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Radiologic Outcome and Its Relationship to Functional Disability in Juvenile Rheumatoid Arthritis
KIEM OEN, MARTIN REED, PETER N. MALLESON, DAVID A. CABRAL, ROSS E. PETTY, ALAN M. ROSENBERG, and MARY CHEANG
ABSTRACT.
Methods. Selection criteria included a diagnosis of JRA made by 1977 American College of Rheumatology criteria, onset of arthritis ³ 5 years prior to study, current age ³ 8 years, a minimum grade 3 reading ability, and the availability of radiographs. Disability was measured by the Childhood Health Assessment Questionnaire (CHAQ) and Steinbrocker classifications. Radiographs taken within 2 years after onset (early) and the most recent radiographs (late) were examined by a single pediatric radiologist blinded to patients' identities, diagnoses, and outcomes. Multiple regression analyses were performed. Results. On late radiographs the frequencies of joint space narrowing were 38, 14, 43, and 79%, respectively, among patients with systemic, pauciarticular, rheumatoid factor (RF) negative polyarticular, and RF positive polyarticular onset; erosions occurred in 63, 25, 39, and 75%, respectively. Early erosions were most frequent in patients with RF+ polyarticular onset, while both joint space narrowing and erosions occurred early in systemic onset. Radiologic signs of joint damage were most frequent at hips and wrists, while knees and ankles were relatively spared. Based on patients who had radiographs performed within one year of clinical study, 17.7% of the variation in CHAQ score was explained by joint space narrowing, 32.4% by pain, and 5% by a severe rating on physician's global estimate of disease activity. The odds of a Steinbrocker class > I were increased by joint space narrowing, pain, systemic onset, and active joint count. Conclusion. Differences in the frequencies and patterns of joint damage occur both among JRA onset subtypes and among individual joints. Radiographic damage, especially joint space narrowing, correlates with functional disability. However, pain is the major contributor to variation in CHAQ scores. (J Rheumatol 2003;30:832-40) Key Indexing Terms:
JUVENILE RHEUMATOID ARTHRITIS
From the Departments of Pediatrics, Radiology, and Community Health Sciences, University of Manitoba, Winnipeg, Manitoba; the Department of Pediatrics, University of British Columbia, Vancouver, British Columbia; and the Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada. Supported by grants from the Children's Hospital Foundation, Winnipeg, Manitoba; the Health Sciences Centre Foundation; the Winnipeg Foundation; and The Arthritis Society. K. Oen, MD, FRCPC, Professor, Department of Pediatrics; M. Reed, MD, FRCPC, Professor, Department of Radiology; M. Cheang, M Math (Stat), Biostatistical Consultant, Department of Community Health Sciences, University of Manitoba; P.N. Malleson, MBBS, MRCP (UK), FRCPC, Professor; D. Cabral, MBBS, FRCPC, Assistant Clinical Professor; R.E. Petty, MD, PhD, FRCPC, Professor, Department of Pediatrics, University of British Columbia; A.M. Rosenberg MD, FRCPC, Professor, Department of Pediatrics, University of Saskatchewan. Address reprint requests to Dr. K. Oen, RR149 Rehabilitation Centre, Health Sciences Centre, 800 Sherbrook Street, Winnipeg, Manitoba R3A 1M4, Canada. Submitted November 16, 2001; revision accepted September 27, 2002. |