Pediatric Radiology

, Volume 36, Issue 8, pp 759–772

A critical appraisal of radiographic scoring systems for assessment of juvenile idiopathic arthritis

Review

Abstract

Assessing structural damage to joints over time is essential for evaluating the effectiveness of therapeutic interventions for patients with inflammatory arthritis. Although radiography is able to quantify joint damage, the changes found with conventional radiography early in the disease course are nonspecific, and late radiographic changes are often irreversible. Although many clinical trials on drug development for children still use radiographic scales as endpoints for the study, more specific therapies have been developed for juvenile idiopathic arthritis (JIA) that would enable imaging to “fine-tune” patients to placement into specific treatment algorithms. As a result, new imaging scales to identify early abnormalities are clearly needed. Many pediatric rheumatology centers around the world persistently apply adult-designed radiographic scoring systems to evaluate the progression of JIA. Few pediatric-targeted radiographic scales are available for assessment of progression of JIA in growing joints, and the clinimetric and psychometric properties of such scales have been poorly investigated. We present a critique to the evaluative, discriminative, and predictive roles of the van der Heijde modification of Sharp’s radiographic method, a scale originally designed to assess damage to joints of adults with rheumatoid arthritis, when it is applied to a pediatric population. We discuss the advantages and drawbacks of this radiographic scoring system for assessing growing joints and the ability of MRI to overcome inadequacies of conventional radiography.

Keywords

Juvenile idiopathic arthritis Scoring system MRI 

References

  1. 1.
    Cassidy JT, Petty RE (1995) Juvenile rheumatoid arthritis. In: Cassidy JT, Petty RE (eds) Textbook of pediatric rheumatology, 3rd edn. Saunders, Philadelphia, pp 133–223Google Scholar
  2. 2.
    Hashkes PJ, Laxer RM (2005) Medical treatment of juvenile idiopathic arthritis. JAMA 294:1671–1684CrossRefPubMedGoogle Scholar
  3. 3.
    Cassidy JT (1993) Juvenile rheumatoid arthritis. In: Kelly WN (ed) Textbook of rheumatology. Saunders, Philadelphia, pp 1189–1208Google Scholar
  4. 4.
    Graham TB, Blebea JS, Gylys-Morin V, et al (1997) Magnetic resonance imaging in juvenile rheumatoid arthritis. Semin Arthritis Rheum 27:161–168CrossRefPubMedGoogle Scholar
  5. 5.
    Belt EA, Kaarela K, Kauppi MJ, et al (1999) Assessment of mutilans-like hand deformities in chronic inflammatory joint diseases. A radiographic study of 52 patients. Ann Rheum Dis 58:250–252PubMedGoogle Scholar
  6. 6.
    Oen K, Reed M, Malleson PN, et al (2003) Radiologic outcome and its relationship to functional disability in juvenile rheumatoid arthritis. J Rheumatol 30:832–840PubMedGoogle Scholar
  7. 7.
    St Clair EW, van der Heijde DM, Smolen JS, et al (2004) Combination of infliximab and methotrexate therapy for early rheumatoid arthritis: a randomized, controlled trial. Arthritis Rheum 50:3432–3443CrossRefPubMedGoogle Scholar
  8. 8.
    Welsing PM, Landewe RB, van Riel PL, et al (2004) The relationship between disease activity and radiologic progression in patients with rheumatoid arthritis: a longitudinal analysis. Arthritis Rheum 50:2082–2093CrossRefPubMedGoogle Scholar
  9. 9.
    Doria AS, de Castro CC, Kiss MH, et al (2003) Inter- and intrareader variability in the interpretation of two radiographic classification systems for juvenile rheumatoid arthritis. Pediatr Radiol 33:673–681CrossRefPubMedGoogle Scholar
  10. 10.
    Pettersson H, Rydholm U (1984) Radiologic classification of knee joint destruction in juvenile chronic arthritis. Pediatr Radiol 14:419–421CrossRefPubMedGoogle Scholar
  11. 11.
    Kirshner B, Guyatt G (1985) A methodological framework for assessing health indices. J Chronic Dis 38:27–36CrossRefPubMedGoogle Scholar
  12. 12.
    van der Heijde DM, van Riel PL, Nuver-Zwart IH, et al (1989) Effects of hydroxychloroquine and sulphasalazine on progression of joint damage in rheumatoid arthritis. Lancet 1:1036–1038PubMedGoogle Scholar
  13. 13.
    Kellgren JH, Jefrey MR, Ball J (1963) Atlas of standard radiographs of arthritis. The epidemiology of chronic rheumatism. Blackwell Scientific Publications, OxfordGoogle Scholar
  14. 14.
    Larsen A, Dale K, Eek M (1977) Radiographic evaluation of rheumatoid arthritis and related conditions by standard reference films. Acta Radiol Diagn 18:481–491Google Scholar
  15. 15.
    Sharp JT, Lidsky MD, Collins LC, et al (1971) Methods of scoring the progression of radiologic changes in rheumatoid arthritis. Correlation of radiologic, clinical and laboratory abnormalities. Arthritis Rheum 14:706–720PubMedCrossRefGoogle Scholar
  16. 16.
    Steinbrocker O, Traeger CH, Batterman RC (1949) Therapeutic criteria in rheumatoid arthritis. JAMA 140:659–662Google Scholar
  17. 17.
    Brook A, Corbett M (1977) Radiographic changes in early rheumatoid disease. Ann Rheum Dis 36:71–73PubMedGoogle Scholar
  18. 18.
    Brook A, Fleming A, Corbett M (1977) Relationship of radiological change to clinical outcome in rheumatoid arthritis. Ann Rheum Dis 36:274–275PubMedGoogle Scholar
  19. 19.
    Regan-Smith MG, O’Connor GT, Kwoh CK, et al (1989) Lack of correlation between the Steinbrocker staging of hand radiographs and the functional health status of individuals with rheumatoid arthritis. Arthritis Rheum 32:128–133PubMedCrossRefGoogle Scholar
  20. 20.
    Kaye JJ, Fuchs HA, Moseley JW, et al (1990) Problems with the Steinbrocker staging system for radiographic assessment of the rheumatoid hand and wrist. Invest Radiol 25:536–544PubMedCrossRefGoogle Scholar
  21. 21.
    Scott DL, Houssien DA, Laasonen L (1995) Proposed modification to Larsen’s scoring methods for hand and wrist radiographs. Br J Rheumatol 34:56PubMedCrossRefGoogle Scholar
  22. 22.
    Sharp JT, Bluhm GB, Brook A, et al (1985) Reproducibility of multiple-observer scoring of radiologic abnormalities in the hands and wrists of patients with rheumatoid arthritis. Arthritis Rheum 28:16–24PubMedCrossRefGoogle Scholar
  23. 23.
    Van der Heijde DM (1999) How to read radiographs according to the Sharp/van der Heijde method. J Rheumatol 26:743–745PubMedGoogle Scholar
  24. 24.
    Scott DL, Coulton BL, Popert AJ (1986) Long-term progression of joint damage in rheumatoid arthritis. Ann Rheum Dis 45:373–378PubMedGoogle Scholar
  25. 25.
    Sharp JT (2000) An overview of radiographic analysis of joint damage in rheumatoid arthritis and its use in metaanalysis. J Rheumatol 27:254–260PubMedGoogle Scholar
  26. 26.
    Van der Heijde DM, van Riel PL, van Leeuwen MA, et al (1992) Prognostic factors for radiographic damage and physical disability in early rheumatoid arthritis. A prospective follow-up study of 147 patients. Br J Rheumatol 31:519–525PubMedCrossRefGoogle Scholar
  27. 27.
    Mottonen TT (1988) Prediction of erosiveness and rate of development of new erosions in early rheumatoid arthritis. Ann Rheum Dis 47:648–653PubMedCrossRefGoogle Scholar
  28. 28.
    Smith HJ (1996) Contrast-enhanced MRI of rheumatic joint disease. Br J Rheumatol 35 [Suppl 3]:45–47PubMedGoogle Scholar
  29. 29.
    Gylys-Morin VM, Graham TB, Blebea JS, et al (2001) Knee in early juvenile rheumatoid arthritis: MR imaging findings. Radiology 220:696–706PubMedCrossRefGoogle Scholar
  30. 30.
    Yulish BS, Lieberman JM, Newman AJ, et al (1987) Juvenile rheumatoid arthritis: assessment with MR imaging. Radiology 165:149–152PubMedGoogle Scholar
  31. 31.
    Disler DG, McCauley TR, Kelman CG, et al (1996) Fat-suppressed three-dimensional spoiled gradient-echo MR imaging of hyaline cartilage defects in the knee: comparison with standard MR imaging and arthroscopy. AJR 167:127–132PubMedGoogle Scholar
  32. 32.
    Hardy PA, Recht MP, Piraino D, et al (1996) Optimization of a dual echo in the steady state (DESS) free-precession sequence for imaging cartilage. J Magn Reson Imaging 6:329–335PubMedCrossRefGoogle Scholar
  33. 33.
    Ruehm S, Zanetti M, Romero J, et al (1998) MRI of patellar articular cartilage: evaluation of an optimized gradient echo sequence (3D-DESS). J Magn Reson Imaging 8:1246–1251PubMedCrossRefGoogle Scholar
  34. 34.
    Reeder SB, Wen Z, Yu H, et al (2004) Multicoil Dixon chemical species separation with an iterative least-squares estimation method. Magn Reson Med 51:35–45CrossRefPubMedGoogle Scholar
  35. 35.
    Duerk JL, Lewin JS, Wendt M, et al (1998) Remember true FISP? A high SNR, near 1-second imaging method for T2-like contrast in interventional MRI at .2 T. J Magn Reson Imaging 8:203–208PubMedCrossRefGoogle Scholar
  36. 36.
    McQueen F, Lassere M, Edmonds J, et al (2003) OMERACT Rheumatoid Arthritis Magnetic Resonance Imaging Studies. Summary of OMERACT 6 MR Imaging Module. J Rheumatol 30:1387–1392PubMedGoogle Scholar
  37. 37.
    Ostergaard M, Klarlund M, Lassere M, et al (2001) Interreader agreement in the assessment of magnetic resonance images of rheumatoid arthritis wrist and finger joints—an international multicenter study. J Rheumatol 28:1143–1150PubMedGoogle Scholar
  38. 38.
    de Carvalho A, Graudal H (1980) Relationship between radiologic and clinical findings in rheumatoid arthritis. Acta Radiol Diagn 21:797–802Google Scholar
  39. 39.
    Fuchs HA, Callahan LF, Kaye JJ, et al (1988) Radiographic and joint count findings of the hand in rheumatoid arthritis. Related and unrelated findings. Arthritis Rheum 31:44–51PubMedCrossRefGoogle Scholar
  40. 40.
    Rau R, Wassenberg S, Herborn G, et al (2001) Identification of radiologic healing phenomena in patients with rheumatoid arthritis. J Rheumatol 28:2608–2615PubMedGoogle Scholar
  41. 41.
    Harcke HT, Mandell GA, Cassell IL (1997) Imaging techniques in childhood arthritis. Rheum Dis Clin North Am 23:523–544CrossRefPubMedGoogle Scholar
  42. 42.
    Petty RE, Southwood TR, Baum J, et al (1998) Revision of the proposed classification criteria for juvenile idiopathic arthritis: Durban, 1997. J Rheumatol 25:1991–1994PubMedGoogle Scholar
  43. 43.
    Kellenberger CJ, Epelman M, Miller SF, et al S (2004) Fast STIR whole-body MR imaging in children. Radiographics 24:1317–1330PubMedCrossRefGoogle Scholar
  44. 44.
    Mazumdar A, Siegel MJ, Narra V, et al (2002) Whole-body fast inversion recovery MR imaging of small cell neoplasms in pediatric patients: a pilot study. AJR 179:1261–1266PubMedGoogle Scholar
  45. 45.
    Stanley PSM (1990) Miscellaneous disorders of the musculoskeletal system. In: Cohen MD, Edwards MK (eds) Magnetic resonance imaging of children, B.C. Decker, Philadelphia, p 944Google Scholar
  46. 46.
    Bird P, Ejbjerg B, McQueen F, et al (2003) OMERACT rheumatoid arthritis magnetic resonance imaging studies. Exercise 5: an international multicenter reliability study using computerized MRI erosion volume measurements. J Rheumatol 30:1380–1384PubMedGoogle Scholar
  47. 47.
    Brower AC (1990) Use of the radiograph to measure the course of rheumatoid arthritis. The gold standard versus fool’s gold. Arthritis Rheum 33:316–324PubMedCrossRefGoogle Scholar
  48. 48.
    Benton N, Stewart N, Crabbe J, et al (2004) MRI of the wrist in early rheumatoid arthritis can be used to predict functional outcome at 6 years. Ann Rheum Dis 63:555–561CrossRefPubMedGoogle Scholar
  49. 49.
    Hoving JL, Buchbinder R, Hall S, et al (2004) A comparison of magnetic resonance imaging, sonography, and radiography of the hand in patients with early rheumatoid arthritis. J Rheumatol 31:663–675PubMedGoogle Scholar
  50. 50.
    Jevtic V, Watt I, Rozman B, et al (1995) Distinctive radiological features of small hand joints in rheumatoid arthritis and seronegative spondyloarthritis demonstrated by contrast-enhanced (Gd-DTPA) magnetic resonance imaging. Skeletal Radiol 24:351–355CrossRefPubMedGoogle Scholar
  51. 51.
    Plant MJ, Saklatvala J, Borg AA, et al (1994) Measurement and prediction of radiological progression in early rheumatoid arthritis. J Rheumatol 21:1808–1813PubMedGoogle Scholar
  52. 52.
    Boers M, Kostense PJ, Verhoeven AC, et al (2001) Inflammation and damage in an individual joint predict further damage in that joint in patients with early rheumatoid arthritis. Arthritis Rheum 44:2242–2246CrossRefPubMedGoogle Scholar
  53. 53.
    Ostergaard M, Gideon P, Henriksen O, et al (1994) Synovial volume—a marker of disease severity in rheumatoid arthritis? Quantification by MRI. Scand J Rheumatol 23:197–202PubMedCrossRefGoogle Scholar
  54. 54.
    Pincus T, Callahan LF, Brooks RH, et al J (1989) Self-report questionnaire scores in rheumatoid arthritis compared with traditional physical, radiographic, and laboratory measures. Ann Intern Med 110:259–266PubMedGoogle Scholar
  55. 55.
    Kirwan J, Byron M, Watt I (2001) The relationship between soft tissue swelling, joint space narrowing and erosive damage in hand X-rays of patients with rheumatoid arthritis. Rheumatology (Oxford) 40:297–301CrossRefGoogle Scholar
  56. 56.
    Lopez-Mendez A, Daniel WW, Reading JC, et al (1993) Radiographic assessment of disease progression in rheumatoid arthritis patients enrolled in the cooperative systematic studies of the rheumatic diseases program randomized clinical trial of methotrexate, auranofin, or a combination of the two. Arthritis Rheum 36:1364–1369PubMedCrossRefGoogle Scholar
  57. 57.
    Gaffney K, Cookson J, Blake D, et al (1995) Quantification of rheumatoid synovitis by magnetic resonance imaging. Arthritis Rheum 38:1610–1617PubMedCrossRefGoogle Scholar
  58. 58.
    Jevtic V, Watt I, Rozman B, et al (1996) Prognostic value of contrast-enhanced Gd-DTPA MRI for development of bone erosive changes in rheumatoid arthritis. Br J Rheumatol 35 [Suppl 3]:26–30PubMedGoogle Scholar
  59. 59.
    Sugimoto H, Takeda A, Kano S (1998) Assessment of disease activity in rheumatoid arthritis using magnetic resonance imaging: quantification of pannus volume in the hands. Br J Rheumatol 37:854–861CrossRefPubMedGoogle Scholar
  60. 60.
    Cassidy JT, Petty RE (1995) Etiology and pathogenesis of rheumatic diseases: basic concepts. Saunders, Philadelphia, pp 16–64Google Scholar
  61. 61.
    Greulich WW, Pyle SI (1959) Radiographic atlas of skeletal development of the hand and wrist. Stanford University Press, Stanford, CaliforniaGoogle Scholar
  62. 62.
    Dawes PT (1988) Radiological assessment of outcome in rheumatoid arthritis. Br J Rheumatol 27 [Suppl 1]:21–36PubMedGoogle Scholar
  63. 63.
    Jeremy R, Schaller J, Arkless R, et al (1968) Juvenile rheumatoid arthritis persisting into adulthood. Am J Med 45:419–434CrossRefPubMedGoogle Scholar
  64. 64.
    Scott DL, Symmons DP, Coulton BL, et al (1987) Long-term outcome of treating rheumatoid arthritis: results after 20 years. Lancet 1:1108–1111CrossRefPubMedGoogle Scholar
  65. 65.
    Unger K, Rahimi F, Bareither D, et al (2000) The relationship between articular cartilage degeneration and bone changes of the first metatarsophalangeal joint. J Foot Ankle Surg 39:24–33PubMedCrossRefGoogle Scholar
  66. 66.
    Preidler KW, Brossmann J, Daenen B, et al (1997) Measurements of cortical thickness in experimentally created endosteal bone lesions: a comparison of radiography, CT, MR imaging, and anatomic sections. AJR 168:1501–1505PubMedGoogle Scholar
  67. 67.
    Ostergaard M, Hansen M, Stoltenberg M, et al (1999) Magnetic resonance imaging-determined synovial membrane volume as a marker of disease activity and a predictor of progressive joint destruction in the wrists of patients with rheumatoid arthritis. Arthritis Rheum 42:918–929CrossRefPubMedGoogle Scholar
  68. 68.
    Ostendorf B, Peters R, Dann P, et al (2001) Magnetic resonance imaging and miniarthroscopy of metacarpophalangeal joints: sensitive detection of morphologic changes in rheumatoid arthritis. Arthritis Rheum 44:2492–2502CrossRefPubMedGoogle Scholar
  69. 69.
    Doria AS, Rebelo MS, Castro CC, et al (2000) Comparative analysis between three-dimensional and bi-dimensional assessment in magnetic resonance imaging. Clinical applications in knees in juvenile rheumatoid arthritis. Radiol Bras 33:129–137Google Scholar
  70. 70.
    Bathon JM, Martin RW, Fleischmann RM, et al (2000) A comparison of etanercept and methotrexate in patients with early rheumatoid arthritis. N Engl J Med 343:1586–1593CrossRefPubMedGoogle Scholar
  71. 71.
    Lipsky PE, van der Heijde DM, St Clair EW, et al (2000) Infliximab and methotrexate in the treatment of rheumatoid arthritis. Anti-Tumor Necrosis Factor Trial in Rheumatoid Arthritis with Concomitant Therapy Study Group. N Engl J Med 343:1594–1602CrossRefPubMedGoogle Scholar
  72. 72.
    Sharp JT (1996) Scoring radiographic abnormalities in rheumatoid arthritis. Radiol Clin N Am 34:233–241PubMedGoogle Scholar
  73. 73.
    McQueen FM, Benton N, Crabbe J, et al (2001) What is the fate of erosions in early rheumatoid arthritis? Tracking individual lesions using X-rays and magnetic resonance imaging over the first two years of disease. Ann Rheum Dis 60:859–868PubMedGoogle Scholar
  74. 74.
    Feinstein AR, Wells CK, Joyce CM, et al (1985) The evaluation of sensibility and the role of patient collaboration in clinimetric indexes. Trans Assoc Am Physicians 98:146–149PubMedGoogle Scholar
  75. 75.
    Frytak J (2000) Measurement. J Rehabil Outcomes Meas 4:15–31Google Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • Andrea S. Doria
    • 1
    • 2
  • Paul S. Babyn
    • 1
    • 2
  • Brian Feldman
    • 3
    • 4
  1. 1.Department of Diagnostic ImagingThe Hospital for Sick ChildrenTorontoCanada
  2. 2.Department of Medical ImagingUniversity of TorontoTorontoCanada
  3. 3.Department of RheumatologyThe Hospital for Sick ChildrenTorontoCanada
  4. 4.Department of Population Health SciencesUniversity of TorontoTorontoCanada

Personalised recommendations