title: Contrast-enhanced MRI features in the early diagnosis of Juvenile Idiopathic Arthritis.
abstract: OBJECTIVE
  To determine whether clinical, laboratory or Magnetic Resonance Imaging (MRI) measures differentiate Juvenile Idiopathic Arthritis (JIA) from other forms of active childhood arthritis.
  
  
  METHODS
  We prospectively collected data of 80 treatment-naïve patients clinically suspected of JIA with active non-infectious arthritis of (at least) one knee for <12 months duration. Upon presentation patients underwent clinical and laboratory assessments and contrast-enhanced MRI. MRI was not used as a diagnostic criterion.
  
  
  RESULTS
  Forty-four (55%) patients were clinically diagnosed with JIA, whereas in 36 (45%) patients the diagnosis of JIA was discarded on clinical or laboratory findings. MRI-based synovitis was present in 27 (61.4%) JIA patients and in 7 (19.4%) non-JIA patients (P < 0.001). Five factors (male gender, physician's global assessment of overall disease activity, joints with limited range of motion, HLA-B27, MRI-based synovitis) were associated with the onset of JIA. In multivariate analysis MRI-based synovitis proved to be independently associated with JIA (OR 6.58, 95% CI 2.36-18.33). In patients with MRI-based synovitis, the RR of having JIA was 3.16 (95% CI 1.6-6.4).
  
  
  CONCLUSIONS
  The presence of MRI-based synovitis is associated with the clinical onset of JIA. Physical examination could be supported by MRI, particularly to contribute in the early differentiation of different forms of non-infectious childhood arthritis.
  
  
  CONCLUSIONS
  • Juvenile Idiopathic Arthritis (JIA) is a diagnosis of exclusion. • Differentiating JIA and other forms of childhood arthritis can be difficult. • MRI-techniques have substantially improved evaluation of joint abnormalities in JIA patients. • MRI-based synovitis is significantly associated with the clinical onset of JIA. • MRI could support physical examination in the early differentiation of childhood arthritis.
authors.affiliation: Department of Radiology Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands. r.hemke@amc.nl.
authors.forename: Robert
authors.initials: R
authors.lastname: Hemke
authors.affiliation: Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Disease, Emma Children's Hospital AMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.
authors.forename: Taco W
authors.initials: TW
authors.lastname: Kuijpers
authors.affiliation: Department of Radiology Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands.|Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Disease, Emma Children's Hospital AMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.
authors.forename: Charlotte M
authors.initials: CM
authors.lastname: Nusman
authors.affiliation: Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Disease, Emma Children's Hospital AMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.
authors.forename: Dieneke
authors.initials: D
authors.lastname: Schonenberg-Meinema
authors.affiliation: Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Disease, Emma Children's Hospital AMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.|Department of Pediatric Rheumatology, Reade, Dr. Jan van Breemenstraat 2, Amsterdam, The Netherlands.
authors.forename: Marion A J
authors.initials: MA
authors.lastname: van Rossum
authors.affiliation: Department of Pediatric Rheumatology, Reade, Dr. Jan van Breemenstraat 2, Amsterdam, The Netherlands.|Department of Pediatrics, St. Lucas Andreas Hospital, Jan Tooropstraat 164, Amsterdam, The Netherlands.
authors.forename: Koert M
authors.initials: KM
authors.lastname: Dolman
authors.affiliation: Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Disease, Emma Children's Hospital AMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.|Department of Pediatric Rheumatology, Reade, Dr. Jan van Breemenstraat 2, Amsterdam, The Netherlands.
authors.forename: J Merlijn
authors.initials: JM
authors.lastname: van den Berg
authors.affiliation: Department of Radiology Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands.
authors.forename: Mario
authors.initials: M
authors.lastname: Maas
mesh_terms: D000293:Adolescent; D001171:Arthritis, Juvenile / Q000175:diagnosis* / Q000503:physiopathology; D002648:Child; D003287:Contrast Media; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D006984:Hypertrophy / Q000473:pathology; D007719:Knee Joint / Q000503:physiopathology; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D010808:Physical Examination / Q000379:methods; D011446:Prospective Studies; D016059:Range of Motion, Articular / Q000502:physiology; D013583:Synovial Membrane / Q000473:pathology* / Q000503:physiopathology; D013585:Synovitis / Q000175:diagnosis / Q000503:physiopathology
chemical_list: D003287:Contrast Media
keywords: Childhood arthritis; Juvenile Idiopathic Arthritis; Knee joint; Magnetic Resonance Imaging; Synovitis