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Quantitative Magnetic Resonance Imaging of the Hands and Wrists of Children with Juvenile Rheumatoid Arthritis
T. BRENT GRAHAM, TAL LAOR, and BERNARD J. DARDZINSKI
ABSTRACT. Methods. Ten patients with polyarticular course JRA starting methotrexate (n = 3) or etanercept (n = 7) therapy had MRI with intravenous contrast performed of one hand and wrist at baseline and after 6 weeks and 3 months of pharmacotherapy. Synovial volume was determined for the entire hand and wrist and also for regions. Patients were assessed clinically by the core set of outcome variables for JRA and total hand swelling score, and assessed for clinical improvement based upon change in these variables. Results. Increased synovial volume was observed at entry by MRI in all patients (range 2.4–12.5 cc, median 3.7 cc). Correlation of total synovial volume from MRI with total hand swelling score at each timepoint was good (r = 0.52–0.68). Correlation with other clinical variables was not consistently strong. Patients who improved clinically did not differ from patients who did not improve clinically with respect to change in synovial volume. Conclusion. Determining synovial volume in the hand and wrist in patients with JRA by MRI is feasible and correlates with total hand swelling assessed on physical examination. Inconsistent or poor correlation with other clinical variables and the clinical definition of improvement requires further study. (J Rheumatol 2005;32:1811-20) Key Indexing Terms:
JUVENILE RHEUMATOID ARTHRITIS
From the Department of Pediatrics, Division of Rheumatology; Department of Radiology; and the Imaging Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA. Supported by a Trustees grant from the Cincinnati Children's Hospital Medical Center. T.B. Graham, MD, MS, Department of Pediatrics, Division of Rheumatology; T. Laor, MD, Department of Radiology; B.J. Dardzinski, PhD, Department of Radiology, Imaging Research Center, Cincinnati Children's Hospital Medical Center. Address reprint requests to Dr. T. Brent Graham, Division of Rheumatology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229-3039. E-mail: brent.graham@cchmc.org Accepted for publication April 20, 2005. |