title: Radiographic damage in hands and wrists of patients with juvenile idiopathic arthritis after 29 years of disease duration.
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.
authors.affiliation: Department of Rheumatology, Oslo University Hospital, Rikshospitalet, Post-box 4950, Nydalen, 0424, Oslo, Norway. anselv@ous-hf.no.
authors.forename: Anne M
authors.identifier: http://orcid.org/0000-0001-7122-5897
authors.initials: AM
authors.lastname: Selvaag
authors.affiliation: Department of Radiology and Nuclear Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway.|Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
authors.forename: Eva
authors.initials: E
authors.lastname: Kirkhus
authors.affiliation: Department of Radiology and Nuclear Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway.|Present address: Department of Radiology, Linköping University, Linköping, Sweden.
authors.forename: Lena
authors.initials: L
authors.lastname: Törnqvist
authors.affiliation: Department of Rheumatology, Oslo University Hospital, Rikshospitalet, Post-box 4950, Nydalen, 0424, Oslo, Norway.
authors.forename: Vibke
authors.initials: V
authors.lastname: Lilleby
authors.affiliation: Department of Rheumatology, Oslo University Hospital, Rikshospitalet, Post-box 4950, Nydalen, 0424, Oslo, Norway.|Present address: Department of Internal Medicine, Diakonhjemmet Hospital, Oslo, Norway.
authors.forename: Hanne A
authors.initials: HA
authors.lastname: Aulie
authors.affiliation: Department of Rheumatology, Oslo University Hospital, Rikshospitalet, Post-box 4950, Nydalen, 0424, Oslo, Norway.|Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
authors.forename: Berit
authors.initials: B
authors.lastname: Flatø
mesh_terms: D000328:Adult; D001171:Arthritis, Juvenile / Q000000981:diagnostic imaging* / Q000503:physiopathology; D005260:Female; D005384:Finger Joint / Q000000981:diagnostic imaging* / Q000503:physiopathology; D005500:Follow-Up Studies; D050823:Hand Joints / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D008297:Male; D008662:Metacarpophalangeal Joint / Q000000981:diagnostic imaging* / Q000503:physiopathology; D011859:Radiography; D012720:Severity of Illness Index; D014955:Wrist Joint / Q000000981:diagnostic imaging* / Q000503:physiopathology
keywords: Disease progression; Follow-up studies; Juvenile idiopathic arthritis; Longitudinal studies; Prognosis; Radiography; Risk factors