title: Frequency of abnormal hand and wrist radiographs at time of diagnosis of polyarticular juvenile rheumatoid arthritis.
abstract: OBJECTIVE
  To determine the frequency of radiographic abnormalities in hand/wrist radiographs of children with newly diagnosed polyarticular juvenile rheumatoid arthritis (polyJRA) because radiographs of small joints are an important tool in assessing outcomes in RA and there are clinical similarities between RA and polyJRA.
  
  
  METHODS
  A medical record review was performed to identify cases of polyJRA seen at Mayo Clinic from January 1, 1994, to December 31, 2001. Hand/wrist radiographs, obtained at the time of diagnosis, were reviewed by 3 radiologists with attention to periarticular osteopenia, joint space narrowing (JSN), or erosion. At least 2 radiologists had to independently identify abnormal findings on the same radiograph. The relative carpal length (RCL), judged by Poznanski's method, was also determined.
  
  
  RESULTS
  From the review of 159 medical records, 60 cases of newly diagnosed polyJRA were identified. Twenty-five of these had hand/wrist radiographs at diagnosis; 18 sets were available for this study. Of those, 2/3 were female, 6% (1/18) had subcutaneous nodules, 7% (1/14) had elevated levels of serum rheumatoid factor, and 44% (7/16) had elevated serum levels of antinuclear antibodies. Median age at diagnosis was 10.2 years, median duration of hand/wrist symptoms at diagnosis was 10 months, and median number of joints with either swelling, pain on range of motion (ROM), or limited ROM was 14.5. Sixty-one percent of radiographs taken at the time of diagnosis of polyJRA were abnormal. While 44% had periarticular osteopenia, 28% had either erosions or JSN. Six (33%) had RCL > 2 SD below the mean for age. Five (83%) of those with RCL, > 2 SD below the mean for age, had periarticular osteopenia, JSN, or erosion.
  
  
  CONCLUSIONS
  We conclude the frequency of abnormal hand/wrist radiographs is very high very early in the course of polyJRA. More studies are needed to determine to what extent these radiographic abnormalities correlate with clinical outcomes.
authors.affiliation: Department of Radiology, Mayo Clinic, Rochester, Minnesota 55905, USA.
authors.forename: Tom
authors.initials: T
authors.lastname: Mason
authors.forename: Ann M
authors.initials: AM
authors.lastname: Reed
authors.forename: Audrey M
authors.initials: AM
authors.lastname: Nelson
authors.forename: Kristen B
authors.initials: KB
authors.lastname: Thomas
authors.forename: Alice
authors.initials: A
authors.lastname: Patton
authors.forename: Alan D
authors.initials: AD
authors.lastname: Hoffman
authors.forename: Sara
authors.initials: S
authors.lastname: Achenbach
authors.forename: William M
authors.initials: WM
authors.lastname: O'Fallon
mesh_terms: D000974:Antibodies, Antinuclear / Q000032:analysis; D001171:Arthritis, Juvenile / Q000097:blood / Q000150:complications / Q000000981:diagnostic imaging*; D001175:Arthrography; D001851:Bone Diseases, Metabolic / Q000000981:diagnostic imaging / Q000209:etiology; D002648:Child; D005260:Female; D005384:Finger Joint / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D010146:Pain / Q000209:etiology / Q000503:physiopathology; D016059:Range of Motion, Articular; D012217:Rheumatoid Factor / Q000097:blood; D012218:Rheumatoid Nodule / Q000000981:diagnostic imaging / Q000209:etiology; D014955:Wrist Joint / Q000000981:diagnostic imaging*
chemical_list: D000974:Antibodies, Antinuclear; D012217:Rheumatoid Factor