y, Chen Y, Hou Z, Li X, Jiang Y. Bone age assessment based on deep neural networks with annotation-free cascaded critical bone region extraction. Front Artif Intell 2023; 6:1142895. [PMID: 36937708 PMCID: PMC10017763 DOI: 10.3389/frai.2023.1142895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 02/06/2023] [Indexed: 03/06/2023] Open
Abstract
Bone age assessment (BAA) from hand radiographs is crucial for diagnosing endocrinology disorders in adolescents and supplying therapeutic investigation. In practice, due to the conventional clinical assessment being a subjective estimation, the accuracy of BAA relies highly on the pediatrician's professionalism and experience. Recently, many deep learning methods have been proposed for the automatic estimation of bone age and had good results. However, these methods do not exploit sufficient discriminative information or require additional manual annotations of critical bone regions that are important biological identifiers in skeletal maturity, which may restrict the clinical application of these approaches. In this research, we propose a novel two-stage deep learning method for BAA without any manual region annotation, which consists of a cascaded critical bone region extraction network and a gender-assisted bone age estimation network. First, the cascaded critical bone region extraction network automatically and sequentially locates two discriminative bone regions via the visual heat maps. Second, in order to obtain an accurate BAA, the extracted critical bone regions are fed into the gender-assisted bone age estimation network. The results showed that the proposed method achieved a mean absolute error (MAE) of 5.45 months on the public dataset Radiological Society of North America (RSNA) and 3.34 months on our private dataset.
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Affiliation(s)
- Zhangyong Li
- Chongqing Engineering Research Center of Medical Electronics and Information Technology, Chongqing University of Posts and Telecommunications, Chongqing, China
| | - Wang Chen
- Chongqing Engineering Research Center of Medical Electronics and Information Technology, Chongqing University of Posts and Telecommunications, Chongqing, China
| | - Yang Ju
- Department of Mechanical Science and Engineering, Graduate School of Engineering, Nagoya University, Nagoya, Japan
| | - Yong Chen
- Chongqing Engineering Research Center of Medical Electronics and Information Technology, Chongqing University of Posts and Telecommunications, Chongqing, China
| | - Zhengjun Hou
- Chongqing Engineering Research Center of Medical Electronics and Information Technology, Chongqing University of Posts and Telecommunications, Chongqing, China
| | - Xinwei Li
- Chongqing Engineering Research Center of Medical Electronics and Information Technology, Chongqing University of Posts and Telecommunications, Chongqing, China
| | - Yuhao Jiang
- Chongqing Engineering Research Center of Medical Electronics and Information Technology, Chongqing University of Posts and Telecommunications, Chongqing, China
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Heckert SL, Hissink-Muller PCE, van den Berg JM, Schonenberg-Meinema D, van Suijlekom-Smit LWA, van Rossum MAJ, Koopman Y, Ten Cate R, Brinkman DMC, Huizinga TWJ, Allaart CF, Bergstra SA. Patterns of clinical joint inflammation in juvenile idiopathic arthritis. RMD Open 2023; 9:rmdopen-2022-002941. [PMID: 36927851 PMCID: PMC10030666 DOI: 10.1136/rmdopen-2022-002941] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 02/19/2023] [Indexed: 03/18/2023] Open
Abstract
OBJECTIVES We studied patterns of joint inflammation in juvenile idiopathic arthritis (JIA) to assess whether joint activity recurs locally in the same joints. METHODS Joints of 91 patients of the BeSt for Kids study, a treat-to-target trial for children with recent-onset oligoarticular, rheumatoid factor-negative polyarticular and psoriatic JIA, were clinically assessed during 2 years (10 study visits). The association between joint inflammation at baseline and later inflammation in the same joint was assessed using a multilevel mixed-effects logistic regression model at joint level. With a Poisson model, the association between baseline joint inflammation and the number of study visits at which the same joint was recurrently inflamed was tested. RESULTS Of the 6097 joints studied, 15% (897) was clinically inflamed at baseline. In 42% (377/897) of those joints, inflammation recurred during follow-up. Joint inflammation at baseline was statistically significantly associated with joint inflammation during follow-up in the same joint (OR 3.9, 95% CI 3.5 to 4.4) and specifically with the number of episodes of recurrent joint inflammation (IRR 1.6, 95% CI 1.2 to 2.1). CONCLUSION In JIA, joint inflammation has the tendency to recur multiple times in joints that are clinically inflamed at disease onset. This indicates that local factors might play a role in the processes contributing to the occurrence of JIA flares.
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Affiliation(s)
- Sascha L Heckert
- Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Petra C E Hissink-Muller
- Paediatrics/Pediatric Rheumatology, Leiden University Medical Center Willem Alexander Childrens Hospital, Leiden, The Netherlands
| | - J Merlijn van den Berg
- Department of Pediatric Immunology, Rheumatology and Infectious Diseases, Emma Childrens' Hospital UMC, Amsterdam, The Netherlands
| | - Dieneke Schonenberg-Meinema
- Department of Pediatric Immunology, Rheumatology and Infectious Diseases, Emma Childrens' Hospital UMC, Amsterdam, The Netherlands
| | | | - Marion A J van Rossum
- Department of Pediatrics, Emma Childrens' Hospital UMC, Amsterdam, The Netherlands
- Department of Pediatric Rheumatology, Amsterdam Rheumatology and Immunology Center, location Reade, Amsterdam, The Netherlands
| | - Yvonne Koopman
- Pediatrics, Haga Hospital Juliana Children's Hospital, Den Haag, The Netherlands
| | - Rebecca Ten Cate
- Paediatrics/Pediatric Rheumatology, Leiden University Medical Center Willem Alexander Childrens Hospital, Leiden, The Netherlands
| | - Danielle M C Brinkman
- Paediatrics/Pediatric Rheumatology, Leiden University Medical Center Willem Alexander Childrens Hospital, Leiden, The Netherlands
| | - Tom W J Huizinga
- Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
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Wang C, Wu Y, Wang C, Zhou X, Niu Y, Zhu Y, Gao X, Wang C, Yu Y. Attention-based multiple-instance learning for Pediatric bone age assessment with efficient and interpretable. Biomed Signal Process Control 2023. [DOI: 10.1016/j.bspc.2022.104028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Chen C, Chen Z, Jin X, Li L, Speier W, Arnold CW. Attention-Guided Discriminative Region Localization and Label Distribution Learning for Bone Age Assessment. IEEE J Biomed Health Inform 2021; 26:1208-1218. [PMID: 34232898 DOI: 10.1109/jbhi.2021.3095128] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Bone age assessment (BAA) is clinically important as it can be used to diagnose endocrine and metabolic disorders during child development. Existing deep learning based methods for classifying bone age use the global image as input, or exploit local information by annotating extra bounding boxes or key points. However, training with the global image underutilizes discriminative local information, while providing extra annotations is expensive and subjective. In this paper, we propose an attention-guided approach to automatically localize the discriminative regions for BAA without any extra annotations. Specifically, we first train a classification model to learn the attention maps of the discriminative regions, finding the hand region, the most discriminative region (the carpal bones), and the next most discriminative region (the metacarpal bones). Guided by those attention maps, we then crop the informative local regions from the original image and aggregate different regions for BAA. Instead of taking BAA as a general regression task, which is suboptimal due to the label ambiguity problem in the age label space, we propose using joint age distribution learning and expectation regression, which makes use of the ordinal relationship among hand images with different individual ages and leads to more robust age estimation. Extensive experiments are conducted on the RSNA pediatric bone age data set. {\color{red} Without using extra manual} annotations, our method achieves competitive results compared with existing state-of-the-art deep learning-based methods that require manual annotation. Code is available at \url{https://github.com/chenchao666/Bone-Age-Assessment}.
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Nadeem MW, Goh HG, Ali A, Hussain M, Khan MA, Ponnusamy VA. Bone Age Assessment Empowered with Deep Learning: A Survey, Open Research Challenges and Future Directions. Diagnostics (Basel) 2020; 10:E781. [PMID: 33022947 PMCID: PMC7601134 DOI: 10.3390/diagnostics10100781] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 09/06/2020] [Accepted: 09/21/2020] [Indexed: 12/12/2022] Open
Abstract
Deep learning is a quite useful and proliferating technique of machine learning. Various applications, such as medical images analysis, medical images processing, text understanding, and speech recognition, have been using deep learning, and it has been providing rather promising results. Both supervised and unsupervised approaches are being used to extract and learn features as well as for the multi-level representation of pattern recognition and classification. Hence, the way of prediction, recognition, and diagnosis in various domains of healthcare including the abdomen, lung cancer, brain tumor, skeletal bone age assessment, and so on, have been transformed and improved significantly by deep learning. By considering a wide range of deep-learning applications, the main aim of this paper is to present a detailed survey on emerging research of deep-learning models for bone age assessment (e.g., segmentation, prediction, and classification). An enormous number of scientific research publications related to bone age assessment using deep learning are explored, studied, and presented in this survey. Furthermore, the emerging trends of this research domain have been analyzed and discussed. Finally, a critical discussion section on the limitations of deep-learning models has been presented. Open research challenges and future directions in this promising area have been included as well.
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Affiliation(s)
- Muhammad Waqas Nadeem
- Faculty of Information and Communication Technology (FICT), Universiti Tunku Abdul Rahman (UTAR), 31900 Kampar, Perak, Malaysia;
- Department of Computer Science, Lahore Garrison University, Lahore 54000, Pakistan; (A.A.); (M.A.K.)
| | - Hock Guan Goh
- Faculty of Information and Communication Technology (FICT), Universiti Tunku Abdul Rahman (UTAR), 31900 Kampar, Perak, Malaysia;
| | - Abid Ali
- Department of Computer Science, Lahore Garrison University, Lahore 54000, Pakistan; (A.A.); (M.A.K.)
| | - Muzammil Hussain
- Department of Computer Science, School of Systems and Technology, University of Management and Technology, Lahore 54000, Pakistan;
| | - Muhammad Adnan Khan
- Department of Computer Science, Lahore Garrison University, Lahore 54000, Pakistan; (A.A.); (M.A.K.)
| | - Vasaki a/p Ponnusamy
- Faculty of Information and Communication Technology (FICT), Universiti Tunku Abdul Rahman (UTAR), 31900 Kampar, Perak, Malaysia;
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Sallam AA, Briffa N, Mahmoud SS, Imam MA. Normal Wrist Development in Children and Adolescents: A Geometrical Observational Analysis Based on Plain Radiographs. J Pediatr Orthop 2020; 40:e860-e872. [PMID: 32404657 DOI: 10.1097/bpo.0000000000001584] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND To investigate the geometric development of the wrist in relation to the changes in its ossification pattern. This study will help the treating surgeon to identify early deviations from normal in children with musculoskeletal disorders and provide a template for anatomic reduction after trauma scenarios. METHODS A retrospective multicenter analysis was carried out of radiographs of 896 children (896 posteroanterior and 896 lateral views) with normal wrists from January 1996 till April 2016. We stratified patients into different yearly age groups; these included 16 age groups from 1 to 16 years, and 2 sex groups: males and females. We evaluated, depending on the wrist ossification pattern, the ulnar variance, radial and carpal heights, carpal height ratio, radial inclination, volar tilt, together with radiocarpal, scapholunate, and capitate-lunate angles and scapholunate distance. RESULTS Our analysis showed that the ulna minus variance predominates in children. Radial height, radial inclination, and radiocarpal angle increase steadily during growth and reach their respective expected values at the beginning of the pubertal growth spurt. The scapholunate and capitolunate angles showed a downward trend with growth till reaching the adult values at puberty. Carpal height increased constantly, whereas the carpal height ratio was similar to that in adults. Volar tilt was not developed until the age of 12 years, when it started to increase gradually to reach the adult values by puberty. Both sexes have similar measurements. CONCLUSIONS Most radiologic parameters showed reproducible anatomic changes till the 12-year-old time-point. After that, there are minimal changes till adulthood. CLINICAL RELEVANCE The study findings offer a template of pediatric normal values guiding hand and pediatric surgeons in treatment of children with wrist pathology.
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Affiliation(s)
- Asser A Sallam
- Department of Orthopedic Surgery and Trauma, Suez Canal University Hospitals, Ismailia, Egypt
| | - Nikolai Briffa
- South West Thames Trauma and Orthopaedics Training Program, London
| | | | - Mohamed A Imam
- Department of Orthopedic Surgery and Trauma, Suez Canal University Hospitals, Ismailia, Egypt
- Rowley Bristow Orthopedic Unit, Ashford and St Peter's Hospitals, Chertsey
- University of East Anglia, Norwich, UK
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Hemke R, Herregods N, Jaremko JL, Åström G, Avenarius D, Becce F, Bielecki DK, Boesen M, Dalili D, Giraudo C, Hermann KG, Humphries P, Isaac A, Jurik AG, Klauser AS, Kvist O, Laloo F, Maas M, Mester A, Oei E, Offiah AC, Omoumi P, Papakonstantinou O, Plagou A, Shelmerdine S, Simoni P, Sudoł-Szopińska I, Tanturri de Horatio L, Teh J, Jans L, Rosendahl K. Imaging assessment of children presenting with suspected or known juvenile idiopathic arthritis: ESSR-ESPR points to consider. Eur Radiol 2020; 30:5237-5249. [PMID: 32399709 PMCID: PMC7476913 DOI: 10.1007/s00330-020-06807-8] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 02/08/2020] [Accepted: 03/12/2020] [Indexed: 12/17/2022]
Abstract
Juvenile idiopathic arthritis (JIA) is the most common paediatric rheumatic disease. It represents a group of heterogenous inflammatory disorders with unknown origin and is a diagnosis of exclusion in which imaging plays an important role. JIA is defined as arthritis of one or more joints that begins before the age of 16 years, persists for more than 6 weeks and is of unknown aetiology and pathophysiology. The clinical goal is early suppression of inflammation to prevent irreversible joint damage which has shifted the emphasis from detecting established joint damage to proactively detecting inflammatory change. This drives the need for imaging techniques that are more sensitive than conventional radiography in the evaluation of inflammatory processes as well as early osteochondral change. Physical examination has limited reliability, even if performed by an experienced clinician, emphasising the importance of imaging to aid in clinical decision-making. On behalf of the European Society of Musculoskeletal Radiology (ESSR) arthritis subcommittee and the European Society of Paediatric Radiology (ESPR) musculoskeletal imaging taskforce, based on literature review and/or expert opinion, we discuss paediatric-specific imaging characteristics of the most commonly involved, in literature best documented and clinically important joints in JIA, namely the temporomandibular joints (TMJs), spine, sacroiliac (SI) joints, wrists, hips and knees, followed by a clinically applicable point to consider for each joint. We will also touch upon controversies in the current literature that remain to be resolved with ongoing research. KEY POINTS: • Juvenile idiopathic arthritis (JIA) is the most common chronic paediatric rheumatic disease and, in JIA imaging, is increasingly important to aid in clinical decision-making. • Conventional radiographs have a lower sensitivity and specificity for detection of disease activity and early destructive change, as compared to MRI or ultrasound. Nonetheless, radiography remains important, particularly in narrowing the differential diagnosis and evaluating growth disturbances. • Mainly in peripheral joints, ultrasound can be helpful for assessment of inflammation and guiding joint injections. In JIA, MRI is the most validated technique. MRI should be considered as the modality of choice to assess the axial skeleton or where the clinical presentation overlaps with JIA.
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Affiliation(s)
- Robert Hemke
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam Movement Sciences, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Nele Herregods
- Department of Radiology and Medical Imaging, Ghent University Hospital, Ghent, Belgium
| | - Jacob L Jaremko
- Department of Radiology and Diagnostic Imaging, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Gunnar Åström
- Department of Radiology, Uppsala University, Uppsala, Sweden
| | - Derk Avenarius
- Department of Radiology, University Hospital of North Norway, Tromsø, Norway
| | - Fabio Becce
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Dennis K Bielecki
- Department of Diagnostic Imaging, Kings College Hospital, London, UK
| | - Mikael Boesen
- Department of Radiology, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Danoob Dalili
- Department of Radiology, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Chiara Giraudo
- Radiology Institute, Department of Medicine - DIMED, Padova University, Padua, Italy
| | - Kay-Geert Hermann
- Department of Radiology, University Hospital Charité, Berlin, Germany
| | - Paul Humphries
- Department of Radiology, Great Ormond Street Hospital, London, UK
| | - Amanda Isaac
- Department of Radiology, Guy's & St Thomas Hospitals, London, UK
| | - Anne Grethe Jurik
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| | - Andrea S Klauser
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Ola Kvist
- Department of Paediatric Radiology, Karolinska University Hospital, Stockholm, Sweden
| | - Frederiek Laloo
- Department of Radiology and Medical Imaging, Ghent University Hospital, Ghent, Belgium
| | - Mario Maas
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam Movement Sciences, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Adam Mester
- Department of Radiology, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary
| | - Edwin Oei
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center (Erasmus MC), Rotterdam, The Netherlands
| | - Amaka C Offiah
- Academic Unit of Child Health, University of Sheffield, Western Bank, Sheffield, UK
| | - Patrick Omoumi
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, Lausanne, Switzerland
| | | | | | | | - Paolo Simoni
- Department of Radiology, Reine Fabiola Children's University Hospital of Bruxelles, University of Bruxelles, Brussels, Belgium
| | - Iwona Sudoł-Szopińska
- Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation and Department of Medical Imaging, Medical University of Warsaw, Warsaw, Poland
| | | | - James Teh
- Department of Radiology, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Lennart Jans
- Department of Radiology and Medical Imaging, Ghent University Hospital, Ghent, Belgium
| | - Karen Rosendahl
- Department of Radiology, University Hospital of North Norway, Tromsø, Norway
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Malattia C, Ruperto N, Pederzoli S, Palmisani E, Pistorio A, Wouters C, Dolezalova P, Flato B, Garay S, Giancane G, Wells C, Douglass W, Brunner HI, De Benedetti F, Ravelli A. Tocilizumab may slow radiographic progression in patients with systemic or polyarticular-course juvenile idiopathic arthritis: post hoc radiographic analysis from two randomized controlled trials. Arthritis Res Ther 2020; 22:211. [PMID: 32912276 PMCID: PMC7488325 DOI: 10.1186/s13075-020-02303-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 08/24/2020] [Indexed: 11/10/2022] Open
Abstract
Background Few clinical trials have investigated the prevention of radiographic progression in children with juvenile idiopathic arthritis treated with antirheumatic drugs. This study aimed to investigate radiographic progression in patients with systemic juvenile idiopathic arthritis (sJIA) and patients with polyarticular-course juvenile idiopathic arthritis (pcJIA) treated with the anti–interleukin-6 receptor antibody tocilizumab for 2 years in the TENDER and CHERISH randomized controlled trials, respectively. Methods Standard radiographs of both wrists and both hands in the posteroanterior view were obtained within 4 weeks of baseline and were repeated at weeks 52 ± 4 and 104 ± 4 in both trials. All films were scored by two independent readers using the adapted Sharp–van der Heijde (aSH) and Poznanski scoring methods. Although the Poznanski score indicates bone growth limitation or cartilage growth decrease, which are not the same as joint space narrowing in rheumatoid arthritis, its change reflects damage to cartilage. Therefore, impairment in the Poznanski score as well as the aSH score was considered as a measure of structural joint damage. Radiographic progression was defined as worsening of radiographic scores beyond the smallest detectable difference. Results Poznanski and aSH scores were available at baseline and at one or more postbaseline time points for 33 and 47 of 112 sJIA patients and 61 and 87 of 188 pcJIA patients, respectively, providing a representative subset of the study populations. The inter-reader and intra-reader agreement intra-class correlation coefficient was > 0.8. Median baseline Poznanski and aSH scores, respectively, were − 2.4 and 24.6 for sJIA patients and − 1.5 and 8.0 for pcJIA patients. Compared with baseline, aSH scores remained stable for all sJIA patients at week 52, whereas 9.4% of sJIA patients had radiographic progression according to Poznanski scores at week 52; at 104 weeks, radiographic progression according to aSH and Poznanski scores was observed in 5.4% and 11.5%, respectively. In pcJIA patients, radiographic progression from baseline at 52 weeks and at 104 weeks was 12.5% and 2.9%, respectively, using aSH scoring and 6.5% and 4%, respectively, using Poznanski scoring. Conclusion Tocilizumab may delay radiographic progression in children with sJIA and children with pcJIA. Trial registration Trial registration numbers and dates: TENDER, NCT00642460 (March 19, 2008); CHERISH, NCT00988221 (October 1, 2009)
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Affiliation(s)
- Clara Malattia
- Università degli Studi di Genova, Genoa, Italy.,IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia, PRINTO, Via G. Gaslini 5, 16147, Genoa, Italy
| | - Nicolino Ruperto
- IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia, PRINTO, Via G. Gaslini 5, 16147, Genoa, Italy
| | - Silvia Pederzoli
- IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia, PRINTO, Via G. Gaslini 5, 16147, Genoa, Italy
| | - Elena Palmisani
- IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia, PRINTO, Via G. Gaslini 5, 16147, Genoa, Italy
| | - Angela Pistorio
- IRCCS Istituto Giannina Gaslini, Servizio di Epidemiologia e Biostatistica, Genoa, Italy
| | | | - Pavla Dolezalova
- General University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Berit Flato
- Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Stella Garay
- Hospital Sor Maria Ludovica, La Plata, Argentina
| | - Gabriella Giancane
- IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia, PRINTO, Via G. Gaslini 5, 16147, Genoa, Italy
| | | | | | | | | | - Angelo Ravelli
- Università degli Studi di Genova, Genoa, Italy. .,IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia, PRINTO, Via G. Gaslini 5, 16147, Genoa, Italy. .,Sechenov First Moscow State Medical University, Moscow, Russian Federation.
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12
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Haghnegahdar A, Pakshir H, Ghanbari I. Correlation between Skeletal Age and Metacarpal Bones and Metacarpophalangeal Joints Dimensions. JOURNAL OF DENTISTRY (SHIRAZ, IRAN) 2019; 20:159-164. [PMID: 31579689 PMCID: PMC6732183 DOI: 10.30476/dentjods.2019.44904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Statement of the Problem: Currently, two major methods have been introduced for bone age assessment using left hand radiography. The first approach is Greulich and Pyle, which is very subjective. The second method is Tanner and Whitehouse, which is very time consuming and its morphological criteria are not quantitative, therefore it is hardly used.
Purpose: The purpose of this study is to evaluate the relationship between skeletal age and bone size and joint space measurements among Asian children using hand radiographs and using this correlation as an aid in determining bone age.
Materials and Method: In this analytic research, 304 hand radiographs from Asian children with normal development have been included in this study (155 female, 149 male). Two radiologists using Greulich and Pyle method assessed their bone ages. The 2nd-5th metacarpal bones length and width and 2nd-5th metacarpophalangeal joints width and length were manually measured by Adobe Photoshop and compared with subjects’ skeletal age. Pearson correlation was used to determine the relationship.
Results: Pearson correlation between bone age and metacarpal bones length was 0.902-0.938; metacarpal bones width was 0.452-0.850; metacarpophalangeal joints width was 0.656 - 0.811, and metacarpophalangeal joints length was 0.920 - 0.947.
Conclusion: Regarding Pearson correlation, metacarpophalangeal joints length, metacarpal bones length, metacarpophalangeal joints width, and metacarpal bones width showed significant relationship with bone age, respectively. These measurements can be used as accessory criteria for bone age assessment using left hand radiography, to reduce inter-observer reading differences.
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Affiliation(s)
- Abdolaziz Haghnegahdar
- Dept. of Maxillofacial Radiology, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hamidreza Pakshir
- Dept. of Maxillofacial Orthodontics School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ilnaz Ghanbari
- Postgraduate Student Dept. of Oral and Maxillofacial Surgery, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
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No radiographic wrist damage after treatment to target in recent-onset juvenile idiopathic arthritis. Pediatr Rheumatol Online J 2019; 17:62. [PMID: 31484539 PMCID: PMC6727344 DOI: 10.1186/s12969-019-0362-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 08/09/2019] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND To evaluate radiographic progression of patients with new-onset juvenile idiopathic arthritis (JIA) in response to an early, tightly-controlled, treatment-to-target. METHODS Patients with JIA participating in the BeSt-for-Kids-study, randomized to 3 treatment strategy arms, were eligible if at least 1 conventional wrist-radiograph was available. Bone damage as reflected by carpal length was assessed using the Poznanski-score. The BoneXpert-method was used to determine the Bone Age (BA, > 5 years) and bone mineral density (BMD) of the wrist. These scores were evaluated over time and compared between the treatment arms and mean JADAS10-score using linear mixed models corrected for age and symptom duration. RESULTS In 60 patients, 252 radiographs were analysed. Baseline age and symptom duration were different between the arms. No difference in comparison to the healthy reference population was found at baseline for the Poznanski-score (IQR varying from - 0,82; 0.68), nor for BA (varying from - 0.88 to 0.74). Baseline BMD was statistically significantly lower in arm 3 (initial treatment with etanercept and methotrexate) (- 1.48; - 0.68) compared to arm 1 (- 0.84; - 0.04) and arm 2 (- 0.93; 0.15). After treatment to target inactive disease, the Poznanski-scores and the BA remained clinically unchanged, while the BMD in arm 3 improved (p < 0.05 vs arm 1). CONCLUSIONS Recent-onset JIA patients, treated-to-target aimed at inactive disease, showed no signs of radiographic wrist damage (Poznanski-score, BA or BMD) either at baseline or at follow-up, irrespective of treatment arm. A lower BMD at baseline in arm 3, initially treated with methotrexate and etanercept, improved significantly after treatment. TRIAL REGISTRATION NTR, NL1504 (NTR1574). Registered 01-06-2009.
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Malattia C, Rinaldi M, Martini A. The role of imaging in juvenile idiopathic arthritis. Expert Rev Clin Immunol 2018; 14:681-694. [PMID: 29972659 DOI: 10.1080/1744666x.2018.1496019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION The prognosis of juvenile idiopathic arthritis (JIA) has changed dramatically due to the availability of novel drugs. Prompt diagnosis and treatment are essential to prevent permanent joint damage. As a result, methods to improve JIA diagnosis and prognosis are of high priority to tailor treatment strategies and maximize their efficacy. Musculoskeletal ultrasound and magnetic resonance imaging are more sensitive than clinical examination and radiography in the detection of joint involvement and might play a substantial role to optimize the management of JIA. Areas covered: This review compiles an inventory of potential uses of imaging studies in the modern practice of pediatric rheumatology, together with a critical analysis of the major challenges that are still to be addressed. Imaging appearance of normal growth-related changes of the musculoskeletal system will be discussed. Expert commentary: Knowledge of the evolving patterns of skeletal maturity is paramount to define pathological findings and avoid misinterpretations. Establishing a novel radiological algorithm for a rational use of imaging in JIA is of high priority to allow a speedier integration of imaging into the clinical workflow and decision-making process.
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Affiliation(s)
- Clara Malattia
- a Clinica Pediatrica e Reumatologia , Istituto Giannina Gaslini , Genova , Italy.,b Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili , Università degli studi di Genova , Italy
| | - Mariangela Rinaldi
- a Clinica Pediatrica e Reumatologia , Istituto Giannina Gaslini , Genova , Italy
| | - Alberto Martini
- c Direzione Scientifica Istituto Giannina Gaslini , Genova Italy
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Avenarius DFM, Nusman C, Malattia C, de Horatio LT, Rosendahl K, Maas M, Müller LSO. Current status of wrist imaging in juvenile idiopathic arthritis. Pediatr Radiol 2018; 48:801-810. [PMID: 29766247 DOI: 10.1007/s00247-017-4063-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 11/19/2017] [Accepted: 12/18/2017] [Indexed: 10/17/2022]
Abstract
Wrist involvement occurs in about one-quarter of patients diagnosed with juvenile idiopathic arthritis (JIA), increasing to 40% 5 years after diagnosis. The imaging appearances, both for active inflammation and permanent change, differ from those seen in adult rheumatoid arthritis; therefore, a child-specific approach is crucial for correct assessment. In this review article, we provide an update on the current status for imaging wrist JIA, with a focus on evidence-based practice.
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Affiliation(s)
| | - Charlotte Nusman
- Department of Paediatric Haematology, Rheumatology, Immunology, and Infectious Disease, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands.,Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Clara Malattia
- Department of Paediatrics, University of Genoa, Genova, Italy
| | | | - Karen Rosendahl
- Department of Radiology, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, K1, University of Bergen, Bergen, Norway
| | - Mario Maas
- Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Lil-Sofie Ording Müller
- Department of Radiology and Intervention Unit for Paediatric Radiology, Oslo University, Oslo, Norway
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A novel radiographic scoring system for growth abnormalities and structural change in children with juvenile idiopathic arthritis of the hip. Pediatr Radiol 2018; 48:1086-1095. [PMID: 29717335 PMCID: PMC6061460 DOI: 10.1007/s00247-018-4136-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 02/02/2018] [Accepted: 04/12/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Approximately 20-50% of children with juvenile idiopathic arthritis (JIA) have hip involvement within 6 years of diagnosis. Scoring systems for hip-related radiographic changes are lacking. OBJECTIVE To examine precision of potential radiographic variables and to suggest a scoring system. MATERIALS AND METHODS We reviewed a set of 75 pelvic radiographs from 75 children with JIA hip involvement across two European centres. We assessed findings of (1) destructive change and (2) growth abnormality, according to a pre-defined scoring system. All radiographs were scored independently by two sets of radiologists. One set scored the radiographs a second time. We used kappa statistics to rate inter- and intra-observer variability. RESULTS Assessment of erosions of the femoral head, femoral neck and the acetabulum showed moderate to good agreement for the same reader (kappa of 0.5-0.8). The inter-reader agreement was, however, low (kappa of 0.1-0.3). There was moderate to high agreement for the assessment of femoral head flattening (kappa of 0.6-0.7 for the same reader, 0.3-0.7 between readers). Joint space narrowing showed moderate to high agreement both within and between observers (kappa of 0.4-0.8). Femoral neck length and width measurements, the centrum-collum-diaphysis angle, and trochanteric-femoral head lengths were relatively precise, with 95% limits of agreement within 10-15% of the observer average. CONCLUSION Several radiographic variables of destructive and growth abnormalities in children with hip JIA have reasonable reproducibility. We suggest that future studies on clinical validity focus on assessing only reproducible radiographic variables.
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Dimitriou C, Boitsios G, Badot V, Lê PQ, Goffin L, Simoni P. Imaging of Juvenile Idiopathic Arthritis. Radiol Clin North Am 2017; 55:1071-1083. [DOI: 10.1016/j.rcl.2017.04.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Selvaag AM, Kirkhus E, Törnqvist L, Lilleby V, Aulie HA, Flatø B. Radiographic damage in hands and wrists of patients with juvenile idiopathic arthritis after 29 years of disease duration. Pediatr Rheumatol Online J 2017; 15:20. [PMID: 28399930 PMCID: PMC5387251 DOI: 10.1186/s12969-017-0151-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 03/23/2017] [Indexed: 03/05/2023] Open
Abstract
BACKGROUND There are few studies on radiographic outcome after long-term disease duration in juvenile idiopathic arthritis (JIA). We wanted to evaluate 29-year radiographic outcome in hands/wrists and predictors of damage in patients with long-term active JIA. METHODS Patients diagnosed from 1980 to 1985, who had active disease at 15-, 23- or 29-year follow-up and arthritis in the wrists during the disease course, were reexamined with radiographs of hands/wrists. We used the adapted version of the Sharp van der Heijde (aSvdH) score and Carpal Height Ratio (CHR) to evaluate radiographic outcome. RESULTS Sixty patients, mean age 38 years, were reexamined at median 29-year follow-up. 33 patients (55%) had an aSvdH score >0, median score was 4.0 (range 0-313), and 25% of the scores were high (≥53). Most patients with radiographic damage (88%) had both erosions and JSN. 52% of the patients had damage in the wrists, 43% in the MCP joints and 40% in the PIP joints. The CHR correlated strongly with the aSvdH. Both scores had high correlations with the Juvenile Arthritis Damage Index and the number of joints with limited range of motion (LROM) (rs = -0.688 to 0.743, p ≤ 0.001). The aSvdH correlated weakly with measures of disease activity. The number of joints with LROM, ESR and the HAQ disability score at 15 years and HLAB27 positivity predicted the aSvdH score and the CHR at 29-year follow-up. CONCLUSIONS The majority of patients with long-term active JIA had modest radiographic damage, but more frequently in wrists than in fingers. The radiographic scores correlated well with measures of disease damage. Restricted mobility in joints at 15 years was the most important predictor of radiographic damage at 29 years.
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Affiliation(s)
- Anne M. Selvaag
- grid.55325.34Department of Rheumatology, Oslo University Hospital, Rikshospitalet, Post-box 4950, Nydalen, 0424 Oslo, Norway
| | - Eva Kirkhus
- grid.55325.34Department of Radiology and Nuclear Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway ,grid.5510.1Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Lena Törnqvist
- grid.55325.34Department of Radiology and Nuclear Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway ,grid.5640.7Present address: Department of Radiology, Linköping University, Linköping, Sweden
| | - Vibke Lilleby
- grid.55325.34Department of Rheumatology, Oslo University Hospital, Rikshospitalet, Post-box 4950, Nydalen, 0424 Oslo, Norway
| | - Hanne A. Aulie
- grid.55325.34Department of Rheumatology, Oslo University Hospital, Rikshospitalet, Post-box 4950, Nydalen, 0424 Oslo, Norway ,grid.413684.cPresent address: Department of Internal Medicine, Diakonhjemmet Hospital, Oslo, Norway
| | - Berit Flatø
- grid.55325.34Department of Rheumatology, Oslo University Hospital, Rikshospitalet, Post-box 4950, Nydalen, 0424 Oslo, Norway ,grid.5510.1Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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Spampinato C, Palazzo S, Giordano D, Aldinucci M, Leonardi R. Deep learning for automated skeletal bone age assessment in X-ray images. Med Image Anal 2017; 36:41-51. [DOI: 10.1016/j.media.2016.10.010] [Citation(s) in RCA: 137] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 10/10/2016] [Accepted: 10/12/2016] [Indexed: 10/20/2022]
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Avenarius DFM, Ording Müller LS, Rosendahl K. Erosion or normal variant? 4-year MRI follow-up of the wrists in healthy children. Pediatr Radiol 2016; 46:322-30. [PMID: 26637316 PMCID: PMC4767868 DOI: 10.1007/s00247-015-3494-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 09/03/2015] [Accepted: 10/28/2015] [Indexed: 12/02/2022]
Abstract
BACKGROUND A large proportion of healthy children have wrist changes on MRI, namely carpal depressions, findings that have been described as pathological in children with juvenile idiopathic arthritis. OBJECTIVE We performed follow-up imaging in a cohort of healthy children to evaluate carpal surface depressions over time, focusing on the presence of overlying cartilage as a potential discriminator between normal variants and true erosions. MATERIALS AND METHODS 74 of the initial cohort of 89 healthy children (83%) had a re-scan of their wrists using the same protocol, including coronal T1 and fat-saturated T2 sequences. A cartilage-selective sequence was added for this study. We registered number and location of bony depressions and presence of overlying cartilage. RESULTS The total number of carpal depressions increased by age group and over time; their location was unchanged in 370 of 487 (76%) carpal sites and 91 of 117 (78%) metacarpal sites. In total, 426 of the 1,087 (39.2%) bony depressions were covered by cartilage, with a decreasing percentage by age (P = 0.001). CONCLUSION Normal appearances during growth, such as bony depressions, should not be mistaken for pathology. There must be additional findings to support a diagnosis of disease. A cartilage sequence may add to the diagnostic image analysis.
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Affiliation(s)
- Derk F. M. Avenarius
- />Faculty of Health Sciences, University of Tromsø, 9037 Tromsø, Norway , />Department of Radiology, University Hospital of North Norway, Tromsø, Norway
| | | | - Karen Rosendahl
- />Department of Radiology, Haukeland University Hospital, Bergen, Norway , />Department of Clinical Medicine K1, University of Bergen, Bergen, Norway
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van Dijkhuizen EHP, Wulffraat NM. Early predictors of prognosis in juvenile idiopathic arthritis: a systematic literature review. Ann Rheum Dis 2015; 74:1996-2005. [PMID: 24962873 DOI: 10.1136/annrheumdis-2014-205265] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 05/25/2014] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Juvenile idiopathic arthritis (JIA) is subdivided into seven categories. Even within these categories, the prognosis varies markedly. To start appropriate treatment in patients with JIA and to inform patients and their parents correctly, it is essential to know the individual prognosis, preferably at the time of diagnosis. The aim of this study was to identify variables that predict disease activity, joint damage, functional ability and quality of life (QoL) early in the disease course. METHODS A systematic literature review was performed, and 3679 articles were identified. The results were screened and critically appraised using predefined criteria. Articles that described validated outcomes, such as the Wallace criteria, the childhood health assessment questionnaire (CHAQ) and the juvenile arthritis damage index (JADI), and that determined predictors in the first 6 months of disease were selected. RESULTS Forty mostly retrospective articles were selected. Polyarticular onset predicted a worse prognosis for all outcomes, except QoL. A diagnostic delay and the systemic category predicted continuation of active disease. Notably, antinuclear antibodies (ANA) did not predict disease activity. Symmetric involvement and rheumatoid factor positivity predicted less damage. More disease activity was mainly associated with worse functional outcome. However, most predictors were not validated. CONCLUSIONS Few predictors for the selected outcomes were found. Prospective, longitudinal studies using standardised outcome measurements, and evaluating a broader range of predictors, such as genetics, immunological and imaging data, should be performed. For the outcomes joint assessment and quality of life, standardised and validated outcomes should be developed.
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Affiliation(s)
- E H Pieter van Dijkhuizen
- Pediatria II, Reumatologia, IRCCS G. Gaslini, Genoa, Italy Department of Paediatric Immunology, University Medical Centre Utrecht, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Nico M Wulffraat
- Department of Paediatric Immunology, University Medical Centre Utrecht, Wilhelmina Children's Hospital, Utrecht, The Netherlands
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Nusman CM, Ording Muller LS, Hemke R, Doria AS, Avenarius D, Tzaribachev N, Malattia C, van Rossum MAJ, Maas M, Rosendahl K. Current Status of Efforts on Standardizing Magnetic Resonance Imaging of Juvenile Idiopathic Arthritis: Report from the OMERACT MRI in JIA Working Group and Health-e-Child. J Rheumatol 2015; 43:239-44. [PMID: 25979714 DOI: 10.3899/jrheum.141276] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To report on the progress of an ongoing research collaboration on magnetic resonance imaging (MRI) in juvenile idiopathic arthritis (JIA) and describe the proceedings of a meeting, held prior to Outcome Measures in Rheumatology (OMERACT) 12, bringing together the OMERACT MRI in JIA working group and the Health-e-Child radiology group. The goal of the meeting was to establish agreement on scoring definitions, locations, and scales for the assessment of MRI of patients with JIA for both large and small joints. METHODS The collaborative work process included premeeting surveys, presentations, group discussions, consensus on scoring methods, pilot scoring, conjoint review, and discussion of a future research agenda. RESULTS The meeting resulted in preliminary statements on the MR imaging protocol of the JIA knee and wrist and determination of the starting point for development of MRI scoring systems based on previous studies. It was also considered important to be descriptive rather than explanatory in the assessment of MRI in JIA (e.g., "thickening" instead of "hypertrophy"). Further, the group agreed that well-designed calibration sessions were warranted before any future scoring exercises were conducted. CONCLUSION The combined efforts of the OMERACT MRI in JIA working group and Health-e-Child included the assessment of currently available material in the literature and determination of the basis from which to start the development of MRI scoring systems for both the knee and wrist. The future research agenda for the knee and wrist will include establishment of MRI scoring systems, an atlas of MR imaging in healthy children, and MRI protocol requisites.
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Affiliation(s)
- Charlotte M Nusman
- From the Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands; Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Disease, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands; Department of Radiology, Oslo University Hospital, Oslo, Norway; Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Radiology, University Hospital North Norway, Tromsø, Norway; Pediatric Rheumatology Research Institute, Bad Bramstedt, Germany; Department of Pediatrics, University of Genoa, Genoa, Italy; Department of Pediatric Rheumatology, Reade Institute, location Jan van Breemen, Amsterdam, The Netherlands; Department of Clinical Medicine, K1, University of Bergen, and Department of Pediatric Radiology, Haukeland University Hospital, Bergen, Norway.C.M. Nusman, MSc, Department of Radiology, Academic Medical Center; Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Disease, Emma Children's Hospital, Academic Medical Center; L.S. Ording Muller, MD, PhD, Department of Radiology, Oslo University Hospital; R. Hemke, MD, PhD, Department of Radiology, Academic Medical Center; Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Disease, Emma Children's Hospital, Academic Medical Center; A.S. Doria, MD, PhD, Department of Diagnostic Imaging, The Hospital for Sick Children; D. Avenarius, MD, Department of Radiology, University Hospital North Norway; N. Tzaribachev, MD, Pediatric Rheumatology Research Institute; C. Malattia, MD, PhD, Department of Pediatrics, University of Genoa; M.A. van Rossum, MD, PhD, Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Disease, Emma Children's Hospital, Academic Medical Center, and Department of Pediatric Rheumatology, Reade Institute, location Jan van Breemen; M. Maas, MD, PhD, Department of Radiology, Academic Medical Center; K. Rosendahl, MD, PhD, Department o
| | - Lil-Sofie Ording Muller
- From the Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands; Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Disease, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands; Department of Radiology, Oslo University Hospital, Oslo, Norway; Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Radiology, University Hospital North Norway, Tromsø, Norway; Pediatric Rheumatology Research Institute, Bad Bramstedt, Germany; Department of Pediatrics, University of Genoa, Genoa, Italy; Department of Pediatric Rheumatology, Reade Institute, location Jan van Breemen, Amsterdam, The Netherlands; Department of Clinical Medicine, K1, University of Bergen, and Department of Pediatric Radiology, Haukeland University Hospital, Bergen, Norway.C.M. Nusman, MSc, Department of Radiology, Academic Medical Center; Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Disease, Emma Children's Hospital, Academic Medical Center; L.S. Ording Muller, MD, PhD, Department of Radiology, Oslo University Hospital; R. Hemke, MD, PhD, Department of Radiology, Academic Medical Center; Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Disease, Emma Children's Hospital, Academic Medical Center; A.S. Doria, MD, PhD, Department of Diagnostic Imaging, The Hospital for Sick Children; D. Avenarius, MD, Department of Radiology, University Hospital North Norway; N. Tzaribachev, MD, Pediatric Rheumatology Research Institute; C. Malattia, MD, PhD, Department of Pediatrics, University of Genoa; M.A. van Rossum, MD, PhD, Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Disease, Emma Children's Hospital, Academic Medical Center, and Department of Pediatric Rheumatology, Reade Institute, location Jan van Breemen; M. Maas, MD, PhD, Department of Radiology, Academic Medical Center; K. Rosendahl, MD, PhD, Department o
| | - Robert Hemke
- From the Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands; Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Disease, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands; Department of Radiology, Oslo University Hospital, Oslo, Norway; Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Radiology, University Hospital North Norway, Tromsø, Norway; Pediatric Rheumatology Research Institute, Bad Bramstedt, Germany; Department of Pediatrics, University of Genoa, Genoa, Italy; Department of Pediatric Rheumatology, Reade Institute, location Jan van Breemen, Amsterdam, The Netherlands; Department of Clinical Medicine, K1, University of Bergen, and Department of Pediatric Radiology, Haukeland University Hospital, Bergen, Norway.C.M. Nusman, MSc, Department of Radiology, Academic Medical Center; Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Disease, Emma Children's Hospital, Academic Medical Center; L.S. Ording Muller, MD, PhD, Department of Radiology, Oslo University Hospital; R. Hemke, MD, PhD, Department of Radiology, Academic Medical Center; Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Disease, Emma Children's Hospital, Academic Medical Center; A.S. Doria, MD, PhD, Department of Diagnostic Imaging, The Hospital for Sick Children; D. Avenarius, MD, Department of Radiology, University Hospital North Norway; N. Tzaribachev, MD, Pediatric Rheumatology Research Institute; C. Malattia, MD, PhD, Department of Pediatrics, University of Genoa; M.A. van Rossum, MD, PhD, Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Disease, Emma Children's Hospital, Academic Medical Center, and Department of Pediatric Rheumatology, Reade Institute, location Jan van Breemen; M. Maas, MD, PhD, Department of Radiology, Academic Medical Center; K. Rosendahl, MD, PhD, Department o
| | - Andrea S Doria
- From the Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands; Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Disease, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands; Department of Radiology, Oslo University Hospital, Oslo, Norway; Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Radiology, University Hospital North Norway, Tromsø, Norway; Pediatric Rheumatology Research Institute, Bad Bramstedt, Germany; Department of Pediatrics, University of Genoa, Genoa, Italy; Department of Pediatric Rheumatology, Reade Institute, location Jan van Breemen, Amsterdam, The Netherlands; Department of Clinical Medicine, K1, University of Bergen, and Department of Pediatric Radiology, Haukeland University Hospital, Bergen, Norway.C.M. Nusman, MSc, Department of Radiology, Academic Medical Center; Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Disease, Emma Children's Hospital, Academic Medical Center; L.S. Ording Muller, MD, PhD, Department of Radiology, Oslo University Hospital; R. Hemke, MD, PhD, Department of Radiology, Academic Medical Center; Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Disease, Emma Children's Hospital, Academic Medical Center; A.S. Doria, MD, PhD, Department of Diagnostic Imaging, The Hospital for Sick Children; D. Avenarius, MD, Department of Radiology, University Hospital North Norway; N. Tzaribachev, MD, Pediatric Rheumatology Research Institute; C. Malattia, MD, PhD, Department of Pediatrics, University of Genoa; M.A. van Rossum, MD, PhD, Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Disease, Emma Children's Hospital, Academic Medical Center, and Department of Pediatric Rheumatology, Reade Institute, location Jan van Breemen; M. Maas, MD, PhD, Department of Radiology, Academic Medical Center; K. Rosendahl, MD, PhD, Department o
| | - Derk Avenarius
- From the Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands; Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Disease, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands; Department of Radiology, Oslo University Hospital, Oslo, Norway; Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Radiology, University Hospital North Norway, Tromsø, Norway; Pediatric Rheumatology Research Institute, Bad Bramstedt, Germany; Department of Pediatrics, University of Genoa, Genoa, Italy; Department of Pediatric Rheumatology, Reade Institute, location Jan van Breemen, Amsterdam, The Netherlands; Department of Clinical Medicine, K1, University of Bergen, and Department of Pediatric Radiology, Haukeland University Hospital, Bergen, Norway.C.M. Nusman, MSc, Department of Radiology, Academic Medical Center; Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Disease, Emma Children's Hospital, Academic Medical Center; L.S. Ording Muller, MD, PhD, Department of Radiology, Oslo University Hospital; R. Hemke, MD, PhD, Department of Radiology, Academic Medical Center; Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Disease, Emma Children's Hospital, Academic Medical Center; A.S. Doria, MD, PhD, Department of Diagnostic Imaging, The Hospital for Sick Children; D. Avenarius, MD, Department of Radiology, University Hospital North Norway; N. Tzaribachev, MD, Pediatric Rheumatology Research Institute; C. Malattia, MD, PhD, Department of Pediatrics, University of Genoa; M.A. van Rossum, MD, PhD, Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Disease, Emma Children's Hospital, Academic Medical Center, and Department of Pediatric Rheumatology, Reade Institute, location Jan van Breemen; M. Maas, MD, PhD, Department of Radiology, Academic Medical Center; K. Rosendahl, MD, PhD, Department o
| | - Nikolay Tzaribachev
- From the Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands; Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Disease, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands; Department of Radiology, Oslo University Hospital, Oslo, Norway; Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Radiology, University Hospital North Norway, Tromsø, Norway; Pediatric Rheumatology Research Institute, Bad Bramstedt, Germany; Department of Pediatrics, University of Genoa, Genoa, Italy; Department of Pediatric Rheumatology, Reade Institute, location Jan van Breemen, Amsterdam, The Netherlands; Department of Clinical Medicine, K1, University of Bergen, and Department of Pediatric Radiology, Haukeland University Hospital, Bergen, Norway.C.M. Nusman, MSc, Department of Radiology, Academic Medical Center; Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Disease, Emma Children's Hospital, Academic Medical Center; L.S. Ording Muller, MD, PhD, Department of Radiology, Oslo University Hospital; R. Hemke, MD, PhD, Department of Radiology, Academic Medical Center; Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Disease, Emma Children's Hospital, Academic Medical Center; A.S. Doria, MD, PhD, Department of Diagnostic Imaging, The Hospital for Sick Children; D. Avenarius, MD, Department of Radiology, University Hospital North Norway; N. Tzaribachev, MD, Pediatric Rheumatology Research Institute; C. Malattia, MD, PhD, Department of Pediatrics, University of Genoa; M.A. van Rossum, MD, PhD, Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Disease, Emma Children's Hospital, Academic Medical Center, and Department of Pediatric Rheumatology, Reade Institute, location Jan van Breemen; M. Maas, MD, PhD, Department of Radiology, Academic Medical Center; K. Rosendahl, MD, PhD, Department o
| | - Clara Malattia
- From the Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands; Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Disease, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands; Department of Radiology, Oslo University Hospital, Oslo, Norway; Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Radiology, University Hospital North Norway, Tromsø, Norway; Pediatric Rheumatology Research Institute, Bad Bramstedt, Germany; Department of Pediatrics, University of Genoa, Genoa, Italy; Department of Pediatric Rheumatology, Reade Institute, location Jan van Breemen, Amsterdam, The Netherlands; Department of Clinical Medicine, K1, University of Bergen, and Department of Pediatric Radiology, Haukeland University Hospital, Bergen, Norway.C.M. Nusman, MSc, Department of Radiology, Academic Medical Center; Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Disease, Emma Children's Hospital, Academic Medical Center; L.S. Ording Muller, MD, PhD, Department of Radiology, Oslo University Hospital; R. Hemke, MD, PhD, Department of Radiology, Academic Medical Center; Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Disease, Emma Children's Hospital, Academic Medical Center; A.S. Doria, MD, PhD, Department of Diagnostic Imaging, The Hospital for Sick Children; D. Avenarius, MD, Department of Radiology, University Hospital North Norway; N. Tzaribachev, MD, Pediatric Rheumatology Research Institute; C. Malattia, MD, PhD, Department of Pediatrics, University of Genoa; M.A. van Rossum, MD, PhD, Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Disease, Emma Children's Hospital, Academic Medical Center, and Department of Pediatric Rheumatology, Reade Institute, location Jan van Breemen; M. Maas, MD, PhD, Department of Radiology, Academic Medical Center; K. Rosendahl, MD, PhD, Department o
| | - Marion A J van Rossum
- From the Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands; Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Disease, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands; Department of Radiology, Oslo University Hospital, Oslo, Norway; Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Radiology, University Hospital North Norway, Tromsø, Norway; Pediatric Rheumatology Research Institute, Bad Bramstedt, Germany; Department of Pediatrics, University of Genoa, Genoa, Italy; Department of Pediatric Rheumatology, Reade Institute, location Jan van Breemen, Amsterdam, The Netherlands; Department of Clinical Medicine, K1, University of Bergen, and Department of Pediatric Radiology, Haukeland University Hospital, Bergen, Norway.C.M. Nusman, MSc, Department of Radiology, Academic Medical Center; Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Disease, Emma Children's Hospital, Academic Medical Center; L.S. Ording Muller, MD, PhD, Department of Radiology, Oslo University Hospital; R. Hemke, MD, PhD, Department of Radiology, Academic Medical Center; Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Disease, Emma Children's Hospital, Academic Medical Center; A.S. Doria, MD, PhD, Department of Diagnostic Imaging, The Hospital for Sick Children; D. Avenarius, MD, Department of Radiology, University Hospital North Norway; N. Tzaribachev, MD, Pediatric Rheumatology Research Institute; C. Malattia, MD, PhD, Department of Pediatrics, University of Genoa; M.A. van Rossum, MD, PhD, Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Disease, Emma Children's Hospital, Academic Medical Center, and Department of Pediatric Rheumatology, Reade Institute, location Jan van Breemen; M. Maas, MD, PhD, Department of Radiology, Academic Medical Center; K. Rosendahl, MD, PhD, Department o
| | - Mario Maas
- From the Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands; Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Disease, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands; Department of Radiology, Oslo University Hospital, Oslo, Norway; Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Radiology, University Hospital North Norway, Tromsø, Norway; Pediatric Rheumatology Research Institute, Bad Bramstedt, Germany; Department of Pediatrics, University of Genoa, Genoa, Italy; Department of Pediatric Rheumatology, Reade Institute, location Jan van Breemen, Amsterdam, The Netherlands; Department of Clinical Medicine, K1, University of Bergen, and Department of Pediatric Radiology, Haukeland University Hospital, Bergen, Norway.C.M. Nusman, MSc, Department of Radiology, Academic Medical Center; Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Disease, Emma Children's Hospital, Academic Medical Center; L.S. Ording Muller, MD, PhD, Department of Radiology, Oslo University Hospital; R. Hemke, MD, PhD, Department of Radiology, Academic Medical Center; Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Disease, Emma Children's Hospital, Academic Medical Center; A.S. Doria, MD, PhD, Department of Diagnostic Imaging, The Hospital for Sick Children; D. Avenarius, MD, Department of Radiology, University Hospital North Norway; N. Tzaribachev, MD, Pediatric Rheumatology Research Institute; C. Malattia, MD, PhD, Department of Pediatrics, University of Genoa; M.A. van Rossum, MD, PhD, Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Disease, Emma Children's Hospital, Academic Medical Center, and Department of Pediatric Rheumatology, Reade Institute, location Jan van Breemen; M. Maas, MD, PhD, Department of Radiology, Academic Medical Center; K. Rosendahl, MD, PhD, Department o
| | - Karen Rosendahl
- From the Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands; Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Disease, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands; Department of Radiology, Oslo University Hospital, Oslo, Norway; Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Radiology, University Hospital North Norway, Tromsø, Norway; Pediatric Rheumatology Research Institute, Bad Bramstedt, Germany; Department of Pediatrics, University of Genoa, Genoa, Italy; Department of Pediatric Rheumatology, Reade Institute, location Jan van Breemen, Amsterdam, The Netherlands; Department of Clinical Medicine, K1, University of Bergen, and Department of Pediatric Radiology, Haukeland University Hospital, Bergen, Norway.C.M. Nusman, MSc, Department of Radiology, Academic Medical Center; Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Disease, Emma Children's Hospital, Academic Medical Center; L.S. Ording Muller, MD, PhD, Department of Radiology, Oslo University Hospital; R. Hemke, MD, PhD, Department of Radiology, Academic Medical Center; Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Disease, Emma Children's Hospital, Academic Medical Center; A.S. Doria, MD, PhD, Department of Diagnostic Imaging, The Hospital for Sick Children; D. Avenarius, MD, Department of Radiology, University Hospital North Norway; N. Tzaribachev, MD, Pediatric Rheumatology Research Institute; C. Malattia, MD, PhD, Department of Pediatrics, University of Genoa; M.A. van Rossum, MD, PhD, Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Disease, Emma Children's Hospital, Academic Medical Center, and Department of Pediatric Rheumatology, Reade Institute, location Jan van Breemen; M. Maas, MD, PhD, Department of Radiology, Academic Medical Center; K. Rosendahl, MD, PhD, Department o
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Ording Muller LS, Humphries P, Rosendahl K. The joints in juvenile idiopathic arthritis. Insights Imaging 2015; 6:275-84. [PMID: 25903287 PMCID: PMC4444796 DOI: 10.1007/s13244-015-0406-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 03/19/2015] [Accepted: 03/25/2015] [Indexed: 11/25/2022] Open
Abstract
Abstract Juvenile idiopathic arthritis is the most common rheumatic entity in childhood. Imaging has become an important supplement to the clinical assessment of children with JIA. Radiographs still play an important role in the workup, and long-term follow-up in children with JIA, but are not sensitive to findings in the early disease stage. Both ultrasound and MRI are more sensitive to inflammatory changes than clinical assessment alone. However, the differentiation between normal findings and pathology can be challenging, particularly in early disease. The objective of this review is to discuss the role of imaging in JIA, describe the typical findings on different modalities and highlight the challenges we face regarding the reliability and accuracy of the different methods for imaging the joints in children with JIA. Key Points • Imaging is an important supplement to the clinical examination in JIA. • Ultrasound is more sensitive for detecting synovitis than clinical examination alone. • MRI can depict all relevant structures in joint inflammation. • The differentiation between normal variants and pathology is difficult in children.
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Affiliation(s)
| | - Paul Humphries
- />Institute of Child Health, UCL, University College London Hospital NHS Trust and Great Ormond Street Hospital for Children, London, UK
| | - Karen Rosendahl
- />Department of Radiology, Haukeland University Hospital, Bergen, Norway
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Consolaro A, Negro G, Chiara Gallo M, Bracciolini G, Ferrari C, Schiappapietra B, Pistorio A, Bovis F, Ruperto N, Martini A, Ravelli A. Defining criteria for disease activity states in nonsystemic juvenile idiopathic arthritis based on a three-variable juvenile arthritis disease activity score. Arthritis Care Res (Hoboken) 2014; 66:1703-9. [PMID: 24980508 DOI: 10.1002/acr.22393] [Citation(s) in RCA: 125] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Accepted: 06/24/2014] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To determine cutoff values for defining the states of inactive disease (ID), low disease activity (LDA; or minimal disease activity), moderate disease activity (MDA), and high disease activity (HDA) using the clinical (3-variable) Juvenile Arthritis Disease Activity Score (cJADAS). METHODS For selection of cutoffs, data from a clinical database including 609 children with juvenile idiopathic arthritis (JIA) were used. Optimal cutoffs were determined against external criteria by calculating the 75th and 90th percentile (for ID and LDA) and 10th and 25th percentile (for HDA) of cumulative score distribution and through receiver operating characteristic curve analysis. External criteria included definitions for ID and LDA cutoffs and therapeutic decisions for HDA cutoffs. MDA cutoffs were set at the score interval in-between LDA and HDA cutoffs. Crossvalidation was performed using 2 JIA patient samples (n = 485) and was based on assessment of construct and discriminant validity. RESULTS The selected cutoffs were as follows: ≤1 for ID in both oligoarthritis and polyarthritis; ≤1.5 and ≤2.5 for LDA in oligoarthritis and polyarthritis, respectively; 1.51-4 and 2.51-8.5 for MDA in oligoarthritis and polyarthritis, respectively; and >4 and >8.5 for HDA in oligoarthritis and polyarthritis, respectively. In crossvalidation analyses, the cutoffs showed a strong ability to discriminate between disease activity states defined subjectively by physicians and parents, levels of pain, and presence/absence of functional impairment and disease damage. CONCLUSION Cutoff values for classifying various disease states in nonsystemic JIA using the cJADAS were developed. The cutoffs revealed good measurement characteristics in crossvalidation analyses and are suited for application in clinical practice and research.
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Rose CD, Pans S, Casteels I, Anton J, Bader-Meunier B, Brissaud P, Cimaz R, Espada G, Fernandez-Martin J, Hachulla E, Harjacek M, Khubchandani R, Mackensen F, Merino R, Naranjo A, Oliveira-Knupp S, Pajot C, Russo R, Thomee C, Vastert S, Wulffraat N, Arostegui JI, Foley KP, Bertin J, Wouters CH. Blau syndrome: cross-sectional data from a multicentre study of clinical, radiological and functional outcomes. Rheumatology (Oxford) 2014; 54:1008-16. [DOI: 10.1093/rheumatology/keu437] [Citation(s) in RCA: 104] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Indexed: 11/12/2022] Open
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Impact of ensemble learning in the assessment of skeletal maturity. J Med Syst 2014; 38:87. [PMID: 25012476 DOI: 10.1007/s10916-014-0087-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 06/13/2014] [Indexed: 10/25/2022]
Abstract
The assessment of the bone age, or skeletal maturity, is an important task in pediatrics that measures the degree of maturation of children's bones. Nowadays, there is no standard clinical procedure for assessing bone age and the most widely used approaches are the Greulich and Pyle and the Tanner and Whitehouse methods. Computer methods have been proposed to automatize the process; however, there is a lack of exploration about how to combine the features of the different parts of the hand, and how to take advantage of ensemble techniques for this purpose. This paper presents a study where the use of ensemble techniques for improving bone age assessment is evaluated. A new computer method was developed that extracts descriptors for each joint of each finger, which are then combined using different ensemble schemes for obtaining a final bone age value. Three popular ensemble schemes are explored in this study: bagging, stacking and voting. Best results were achieved by bagging with a rule-based regression (M5P), scoring a mean absolute error of 10.16 months. Results show that ensemble techniques improve the prediction performance of most of the evaluated regression algorithms, always achieving best or comparable to best results. Therefore, the success of the ensemble methods allow us to conclude that their use may improve computer-based bone age assessment, offering a scalable option for utilizing multiple regions of interest and combining their output.
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Aoki C, Inaba Y, Choe H, Kaneko U, Hara R, Miyamae T, Imagawa T, Mori M, Oba MS, Yokota S, Saito T. Discrepancy Between Clinical and Radiological Responses to Tocilizumab Treatment in Patients with Systemic-onset Juvenile Idiopathic Arthritis. J Rheumatol 2014; 41:1171-7. [DOI: 10.3899/jrheum.130924] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Objective.Tocilizumab (TCZ), an antiinterleukin-6 receptor monoclonal antibody, is clinically beneficial in patients with systemic-onset juvenile idiopathic arthritis (sJIA). We investigated the clinical and radiological outcomes of TCZ therapy in patients with sJIA.Methods.We retrospectively evaluated 2 clinical trials (NCT00144599 and NCT00144612) involving 40 patients with sJIA who received intravenous TCZ (8 mg/kg) every 2 weeks. Clinical data and radiographs of the hands and large joints were assessed before and during TCZ treatment. The Poznanski score, modified Larsen scores of the hands and large joints, and Childhood Arthritis Radiographic Score of the Hip (CARSH) were recorded.Results.After a mean duration of 4.5 years of TCZ treatment, clinical data had improved significantly, the mean Poznanski score improved from −1.5 to −1.1, the mean Larsen score of the hands deteriorated from 7.0 to 10.0, the mean Larsen score for the large joints deteriorated from 5.9 to 6.8, and the CARSH worsened from 3.9 to 6.2. The Larsen score for the large joints improved in 11 cases (28%), remained unchanged in 8 cases (20%), and worsened in 21 cases (52%). Matrix metalloproteinase 3 (MMP-3) levels remained significantly higher (278 mg/dl) in patients with worsened Larsen scores than in patients with improved or unchanged scores (65 mg/dl). Logistic regression analysis showed that older age at disease onset was a significant risk factor for radiographic progression.Conclusion.The modified Larsen score of the large joints deteriorated in half the patients who had high MMP-3 levels during TCZ treatment and who were significantly older at disease onset.
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Rouster-Stevens KA, Ardoin SP, Cooper AM, Becker ML, Dragone LL, Huttenlocher A, Jones KB, Kolba KS, Moorthy LN, Nigrovic PA, Stinson JN, Ferguson PJ. Choosing Wisely: The American College of Rheumatology's Top 5 for Pediatric Rheumatology. Arthritis Care Res (Hoboken) 2014; 66:649-57. [DOI: 10.1002/acr.22238] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2013] [Accepted: 11/14/2013] [Indexed: 11/11/2022]
Affiliation(s)
| | | | - Ashley M. Cooper
- University of Texas Southwestern Medical School, Dallas, and Children's Mercy Hospitals and Clinics; Kansas City Missouri
| | - Mara L. Becker
- Children's Mercy Hospitals and Clinics; Kansas City Missouri
| | | | | | | | - Karen S. Kolba
- Pacific Arthritis Center Medical Group; Santa Maria California
| | | | - Peter A. Nigrovic
- Boston Children's Hospital and Brigham and Women's Hospital; Boston Massachusetts
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Ravelli A, Ruperto N, Pederzoli S, Burgos-Vargas R, Kobusinska K, Schmeling H, Sztajnbok F, Weller-Heinemann F, Zholobova E, Zulian F, Allen R, Chaitow J, Keane C, Wells C, Martini A, Lovell DJ, De Benedetti F. A11: Assessment of Radiographic Progression in Patients With Polyarticular-Course Juvenile Idiopathic Arthritis Treated With Tocilizumab: 2-Year Data From CHERISH. Arthritis Rheumatol 2014. [DOI: 10.1002/art.38422] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
| | | | | | | | | | - Heinrike Schmeling
- University of Calgary/Alberta Childrens Hospital Research Institute; Calgary AB
| | | | | | | | | | | | | | | | - Chris Wells
- Roche Products Ltd.; Welwyn Garden City United Kingdom
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Friesen KJ, Chodirker BN, Chudley AE, Reed MH, Elliott AM. Radiographic characterization of the hands in Ritscher-Schinzel/3-C syndrome. SPRINGERPLUS 2013; 2:594. [PMID: 24255872 PMCID: PMC3830001 DOI: 10.1186/2193-1801-2-594] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Accepted: 10/29/2013] [Indexed: 11/10/2022]
Abstract
Abstract Ritscher-Schinzel Syndrome (RSS) is a clinically variable, autosomal recessive disorder, involving cardiac, cerebellar and craniofacial abnormalities. Numerous reports describe hand changes in RSS patients; however, a detailed characterization of the hands has not previously been performed. Objective The purpose of this study was to identify whether specific radiographic hand changes were characteristic of RSS and could serve as a diagnostic tool. Materials and methods We performed a detailed radiographic hand characterization of 8 RSS patients. The patient population consisted of 5 males and 3 females from ages one month to 26 years, 7 months. The hands were characterized using metacarpophalangeal pattern (MCPP) profiles, carpal height and bone age analyses and assessment of bone morphology. Results There was generalized brachydactyly with the second ray being the most severely affected. There was significant shortening of the first metacarpal and the fifth distal phalanx. The MCPP profile generated showed a consistent wavy pattern with average Z-scores ranging from -0.15 (4th proximal phalanx) to -2.13 (1st metacarpal) and 0.53 (4th middle phalanx) to -1.73 (2nd proximal phalanx) for the left and right hands, respectively. Six of eight patients showed a decreased carpal height. Bone age was within normal limits for all patients. Our study population showed consistent radiographic changes including: overtubulation of the bones (especially metacarpals 2-4), prominent tufts of the distal phalanges and a hypoplastic fifth distal phalanx. Conclusion The hand findings identified in this study can provide helpful diagnostic tools to clinicians when the diagnosis of RSS is being considered.
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Affiliation(s)
- Kaitlyn J Friesen
- Department of Biochemistry and Medical Genetics, University of Manitoba, Winnipeg, Manitoba R3E 0W3 Canada
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MRI of the wrist in juvenile idiopathic arthritis: erosions or normal variants? A prospective case-control study. Pediatr Radiol 2013; 43:785-95. [PMID: 23283407 DOI: 10.1007/s00247-012-2575-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Revised: 11/09/2012] [Accepted: 11/12/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Bony depressions at the wrist resembling erosions are frequently seen on MRI in healthy children. The accuracy of MRI in detecting early bony destruction is therefore questionable. We compared findings on MRI of the wrist in healthy children and those with juvenile idiopathic arthritis (JIA) to investigate markers for true disease. MATERIALS AND METHODS We compared the number and localisation of bony depressions at the wrist in 85 healthy children and 68 children with JIA, ages 5-15 years. The size of the wrist was assessed from a radiograph of the wrist performed on the same day as the MRI. RESULTS No significant difference in the number of bony depressions in the carpal bones was seen between healthy children and children with JIA at any age. Depressions are found in similar locations in the two groups, except for a few sites, where bony depressions were seen exclusively in the JIA group, particularly at the CMC joints. The wrist was significantly smaller in children with JIA (P < 0.001). CONCLUSIONS Using adult scoring systems and standard MR sequences in the assessment of bone destruction in children may lead to overstaging or understaging of disease. At present, standard MRI sequences cannot easily be used for assessment of early signs of erosions in children.
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Trachana M, Pratsidou-Gertsi P, Badouraki M, Haidich AB, Pardalos G. Achievement of clinical remission in patients with juvenile idiopathic arthritis under a 2-10-year Etanercept exposure. Clin Rheumatol 2013; 32:1191-7. [PMID: 23604548 DOI: 10.1007/s10067-013-2261-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Revised: 03/15/2013] [Accepted: 04/06/2013] [Indexed: 10/26/2022]
Abstract
The objective of this retrospective study was to record the achievement of clinical remission (CR) in juvenile idiopathic arthritis patients under a 2-10 years' administration of Etanercept (ETN) and to detect any variables associated with CR. Patients previously resistant to conventional regimens were enrolled. The annual impact of ETN was assessed by: (a) the American College of Rheumatology pediatric criteria (ACRpedi), (b) the pre- and posttreatment disease activity score (juvenile arthritis disease activity score [JADAS71]), and (c) Wallace's criteria for CR. A total of 41 patients (F: 31) were registered. The median age and disease duration at baseline were 10.6 and 4.17 years, respectively, and their disease course was mainly polyarthritis (32/41). In respect to baseline, there was an impressive JADAS71 reduction posttreatment, most prominent after the first year. From year 1 to 5, more than 50 % of the patients achieved and retained CR and 66 % reached an ACRpedi 70, whereas after the 5th year, no patient was withdrawn due to an ACRpedi <30. JADAS71 at baseline was not associated with the subsequent CR achievement. However, JADAS71 1-year posttreatment had a significant association with the CR of the second posttreatment year, (p = 0.028, OR 0.79; 95 % CI 0.63-0.98) and a similar trend was observed for the following years. These findings emphasize the sustained impact of ETN in the achievement of CR. A low JADAS71 score 1-year posttreatment, may be associated with the maintenance of CR over the next treatment year.
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Affiliation(s)
- Maria Trachana
- Pediatric Immunology and Rheumatology Referral Center, 1st Department of Pediatrics, Aristotle University, Ippokration Hospital, Thessaloniki, Greece.
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Malattia C, Damasio MB, Basso C, Santoro M, Verri A, Pederzoli S, Mattiuz C, Viola S, Buoncompagni A, Madeo A, Mazzoni M, Rosendahl K, Lambot-Juhan K, Tanturri de Horatio L, Magnano GM, Ravelli A, Martini A. Novel automated system for magnetic resonance imaging quantification of the inflamed synovial membrane volume in patients with juvenile idiopathic arthritis. Arthritis Care Res (Hoboken) 2012; 64:1657-64. [DOI: 10.1002/acr.21739] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Consolaro A, Bracciolini G, Ruperto N, Pistorio A, Magni-Manzoni S, Malattia C, Pederzoli S, Davì S, Martini A, Ravelli A. Remission, minimal disease activity, and acceptable symptom state in juvenile idiopathic arthritis: defining criteria based on the juvenile arthritis disease activity score. ACTA ACUST UNITED AC 2012; 64:2366-74. [PMID: 22231288 DOI: 10.1002/art.34373] [Citation(s) in RCA: 151] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To determine cutoff values for defining remission, minimal disease activity, and parent and child acceptable symptom state in juvenile idiopathic arthritis (JIA) using the Juvenile Arthritis Disease Activity Score (JADAS). METHODS For the selection of cutoff values, data from a clinical database including 609 children with JIA were used. Optimal cutoff values were determined against external criteria by calculating the 75th percentile of cumulative score distribution and through receiver operating characteristic curve analysis. External criteria included formal definitions of inactive disease and minimal disease activity, subjective rating of remission by physicians, parents, and children, and rating of acceptable symptom state by parents and children. The choice of cutoffs was made based on clinical and statistical grounds. Cross-validation was performed using 4 JIA patient samples that included a total of 1,323 patients, and was based on assessment of construct, discriminant, and predictive validity. RESULTS With all versions of the JADAS, the cutoff score for classifying a patient as having inactive disease was 1, whereas the cutoff for classification of minimal disease activity was 2 for oligoarticular JIA and 3.8 for polyarticular JIA. Cutoffs for physicians', parents', and children's subjective rating of remission ranged from 2 to 2.3. Cutoffs for acceptable symptom state ranged from 3.2 to 5.4 for parents and from 3 to 4.5 for children. Results of cross-validation analyses strongly supported the selected cutoff values. CONCLUSION Cutoff values for classifying various disease states in JIA using the JADAS were developed. In cross-validation analyses, they proved to have good construct and discriminant validity and ability to predict disease outcome.
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Radiologic analysis of the effect of tocilizumab on hands and large joints in children with systemic juvenile idiopathic arthritis. Mod Rheumatol 2012; 23:667-73. [PMID: 22791270 DOI: 10.1007/s10165-012-0711-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Accepted: 06/14/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVES To assess the efficacy of tocilizumab for preventing damage to the joints of systemic juvenile idiopathic arthritis (sJIA) patients, we examined serial radiographs of the hands and large weight-bearing joints of these patients before and after treatment with this agent. METHODS Nine patients with sJIA receiving 8 mg/kg of tocilizumab intravenously every 2 weeks were studied. The mean follow-up period was 82 months. The number of active joints and laboratory markers of inflammation were assessed before and after tocilizumab treatment, together with radiologic evaluation of the hips, knees, ankles, shoulders, and elbows. The latter examination included soft tissue swelling, juxta-articular osteoporosis, epiphyseal irregularity, joint-space narrowing, cyst formation, erosion, and localized growth abnormalities. Modified Larsen scores for the large joints and the Poznanski score were also recorded. RESULTS After tocilizumab treatment, the number of active joints and serum inflammatory markers decreased (p < 0.01). There was a decrease in radiologic abnormalities at the final follow-up (p < 0.01) with the exception of localized growth abnormalities. Radiologic improvement was observed in 47 joints (52%), but ten (11%) worsened. Total Larsen score was decreased from 15.8 to 10.9 at the final follow-up. Although the Poznanski score did not change after tocilizumab treatment, it was closely correlated with the total Larsen score (r = 0.53, p < 0.05). CONCLUSIONS We describe radiologic improvement of the majority of damaged large joints in sJIA following tocilizumab therapy, but some deteriorated further despite stabilization of systemic inflammatory responses. Further studies with a larger number of patients are needed.
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Breton S, Jousse-Joulin S, Finel E, Marhadour T, Colin D, de Parscau L, Devauchelle-Pensec V. Imaging Approaches for Evaluating Peripheral Joint Abnormalities in Juvenile Idiopathic Arthritis. Semin Arthritis Rheum 2012; 41:698-711. [DOI: 10.1016/j.semarthrit.2011.08.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2011] [Revised: 08/16/2011] [Accepted: 08/23/2011] [Indexed: 12/14/2022]
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Shire NJ, Dardzinski BJ. Picture-perfect: imaging techniques in juvenile idiopathic arthritis. ACTA ACUST UNITED AC 2011. [DOI: 10.2217/iim.11.63] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Kerensky TA, Gottlieb AB, Yaniv S, Au SC. Etanercept: efficacy and safety for approved indications. Expert Opin Drug Saf 2011; 11:121-39. [DOI: 10.1517/14740338.2012.633509] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Ozawa R, Inaba Y, Mori M, Hara R, Kikuchi M, Higuchi R, Miyamae T, Imagawa T, Fujiwara T, Saito T, Yokota S. Definitive differences in laboratory and radiological characteristics between two subtypes of juvenile idiopathic arthritis: systemic arthritis and polyarthritis. Mod Rheumatol 2011; 22:558-64. [PMID: 21984130 DOI: 10.1007/s10165-011-0540-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2011] [Accepted: 09/21/2011] [Indexed: 11/25/2022]
Abstract
We performed this study to investigate the differences in radiological and laboratory findings between systemic juvenile idiopathic arthritis (s-JIA) and polyarthritis (p-JIA). Twenty-two patients with s-JIA and 18 with p-JIA were enrolled. Their laboratory findings and radiographs were examined retrospectively. Plain radiographs were obtained before the induction of biological agents. All radiographs were examined for the presence of soft tissue swelling, juxta-articular osteopenia, joint space narrowing, subchondral bone cyst, erosion, epiphyseal irregularity, and growth abnormalities. Carpal length and bone mineral density of the lumbar spine, an indicator of generalized osteoporosis, were also investigated in all the patients enrolled. Laboratory examinations involved white blood cell counts, platelets, C-reactive protein (CRP), rheumatoid factor (RF), anti-cyclic citrullinated peptide (CCP) antibody, and matrix metalloproteinase (MMP)-3. Comparisons of the laboratory findings between s-JIA and p-JIA indicated that the titers of anti-CCP antibody and RF were significantly increased in p-JIA sera (P < 0.05). There was no difference in BMD between the two groups of patients. Carpal length was significantly shorter in p-JIA patients than in s-JIA patients (P < 0.05). The most frequent radiological abnormality in s-JIA was juxta-articular osteopenia (93.8%), in comparison to a frequency of 50.0% in p-JIA. Joint space narrowing was shown in 9.8% of the s-JIA patients compared to 35.7% of the p-JIA patients. Subchondral bone cyst and erosion were more frequent in p-JIA than s-JIA. In conclusion, there were differences in radiographic characteristics and laboratory data between s-JIA and p-JIA in this study. In the radiological evaluation, bone-related abnormality was prominent in s-JIA and joint-related abnormality was striking in p-JIA, and these results indicated that the pathogenic bases of arthritis appear to differ between these two subtypes of JIA.
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Affiliation(s)
- Remi Ozawa
- Department of Pediatrics, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
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Inaba Y, Ozawa R, Imagawa T, Mori M, Hara Y, Miyamae T, Aoki C, Saito T, Yokota S. Radiographic improvement of damaged large joints in children with systemic juvenile idiopathic arthritis following tocilizumab treatment. Ann Rheum Dis 2011; 70:1693-5. [PMID: 21402562 DOI: 10.1136/ard.2010.145359] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Malattia C, Damasio MB, Pistorio A, Ioseliani M, Vilca I, Valle M, Ruperto N, Viola S, Buoncompagni A, Magnano GM, Ravelli A, Tomà P, Martini A. Development and preliminary validation of a paediatric-targeted MRI scoring system for the assessment of disease activity and damage in juvenile idiopathic arthritis. Ann Rheum Dis 2011; 70:440-6. [PMID: 21109519 DOI: 10.1136/ard.2009.126862] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To develop and validate a paediatric-targeted MRI scoring system for the assessment of disease activity and damage in juvenile idiopathic arthritis (JIA). To compare the paediatric MRI score with the adult-designed. Outcome Measures in Rheumatology Clinical Trials-Rheumatoid Arthritis MRI Score (RAMRIS), whose suitability for assessing growing joints was tested. METHODS In 66 patients with JIA the clinically more affected wrist was studied. Thirty-nine patients had a 1-year MRI follow-up. Two readers independently assigned the paediatric score and the RAMRIS to all studies. Validation procedures included analysis of reliability, construct validity and responsiveness to change. A reduced version of the bone erosion score was also developed and tested. RESULTS The paediatric score showed an excellent reproducibility (interclass correlation coefficient >0.9). The interobserver agreement of RAMRIS was moderate for bone erosions and excellent for bone marrow oedema (BMO). The paediatric score and RAMRIS provided similar results for construct validity. The responsiveness to change of the paediatric score was moderate for synovitis and bone erosion, and poor for BMO and did not improve when RAMRIS was applied. The reduced version of the bone erosion was valuable for the assessment of joint damage, and provided time-saving advantages. CONCLUSION The results demonstrate that the paediatric MRI score is a reliable and valid method for assessing disease activity and damage in JIA. Unexpectedly, the RAMRIS provides acceptable suitability for use in the paediatric age group. Further work, especially in a longitudinal setting, is required before defining the most suitable MRI scale for assessing growing joints.
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Affiliation(s)
- Clara Malattia
- Correspondence to Dr Clara Malattia, Pediatria II, irccs G Gaslini, Largo G Gaslini 5, 16147 Genova, Italy.
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de Luis-García R, Westin CF, Alberola-López C. Gaussian mixtures on tensor fields for segmentation: applications to medical imaging. Comput Med Imaging Graph 2010; 35:16-30. [PMID: 20932717 DOI: 10.1016/j.compmedimag.2010.09.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2009] [Revised: 05/10/2010] [Accepted: 09/01/2010] [Indexed: 10/19/2022]
Abstract
In this paper, we introduce a new approach for tensor field segmentation based on the definition of mixtures of Gaussians on tensors as a statistical model. Working over the well-known Geodesic Active Regions segmentation framework, this scheme presents several interesting advantages. First, it yields a more flexible model than the use of a single Gaussian distribution, which enables the method to better adapt to the complexity of the data. Second, it can work directly on tensor-valued images or, through a parallel scheme that processes independently the intensity and the local structure tensor, on scalar textured images. Two different applications have been considered to show the suitability of the proposed method for medical imaging segmentation. First, we address DT-MRI segmentation on a dataset of 32 volumes, showing a successful segmentation of the corpus callosum and favourable comparisons with related approaches in the literature. Second, the segmentation of bones from hand radiographs is studied, and a complete automatic-semiautomatic approach has been developed that makes use of anatomical prior knowledge to produce accurate segmentation results.
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Affiliation(s)
- Rodrigo de Luis-García
- Laboratory of Mathematics in Imaging, Brigham and Women's Hospital, 1249 Boylston St., Boston, MA 02215, USA.
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Sawhney S, Agarwal M. Outcome measures in pediatric rheumatology. Indian J Pediatr 2010; 77:1183-9. [PMID: 20938818 DOI: 10.1007/s12098-010-0208-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2010] [Accepted: 07/14/2010] [Indexed: 11/30/2022]
Abstract
Children with rheumatologic disorders need periodic systematic evaluation of their disease status so that all aspects of the child's life that are affected can be adequately assessed. The commonest rheumatologic disease that afflicts children is Juvenile Idiopathic Arthritis (JIA). The child with JIA should have several domains assessed at regular intervals. These outcome measures include the physical, functional and the quality of life assessment measures. No single measure can capture the full impact of the disease on the child's life. This article highlights the key outcome measures in a child with JIA and introduces the readers to several disease measurement tools that have been developed for assessment of outcome for the child with JIA.
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Affiliation(s)
- Sujata Sawhney
- Pediatric Rheumatology Unit, Centre for Child Health, Sir Ganga Ram Hospital, New Delhi, India.
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Synovial and inflammatory diseases in childhood: role of new imaging modalities in the assessment of patients with juvenile idiopathic arthritis. Pediatr Radiol 2010; 40:985-98. [PMID: 20432018 DOI: 10.1007/s00247-010-1612-z] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2010] [Accepted: 02/06/2010] [Indexed: 10/19/2022]
Abstract
Juvenile idiopathic arthritis (JIA) represents a group of heterogeneous diseases characterized by a chronic inflammatory process primarily targeting the synovial membrane. A persistent synovitis is associated with an increased risk of osteocartilaginous damage.With the advent of effective structure-modifying treatment for JIA, it may be possible to significantly reduce or even completely prevent structural damage and associated functional disability. The trend towards early suppression of inflammation, in order to prevent erosive disease, shifts the emphasis away from conventional radiographic detectable structural damage to the slightest traces of early joint damage, and drives the need for alternative imaging techniques more sensitive in detecting early signs of disease activity and damage. In this regard MRI and US are playing an increasing role in the evaluation of arthritic joints.This article will review the key aspects of the current status and recent important advances of imaging techniques available to investigate the child with rheumatic disease, briefly discussing conventional radiography, and particularly focusing on MRI and US. In this era of advancing imaging technology, knowledge of the relative values of available imaging techniques is necessary to optimize the management of children with JIA.
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BERTAMINO MARTA, ROSSI FEDERICA, PISTORIO ANGELA, LUCIGRAI GIORGIO, VALLE MAURA, VIOLA STEFANIA, MAGNI-MANZONI SILVIA, MALATTIA CLARA, MARTINI ALBERTO, RAVELLI ANGELO. Development and Initial Validation of a Radiographic Scoring System for the Hip in Juvenile Idiopathic Arthritis. J Rheumatol 2009; 37:432-9. [DOI: 10.3899/jrheum.090691] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective. To develop and validate a radiographic scoring system for the assessment of radiographic damage in the hip joint in patients with juvenile idiopathic arthritis (JIA).Methods. The Childhood Arthritis Radiographic Score of the Hip (CARSH) assesses and scores these radiographic abnormalities: joint space narrowing (JSN), erosion, growth abnormalities, subchondral cysts, malalignment, sclerosis of the acetabulum, and avascular necrosis of the femoral head. Score validation was accomplished by evaluating reliability and correlational, construct, and predictive validity in 148 JIA patients with hip disease who had a total of 381 hip radiographs available for study.Results. JSN was the most frequently observed radiographic abnormality, followed by erosion and sclerosis of the acetabulum. The least common abnormalities were avascular necrosis, growth abnormalities, and malalignment. Interobserver and intraobserver reliability on baseline and longitudinal score values and on score changes was good, with intraclass correlation coefficients ranging from 0.76 to 0.98. Early score changes, but not absolute baseline score values, were moderately correlated (rs > 0.4) with clinical indicators of disease damage at last followup observation, thereby demonstrating that the CARSH has good construct and predictive validity. The amount of structural damage in the hip radiograph at last followup observation was predicted better by baseline to 1-year score change (rs = 0.66; p < 0.0001) than by absolute baseline score values (rs = 0.40; p = 0.002).Conclusion. Our results show that the CARSH is reliable and valid for the assessment of radiographic hip damage and its progression in patients with JIA.
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Nieuwenhuis MK, Gonzalez RV, van der Net J, Kuis W, Beek FJA, Buchanan TS, Helders PJM. The Role of the Forearm Muscles Related to Wrist Malalignment in Juvenile Chronic Arthritis. ACTA ACUST UNITED AC 2009. [DOI: 10.1080/140381901750475357] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Nieuwenhuis MK, van der Net J, Helders P, Kuis W, Buchanan T. Assessment of Wrist Malalignment in Juvenile Rheumatoid Arthritis. ACTA ACUST UNITED AC 2009. [DOI: 10.1080/140381999443474] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Bloom BJ, Alario AJ, Miller LC. Persistent elevation of fibrin D-dimer predicts longterm outcome in systemic juvenile idiopathic arthritis. J Rheumatol 2009; 36:422-6. [PMID: 19040298 DOI: 10.3899/jrheum.070600] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE We previously demonstrated that levels of fibrin d-dimer correlate with disease activity and response to therapies in systemic juvenile idiopathic arthritis (sJIA). We hypothesized that persistence of D-dimer elevation in the patterns previously described, but over a longer followup period, would signal poor outcome. METHODS We studied 31 children identified from 2 centers. Subjects were assigned a risk category based on their first obtained D-dimer concentration. Risk categories were based on results of our initial study, where normalization of D-dimer in patients no longer taking immunosuppressive therapy predicted good short-term outcome, and persistent D-dimer elevation while taking immunosuppressives predicted bad outcome (radiographic abnormalities, joint replacement surgery, or poor functional class) or a severe systemic manifestation. Outcome was determined at the last followup visit, a minimum of 2 years after measurement of the initial d-dimer level. RESULTS The 31 children were a mean 16.4 years old at an average of 8.8 years after their initial diagnosis. Ten children had a severe outcome during this period; all 10 had a study baseline risk category of "high." Of the 14 subjects who had a high risk category at study baseline, none had a mild outcome. CONCLUSION Our study indicated that a paradigm of risk of severe disease based upon persistent elevation of fibrin d-dimer on first measurements (greater than a mean of 29 months in our initial study and at least 24 months in the additional subjects) is promising to predict poor longer-term outcome in sJIA. A larger prospective study is warranted to substantiate the preliminary data and assess the relative comparative value to other biomarkers and clinical endpoints.
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Affiliation(s)
- Bradley J Bloom
- Pediatric Rheumatology Clinic, Hasbro Children's Hospital, and Department of Pediatrics, Brown University Medical School, Providence, Rhode Island, USA.
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