Skip to main content

Advertisement

SpringerLink
Log in

Is axial magnetic resonance imaging useful in early juvenile spondyloarthritis—preliminary report

  • Original Article
  • Published:
Clinical Rheumatology Aims and scope Submit manuscript

Abstract

Introduction/objectives

Magnetic resonance imaging (MRI) is recommended for evaluation of changes in juvenile spondyloarthropathies (JSpA). To our knowledge, there is no previous prospective study analysing early changes on axial MRI. The objective is to investigate incidence of reparable changes on axial MRI in patients with established JSpA, lasting for less than 6 months.

Materials and methods

The pilot study included 27 patients with confirmed diagnosis of JSpA examined within 2 years. Prior to imaging, basic demographic and laboratory data and HLA-B27 were collected. Patients filled out a visual analogue scale for pain and a childhood health assessment questionnaire. A paediatric rheumatologist and a paediatric physiatrist examined patients and measured indices of flexion, extension and sagittal flexibility. Contrast-enhanced axial MRI examination and cervical x-ray were performed. Three experienced paediatric radiologists independently reviewed x-ray and MRI images of all patients.

Results

There was no significant correlation between early changes detected on MRI and other parameters. The study revealed early changes of the cervical spine to be the most common finding. More patients had positive cervical MRI than positive sacroiliac joint (SIJ) MRI. Cervical x-ray and MRI were equally useful for diagnosis regardless of other parameters.

Conclusion

Study showed new information on axial involvement, striking cervical spine as the most involved part. The biggest study limitation is the small number of patients. Establishing early JSpA diagnosis is of utmost importance, especially in the light of novel therapy introduced in every day practice. It seems that cervical spine involvement is more represented than previously described in literature, especially in comparison with SIJ.

Key Points

• Contrast-enhanced MRI is considered the gold standard for detection early changes in JSpA.

• Standardization of diagnostic criteria and better classification of changes using the unique scoring system for children are necessary.

• It seems that cervical spine involvement is more represented than previously described in the literature, especially in comparison with SIJ involvement.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Tse SML, Laxer RM (2012) New advances in juvenile spondyloarthritis. Nat Rev Rheumatol 8:269–279. https://doi.org/10.1038/nrrheum.2012.37

    Article  PubMed  CAS  Google Scholar 

  2. Adrovic A, Sezen M, Barut K, Sahin S, Acikel C, Demirkaya E, Kasapcopur O (2017) The performance of classification criteria for juvenile spondyloarthropathies. Rheumatol Int 37:2013–2018. https://doi.org/10.1007/s00296-017-3837-8

    Article  PubMed  Google Scholar 

  3. Burgos-Vargas R, Pacheco-Tena C, Vázquez-Mellado J (2002) The juvenile-onset spondyloarthritides: rationale for clinical evaluation. Best Pract Res Clin Rheumatol 16:551–572. https://doi.org/10.1053/berh.2002.0247

    Article  PubMed  Google Scholar 

  4. Petty RE, Southwood TR, Manners P, Baum J, Glass DN, Goldenberg J, He X, Maldonado-Cocco J, Orozco-Alcala J, Prieur AM, Suarez-Almazor ME, Woo P, International League of Associations for Rheumatology (2004) International League of Associations for Rheumatology classification of juvenile idiopathic arthritis: second revision, Edmonton, 2001. J Rheumatol 31:390–392

    PubMed  Google Scholar 

  5. Dougados M, Van Der Linden S, Juhlin R et al (1991) The European Spondylarthropathy Study Group preliminary criteria for the classification of spondylarthropathy. Arthritis Rheum 34:1218–1227. https://doi.org/10.1002/art.1780341003

    Article  PubMed  CAS  Google Scholar 

  6. Ramanathan A, Srinivasalu H, Colbert RA (2013) Update on juvenile spondyloarthritis. Rheum Dis Clin N Am 39:767–788. https://doi.org/10.1016/j.rdc.2013.06.002

    Article  Google Scholar 

  7. Colbert RA (2010) Classification of juvenile spondyloarthritis: enthesitis-related arthritis and beyond. Nat Rev Rheumatol 6:477–485. https://doi.org/10.1038/nrrheum.2010.103

    Article  PubMed  PubMed Central  Google Scholar 

  8. Damasio MB, Malattia C, Martini A, Tomá P (2010) Synovial and inflammatory diseases in childhood: role of new imaging modalities in the assessment of patients with juvenile idiopathic arthritis. Pediatr Radiol 40:985–998

    Article  Google Scholar 

  9. Martini A, Ravelli A, Avcin T, Beresford MW, Burgos-Vargas R, Cuttica R, Ilowite NT, Khubchandani R, Laxer RM, Lovell DJ, Petty RE, Wallace CA, Wulffraat NM, Pistorio A, Ruperto N, Pediatric Rheumatology International Trials Organization (PRINTO) (2019) Toward new classification criteria for juvenile idiopathic arthritis: first steps, pediatric rheumatology international trials organization international consensus. J Rheumatol 46:190–197. https://doi.org/10.3899/jrheum.180168

    Article  PubMed  Google Scholar 

  10. Weiss PF, Colbert RA (2018) Juvenile spondyloarthritis: a distinct form of juvenile arthritis. Pediatr Clin N Am 65:675–690. https://doi.org/10.1016/j.pcl.2018.03.006

    Article  Google Scholar 

  11. Goirand M, Breton S, Chevallier F, Duong NP, Uettwiller F, Melki I, Mouy R, Wouters C, Bader-Meunier B, Job-Deslandre C, Quartier P (2018) Clinical features of children with enthesitis-related juvenile idiopathic arthritis / juvenile spondyloarthritis followed in a French tertiary care pediatric rheumatology centre. Pediatr Rheumatol 16:21. https://doi.org/10.1186/s12969-018-0238-9

    Article  Google Scholar 

  12. Gmuca S, Weiss PF (2015) Juvenile spondyloarthritis. Curr Opin Rheumatol 27:364–372. https://doi.org/10.1097/BOR.0000000000000185

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  13. Burgos-Vargas R, Clark P (1989) Axial involvement in the seronegative enthesopathy and arthropathy syndrome and its progression to ankylosing spondylitis. J Rheumatol 16:192–197

    PubMed  CAS  Google Scholar 

  14. Pagnini I, Savelli S, Matucci-Cerinic M, Fonda C, Cimaz R, Simonini G (2010) Early predictors of juvenile sacroiliitis in enthesitis-related arthritis. J Rheumatol 37:2395–2401. https://doi.org/10.3899/jrheum.100090

    Article  PubMed  Google Scholar 

  15. Elhai M, Wipff J, Bazeli R et al (2013) Radiological cervical spine involvement in young adults with polyarticular juvenile idiopathic arthritis. Rheumatology 52:267–275. https://doi.org/10.1093/rheumatology/kes054

    Article  PubMed  Google Scholar 

  16. Hofer MF, Cimaz R (2013) Is cervical spine involvement in juvenile polyarthritis under-recognized? Rheumatology 52:221–222

    Article  Google Scholar 

  17. Del Grande M, Del Grande F, Carrino J et al (2014) Cervical spine involvement early in the course of rheumatoid arthritis. Semin Arthritis Rheum 43:738–744. https://doi.org/10.1016/j.semarthrit.2013.12.001

    Article  PubMed  Google Scholar 

  18. Joaquim AF, Appenzeller S (2014) Cervical spine involvement in rheumatoid arthritis - a systematic review. Autoimmun Rev 13:1195–1202. https://doi.org/10.1016/j.autrev.2014.08.014

    Article  PubMed  Google Scholar 

  19. Kim HJ, Nemani VM, Riew KD, Brasington R (2015) Cervical spine disease in rheumatoid arthritis: incidence, manifestations, and therapy. Curr Rheumatol Rep 17:8–12. https://doi.org/10.1007/s11926-014-0486-8

    Article  Google Scholar 

  20. Ključevšek D, Emeršič N, Toplak N, Avčin T (2017) Clinical and MRI outcome of cervical spine lesions in children with juvenile idiopathic arthritis treated with anti-TNFα drugs early in disease course. Pediatr Rheumatol Online J 15:38. https://doi.org/10.1186/s12969-017-0173-1

    Article  PubMed  PubMed Central  Google Scholar 

  21. Beukelman T, Patkar NM, Saag KG, Tolleson-Rinehart S, Cron RQ, DeWitt E, Ilowite NT, Kimura Y, Laxer RM, Lovell DJ, Martini A, Rabinovich CE, Ruperto N (2011) 2011 American College of Rheumatology Recommendations for the treatment of juvenile idiopathic arthritis: initiation and safety monitoring of therapeutic agents for the treatment of arthritis and systemic features. Arthritis Care Res (Hoboken) 63:465–482. https://doi.org/10.1002/acr.20460

    Article  Google Scholar 

  22. Prutki M, Tambic Bukovac L, Jelusic M, Potocki K, Kralik M, Malcic I (2008) Retrospective study of juvenile spondylarthropathies in Croatia over the last 11 years. Clin Exp Rheumatol 26:693–699

    PubMed  CAS  Google Scholar 

  23. Hospach T, Maier J, Müller-Abt P et al (2014) Cervical spine involvement in patients with juvenile idiopathic arthritis - MRI follow-up study. Pediatr Rheumatol Online J 12:1–7. https://doi.org/10.1186/1546-0096-12-9

    Article  Google Scholar 

  24. Neva MH, Myllykangas-Luosujärvi R, Kautiainen H, Kauppi M (2001) Mortality associated with cervical spine disorders: a population-based study of 1666 patients with rheumatoid arthritis who died in Finland in 1989. Rheumatology 40:123–127. https://doi.org/10.1093/rheumatology/40.2.123

    Article  PubMed  CAS  Google Scholar 

  25. Halla JT, Hardin JG, Vitek J, Alarcón GS (1989) Involvement of the cervical spine in rheumatoid arthritis. Arthritis Rheum 32:652–659. https://doi.org/10.1002/anr.1780320522

    Article  PubMed  CAS  Google Scholar 

  26. Weiss PF, Klink AJ, Behrens EM et al (2011) Enthesitis in an inception cohort of enthesitis-related arthritis. Arthritis Care Res (Hoboken) 63:1307–1312. https://doi.org/10.1002/acr.20508

    Article  Google Scholar 

  27. Flatø B, Hoffmann-Vold AM, Reiff A, Førre Ø, Lien G, Vinje O (2006) Long-term outcome and prognostic factors in enthesitis-related arthritis: a case-control study. Arthritis Rheum 54:3573–3582. https://doi.org/10.1002/art.22181

    Article  PubMed  Google Scholar 

  28. Stone M, Warren RW, Bruckel J, Cooper D, Cortinovis D, Inman RD (2005) Juvenile-onset ankylosing spondylitis is associated with worse functional outcomes than adult-onset ankylosing spondylitis. Arthritis Rheum 53:445–451. https://doi.org/10.1002/art.21174

    Article  PubMed  Google Scholar 

  29. Reiter MF, Boden SD (1998) Inflammatory disorders of the cervical spine. Spine (Phila Pa 1976) 23:2755–2766

    Article  CAS  Google Scholar 

  30. Sieper J, Rudwaleit M, Baraliakos X et al (2009) The Assessment of SpondyloArthritis international Society (ASAS) handbook: a guide to assess spondyloarthritis. Ann Rheum Dis 68:1–44. https://doi.org/10.1136/ard.2008.104018

    Article  Google Scholar 

  31. Braun J, Bollow M, Eggens U, König H, Distler A, Sieper J (1994) Use of dynamic magnetic resonance imaging with fast imaging in the detection of early and advanced sacroiliitis in spondylarthropathy patients. Arthritis Rheum 37:1039–1045

    Article  CAS  Google Scholar 

  32. Hemke R, Kuijpers TW, Nusman CM, Schonenberg-Meinema D, van Rossum M, Dolman KM, van den Berg J, Maas M (2015) Contrast-enhanced MRI features in the early diagnosis of juvenile idiopathic arthritis. Eur Radiol 25:3222–3229. https://doi.org/10.1007/s00330-015-3752-x

    Article  PubMed  PubMed Central  Google Scholar 

  33. Nusman CM, Ording Muller L-S, Hemke R et al (2016) 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 43:239–244. https://doi.org/10.3899/jrheum.141276

    Article  PubMed  Google Scholar 

  34. Sheehan NJ (2010) HLA-B27: what’s new? Rheumatology (Oxford) 49:621–631. https://doi.org/10.1093/rheumatology/kep450

    Article  CAS  Google Scholar 

  35. Berntson L, Damgård M, Andersson-Gäre B, Herlin T, Nielsen S, Nordal E, Rygg M, Zak M, Fasth A, Nordic Paediatric Rheumatology Study Group (2008) HLA-B27 predicts a more extended disease with increasing age at onset in boys with juvenile idiopathic arthritis. J Rheumatol 35:2055–2061 https://doi.org/08/13/0913

    PubMed  CAS  Google Scholar 

  36. Harrold LR, Salman C, Shoor S, Curtis JR, Asgari MM, Gelfand JM, Wu JJ, Herrinton LJ (2013) Incidence and prevalence of juvenile idiopathic arthritis among children in a managed care population, 1996-2009. J Rheumatol 40:1218–1225. https://doi.org/10.3899/jrheum.120661

    Article  PubMed  PubMed Central  Google Scholar 

  37. Del Giudice E, Swart JF, Wulffraat NM (2017) Juvenile idiopathic arthritis. In: El Miedany Y (ed) Comorbidity in rheumatic diseases. Springer International Publishing AG, Cham, pp 265–288. https://doi.org/10.1007/978-3-319-59963-2_13

    Chapter  Google Scholar 

  38. Dempster H, Porepa M, Young N, Feldman BM (2001) The clinical meaning of functional outcome scores in children with juvenile arthritis. Arthritis Rheum 44:1768–1774. https://doi.org/10.1002/1529-0131(200108)44:8<1768::AID-ART312>3.0.CO;2-Q

    Article  PubMed  CAS  Google Scholar 

  39. Gardner-Medwin JM, Killeen OG, Ryder CAJ, Bradshaw K, Johnson K (2006) Magnetic resonance imaging identifies features in clinically unaffected knees predicting extension of arthritis in children with monoarthritis. J Rheumatol 33:2337–2343

    PubMed  Google Scholar 

  40. 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 (2011) 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 70:440–446. https://doi.org/10.1136/ard.2009.126862

    Article  PubMed  Google Scholar 

  41. Damasio MB, de Horatio LT, Boavida P, Lambot-Juhan K, Rosendahl K, Tomà P, Muller LO (2013) Imaging in juvenile idiopathic arthritis (JIA): an update with particular emphasis on MRI. Acta Radiol 54:1015–1023. https://doi.org/10.1177/0284185113493777

    Article  PubMed  Google Scholar 

  42. Østergaard M, Edmonds J, Mcqueen F et al (2005) An introduction to the EULAR-OMERACT rheumatoid arthritis MRI reference image atlas. Ann Rheum Dis 64:3–7. https://doi.org/10.1136/ard.2004.031773

    Article  Google Scholar 

  43. McErlane F, Carrasco R, Kearsley-Fleet L, Baildam EM, Wedderburn LR, Foster HE, Ioannou Y, Chieng SEA, Davidson JE, Thomson W, Hyrich KL (2018) Growth patterns in early juvenile idiopathic arthritis: results from the Childhood Arthritis Prospective Study (CAPS). Semin Arthritis Rheum 48:53–60. https://doi.org/10.1016/j.semarthrit.2017.11.002

    Article  PubMed  PubMed Central  Google Scholar 

  44. Smitherman EA, Consolaro A, Morgan EM (2018) Treat to target in juvenile idiopathic arthritis: challenges and opportunities. Curr Treat Options Rheumatol 4:29–43. https://doi.org/10.1007/s40674-018-0090-6

    Article  Google Scholar 

  45. Møller-Bisgaard S, Hørslev-Petersen K, Ejbjerg B, Hetland ML, Ørnbjerg LM, Glinatsi D, Møller J, Boesen M, Christensen R, Stengaard-Pedersen K, Madsen OR, Jensen B, Villadsen JA, Hauge EM, Bennett P, Hendricks O, Asmussen K, Kowalski M, Lindegaard H, Nielsen SM, Bliddal H, Krogh NS, Ellingsen T, Nielsen AH, Balding L, Jurik AG, Thomsen HS, Østergaard M (2019) Effect of magnetic resonance imaging vs conventional treat-to-target strategies on disease activity remission and radiographic progression in rheumatoid arthritis the IMAGINE-RA randomized clinical trial. JAMA - J Am Med Assoc 321:461–472. https://doi.org/10.1001/jama.2018.21362

    Article  Google Scholar 

Download references

Acknowledgements

We thank Pero Hrabač, MD, PhD, for statistical analysis.

Author information

Authors and Affiliations

  1. Department of Paediatric Radiology, Children’s Hospital Zagreb, Klaićeva 16, Zagreb, Croatia

    Ana Tripalo Batoš, Vesna Posarić & Goran Roić

  2. University of Applied Health Sciences, Mlinarska 38, Zagreb, Croatia

    Ana Tripalo Batoš & Goran Roić

  3. School of Medicine, University of Zagreb, Šalata 3, Zagreb, Croatia

    Kristina Potočki, Goran Roić & Alenka Gagro

  4. Department for Diagnostic and Interventional Radiology, University Hospital Centre Zagreb, Kišpatićeva 12, Zagreb, Croatia

    Kristina Potočki

  5. Department of Orthopaedic, Children’s Hospital Zagreb, Klaićeva 16, Zagreb, Croatia

    Matija Žutelija Fattorini

  6. Fattorini Clinic For Paediatric and Adolescent Physical Therapy and Rehabilitation, Zagreb, Croatia

    Matija Žutelija Fattorini

  7. Department of Pulmonology, Allergology, Immunology and Rheumatology, Department of Paediatrics, Children’s Hospital Zagreb, Klaićeva 16, 10000, Zagreb, Croatia

    Alenka Gagro

  8. Faculty of Medicine, Josip Juraj Strossmayerr, Josipa Huttlera 4, University of Osijek, Osijek, Croatia

    Alenka Gagro

Authors
  1. Ana Tripalo Batoš
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kristina Potočki
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Matija Žutelija Fattorini
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Vesna Posarić
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Goran Roić
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Alenka Gagro
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Ana Tripalo Batoš, Kristina Potočki, Matija Žutelija Fattorini, Vesna Posarić, Goran Roić and Alenka Gagro. The first draft of the manuscript was written by Ana Tripalo Batoš and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Alenka Gagro.

Ethics declarations

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of Ethical research committee of Children’s Hospital Zagreb and School of Medicine, University of Zagreb and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tripalo Batoš, A., Potočki, K., Žutelija Fattorini, M. et al. Is axial magnetic resonance imaging useful in early juvenile spondyloarthritis—preliminary report. Clin Rheumatol 39, 3017–3025 (2020). https://doi.org/10.1007/s10067-020-05037-z

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10067-020-05037-z

Keywords

Search

Navigation