Utilizing ultrasound findings of a single indicator joint to assess non-systemic juvenile idiopathic arthritis

Abstract Background: Musculoskeletal ultrasound (MSUS) has been used worldwide in adult patients with rheumatoid arthritis (RA) but is beginning to play an increasing role in patients with juvenile idiopathic arthritis (JIA). The aim of this study was to investigate the application of MSUS findings of a single indicator joint in JIA to assess the disease activity and classify disease subtype.Methods: Thirty-five non-systemic JIA patients with a total of 62 visits were retrospectively recruited in this study. Among the involved joints, the joint with highest value of grey-scale (GS) plus power Doppler (PD) (=GSPD) was selected as the indicator joint at each visit. The correlations between each MSUS parameter (GS, PD, GSPD) of indicator joints and the Physician Global Assessment (PGA) score, the Childhood Health Assessment Questionnaire‐disability index (CHAQ-DI), and laboratory data were analyzed. The ultrasound features in different subtypes of JIA were also compared.Results: PD was weakly correlated with the PGA score (rho=0.323, p=0.010), while both GS and GSPD were moderately correlated with the PGA score (rho=0.405, p=0.001; rho=0.434, p=0.000). On the other hand, GS, PD, and GSPD were weakly correlated with CHAQ-DI. Although erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) had a weak correlation with PGA, they were not statistically correlated with GS, PD, or GSPD. The proportions of effusion, synovial hypertrophy, and enthesopathy in three different subtypes, showed significant differences (Fisher’s exact test, p=0.037; p=0.004; p=0.019). Enthesopathy was only seen in joints of enthesitis-related arthritis (ERA), but not in joints of polyarthritis and oligoarthritis.Conclusions: MSUS is an acceptable non-invasive tool for the patients with JIA, particularly for those with non-systemic JIA, that might assist disease classification, and whose parameters of the indicator joints may potentially contribute to the evaluation of disease activity.

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A single indicator joint in non-systemic juvenile idiopathic arthritis whose ultrasound scores are correlated with disease activity

10.21203/rs.3.rs-40418/v1 ◽

2020 ◽

Author(s):

Yung-Hsien Huang ◽

Ya-Chiao Hu ◽

Chun-Hua Liao ◽

Bor-Luen Chiang ◽

Cheng‐Hsun Lu ◽

...

Keyword(s):

Juvenile Idiopathic Arthritis ◽

Disease Activity ◽

Power Doppler ◽

Laboratory Data ◽

Health Assessment ◽

Systemic Juvenile Idiopathic Arthritis ◽

Disease Classification ◽

Physician Global Assessment ◽

Single Indicator ◽

Systemic Jia

Abstract Background: Musculoskeletal ultrasound (MSUS) has been used worldwide in adult patients with rheumatoid arthritis (RA) but not in juvenile idiopathic arthritis (JIA). The aim of this study was to investigate the application of MSUS findings of a single indicator joint in JIA to assess the disease activity and classify disease subtype.Methods: Thirty-five non-systemic JIA patients with a total of 62 visits were retrospectively recruited in this study. Among involved joints, the one with highest value of grey scale (GS) plus power Doppler (PD) (=GSPD) was selected as the indicator joint of each visit. The correlations between MSUS parameters of indicator joints and the Physician Global Assessment (PGA) score, The Childhood Health Assessment Questionnaire‐disability index (CHAQ-DI), and laboratory data were analyzed. The ultrasound features in different subtypes of JIA were also compared.Results: PD was weakly correlated with the PGA score (rho=0.323, p=0.010), while both GS and GSPD were moderately correlated with the PGA score (rho=0.405, p=0.001; rho=0.434, p=0.000). On the other hand, GS, PD, and GSPD were weakly correlated with CHAQ-DI. Although erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) had a weak correlation with PGA, they were not statistically correlated with GS, PD, or GSPD. The proportions of effusion, synovial hypertrophy, and enthesopathy in 3 different subtypes, showed significant differences (Fisher’s exact test, p=0.037; p=0.004; p=0.019). Enthesopathy was only seen in joints of enthesitis-related arthritis (ERA) but not in joints of polyarthritis and oligoarthritis.Conclusions: MSUS seems to be an acceptable non-invasive tool for JIA, particularly for non-systemic JIA patients, that could assist disease classification, and whose parameters of the indicator joints may potentially contribute to the disease activity evaluation.

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Utilizing ultrasound findings of a single indicator joint to assess non-systemic juvenile idiopathic arthritis

Pediatric Rheumatology ◽

10.1186/s12969-021-00550-0 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Yung-Hsien Huang ◽

Ya-Chiao Hu ◽

Chun-Hua Liao ◽

Bor-Luen Chiang ◽

Cheng-Hsun Lu ◽

...

Keyword(s):

Juvenile Idiopathic Arthritis ◽

Disease Activity ◽

Power Doppler ◽

Laboratory Data ◽

Health Assessment ◽

Systemic Juvenile Idiopathic Arthritis ◽

Disease Classification ◽

Physician Global Assessment ◽

Single Indicator ◽

Systemic Jia

Abstract Background Musculoskeletal ultrasound (MSUS) has been used worldwide in adult patients with rheumatoid arthritis (RA) but is beginning to play an increasing role in patients with juvenile idiopathic arthritis (JIA). The aim of this study was to investigate the application of MSUS findings of a single indicator joint in JIA to assess the disease activity and classify disease subtype. Methods Thirty-five non-systemic JIA patients with a total of 62 visits were retrospectively recruited in this study. Among the involved joints, the joint with highest value of grey-scale (GS) plus power Doppler (PD) (=GSPD) was selected as the indicator joint at each visit. The correlations between each MSUS parameter (GS, PD, GSPD) of indicator joints and the Physician Global Assessment (PGA) score, the Childhood Health Assessment Questionnaire-disability index (CHAQ-DI), and laboratory data were analyzed. The ultrasound features in different subtypes of JIA were also compared. Results PD was weakly correlated with the PGA score (rho = 0.323, p = 0.010), while both GS and GSPD were moderately correlated with the PGA score (rho = 0.405, p = 0.001; rho = 0.434, p = 0.000). On the other hand, GS, PD, and GSPD were weakly correlated with CHAQ-DI. Although erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) had a weak correlation with PGA, they were not statistically correlated with GS, PD, or GSPD. The proportions of effusion, synovial hypertrophy, and enthesopathy in three different subtypes, showed significant differences (Fisher’s exact test, p = 0.037; p = 0.004; p = 0.019). Enthesopathy was only seen in joints of enthesitis-related arthritis (ERA), but not in joints of polyarthritis and oligoarthritis. Conclusions MSUS is an acceptable non-invasive tool for the patients with JIA, particularly for those with non-systemic JIA, that might assist disease classification, and whose parameters of the indicator joints may potentially contribute to the evaluation of disease activity.

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Evaluation of serum ferritin and its correlation with disease activity in non-systemic juvenile idiopathic arthritis

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20210957 ◽

2021 ◽

Vol 8 (4) ◽

pp. 625

Author(s):

Gargi Das ◽

Sumantra Sarkar ◽

Supratim Datta

Keyword(s):

Juvenile Idiopathic Arthritis ◽

Disease Activity ◽

Serum Ferritin ◽

Health Assessment ◽

Systemic Juvenile Idiopathic Arthritis ◽

Acute Phase Reactant ◽

Initial Visit ◽

Systemic Jia ◽

Active Inflammation ◽

Systemic Arthritis

Background: Serum ferritin is considered as an acute phase reactant that often increases in presence of an active inflammation. Its status as a disease activity marker is well-established in systemic juvenile idiopathic arthritis (JIA), but underexplored in other categories. The objective of this study was to evaluate the relation of serum ferritin with disease activity in non-systemic categories of JIAMethods: A prospective analytical study was carried out involving 46 JIA patients (diagnosed and categorized on the basis of ILAR criteria) with high disease activity based on juvenile arthritis disease activity score27 (JADAS27). childhood health assessment questionnaire (CHAQ), erythrocyte sedimentation rate (ESR), serum ferritin, pain VAS (visual analog scale), parent global VAS, JADAS27 were measured at initial visit, six months and one year.Results: 40 (21 female, 19 male) out of 46 patients completed follow-up of 1 year. Amongst them, 11 patients had systemic arthritis, 10 had oligoarthritis, 11 had RF positive polyarthritis and 8 had RF negative polyarthritis. Their median ages at the initial visit were 7, 6.5, 8 and 7.5 years respectively. Serum ferritin, CRP, ESR, CHAQ score and JADAS decreased over time in all four categories of JIA. Median ESR, ferritin, CHAQ and JADAS27 were higher in systemic JIA compared to other groups in all three visits. Serum ferritin significantly correlated with JADAS27 at all three visits in systemic arthritis; at initial visit in oligoarthritis; at initial visit and 6 months in both RF positive and RF negative polyarthritis.Conclusions: In patients with systemic JIA, serum ferritin showed significant correlation throughout disease course even when the disease activity was low. But in non-systemic categories of JIA serum ferritin had a significant positive correlation with disease activity only when the disease activity was high.

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Investigation of Complement-activating Pattern Recognition Molecules and Associated Enzymes as Possible Inflammatory Markers in Oligoarticular and Systemic Juvenile Idiopathic Arthritis

The Journal of Rheumatology ◽

10.3899/jrheum.141449 ◽

2015 ◽

Vol 42 (7) ◽

pp. 1252-1258 ◽

Cited By ~ 9

Author(s):

Christine Petri ◽

Steffen Thiel ◽

Jens Christian Jensenius ◽

Troels Herlin

Keyword(s):

Pattern Recognition ◽

Juvenile Idiopathic Arthritis ◽

Complement System ◽

Serine Proteases ◽

Inflammatory Markers ◽

Systemic Juvenile Idiopathic Arthritis ◽

Lectin Pathway ◽

Paired Samples ◽

Systemic Jia ◽

The Complement System

Objective.The complement system plays a crucial role in the pathogenesis of inflammatory processes. The lectin pathway of the complement system is activated through the recognition of pathogens by soluble pattern recognition molecules (PRM), i.e., mannan-binding lectin (MBL), collectin-LK, and the ficolins. PRM are reportedly correlated to disease activity in rheumatoid arthritis (RA). The aim was to evaluate the pathogenic role of PRM in juvenile idiopathic arthritis (JIA).Methods.We measured MBL, M-ficolin, H-ficolin, MBL-associated serine proteases (MASP) 1, MASP-2, MASP-3, and 2 alternative splice products, MBL-associated protein (MAp) 44 and MAp19, in plasma and synovial fluid (SF) of children with persistent oligoarticular (n = 109 in plasma, n = 38 in SF) and systemic JIA (n = 19 in plasma, n = 11 in SF). The concentrations of the proteins were measured by in-house time-resolved immunofluorometric assays.Results.We observed significantly higher levels of M-ficolin, MASP-1, MASP-2, and MASP-3 in plasma and SF from patients with systemic JIA compared with persistent oligoarticular JIA (p < 0.001). In paired samples of plasma and SF from 47 patients with oligoarticular and systemic JIA, we observed higher concentrations in plasma for both subtypes for 7 of the measured proteins while the reverse relationship was observed for MASP-3. M-ficolin and MASP-2 correlated to erythrocyte sedimentation rate, C-reactive protein, white blood cell count, and platelet count (p < 0.001). M-ficolin was in addition related to the number of active joints and inversely related to hemoglobin levels.Conclusion.Our results point to plasma M-ficolin and MASP-2 as inflammatory markers in JIA. The levels of all proteins are higher in plasma than in SF, except for MASP-3, indicating that MASP-3 may be produced locally in joints.

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Distribution of circulating cells in systemic juvenile idiopathic arthritis across disease activity states

Clinical Immunology ◽

10.1016/j.clim.2009.09.010 ◽

2010 ◽

Vol 134 (2) ◽

pp. 206-216 ◽

Cited By ~ 49

Author(s):

Claudia Macaubas ◽

Khoa Nguyen ◽

Chetan Deshpande ◽

Carolyn Phillips ◽

Ariana Peck ◽

...

Keyword(s):

Juvenile Idiopathic Arthritis ◽

Disease Activity ◽

Systemic Juvenile Idiopathic Arthritis ◽

Circulating Cells

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P05 A national survey of clinical practice of corticosteroid use in newly diagnosed or flaring cases of juvenile idiopathic arthritis across the UK

Rheumatology ◽

10.1093/rheumatology/kez415.002 ◽

2019 ◽

Vol 58 (Supplement_4) ◽

Author(s):

Ashley Jones ◽

Dannii Clayton ◽

Gloria Nkhoma ◽

Frances Sherratt ◽

Matthew Peak ◽

...

Keyword(s):

Juvenile Idiopathic Arthritis ◽

Clinical Practice ◽

Disease Activity ◽

National Survey ◽

Conflicts Of Interest ◽

Newly Diagnosed ◽

Rapid Induction ◽

Systemic Jia ◽

Induction Regimen ◽

The Uk

Abstract Background Background Corticosteroids (CS) are widely used for rapid-action or induction treatment in children and young people (CYP) with juvenile idiopathic arthritis (JIA). Given a lack of evidence base on CS induction regimen for CYP with JIA, and since criteria for choosing CS are based on healthcare professional (HCP) preference, further research is needed (1). Methods A national electronic survey was undertaken among HCPs across the UK as part of the Steroid Induction Regimen for Juvenile Idiopathic Arthritis (SIRJIA) study. We aimed to establish the opinions of HCPs current practice regarding the clinical criteria for commencing CS treatment Results A total of 39 (24%) responses were received from 162 HCPs. These included 22 (56%) NHS consultants, five (13%) grid trainees, eight (21%) clinical nurse specialists and four other HCPs (10%). The most common treatments newly diagnosed JIA or a disease flare were intra-articular IACS or a combination of DMARDs and IAS (except for systemic JIA and oligoarticular JIA). The majority of HCPs 17 would treat new and flaring CYP the same with 53% choosing a different regime or not answering. The key criteria HCPs used for commencing CS and choosing route of administration were rapid induction of remission (31 (89%)), high disease activity (31 (89%)), severity of systemic JIA (30 (86%)) and level of inflammation (28 (80%)), see Table 1. The main determinants of route of administration was disease severity disease subtype. The majority of HCPs (52-72%) would consider entering CYP with JIA into a trial randomising to modes of administration. P14 Table 1 Reasons of CS Choice Number N = 39 Percentage % High Disease Activity 35 89.7 Rapid induction of remission 34 87.18 Severity of Systemic JIA 34 87.18 Level of inflammation 32 82.5 Severe Uveitis 30 76.92 JIA subtype 27 68.21 Targeting Specific Joints 26 66.67 Level of Disability 18 46.15 Level of pain 16 41.03 Long-standing Disease 11 28.1 Patient reluctance to take DMARDS 8 20.5 Conclusion The results from this national survey of clinical practice showed varying practices in the management of new CYP with JIA and those that are flaring. The majority of HCPs who completed this survey, indicated that they would be prepared to consider entering CYP into a trial that randomised to the four CS delivery methods. Conflicts of Interest The authors declare no conflicts of interest.

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Clinical and associated inflammatory biomarker features predictive of short-term outcomes in non-systemic juvenile idiopathic arthritis

Rheumatology ◽

10.1093/rheumatology/kez615 ◽

2020 ◽

Vol 59 (9) ◽

pp. 2402-2411 ◽

Cited By ~ 1

Author(s):

Elham Rezaei ◽

Daniel Hogan ◽

Brett Trost ◽

Anthony J Kusalik ◽

Gilles Boire ◽

...

Keyword(s):

Disease Activity ◽

Clinical Features ◽

Global Assessment ◽

Systemic Juvenile Idiopathic Arthritis ◽

Area Under The Curve ◽

Inactive Disease ◽

Physician Global Assessment ◽

Active Joint ◽

Short Term ◽

Prospective Longitudinal

Abstract Objective To identify early predictors of disease activity at 18 months in JIA using clinical and biomarker profiling. Methods Clinical and biomarker data were collected at JIA diagnosis in a prospective longitudinal inception cohort of 82 children with non-systemic JIA, and their ability to predict an active joint count of 0, a physician global assessment of disease activity of ≤1 cm, and inactive disease by Wallace 2004 criteria 18 months later was assessed. Correlation-based feature selection and ReliefF were used to shortlist predictors and random forest models were trained to predict outcomes. Results From the original 112 features, 13 effectively predicted 18-month outcomes. They included age, number of active/effused joints, wrist, ankle and/or knee involvement, ESR, ANA positivity and plasma levels of five inflammatory biomarkers (IL-10, IL-17, IL-12p70, soluble low-density lipoprotein receptor-related protein 1 and vitamin D), at enrolment. The clinical plus biomarker panel predicted active joint count = 0, physician global assessment ≤ 1, and inactive disease after 18 months with 0.79, 0.80 and 0.83 accuracy and 0.84, 0.83, 0.88 area under the curve, respectively. Using clinical features alone resulted in 0.75, 0.72 and 0.80 accuracy, and area under the curve values of 0.81, 0.78 and 0.83, respectively. Conclusion A panel of five plasma biomarkers combined with clinical features at the time of diagnosis more accurately predicted short-term disease activity in JIA than clinical characteristics alone. If validated in external cohorts, such a panel may guide more rationally conceived, biologically based, personalized treatment strategies in early JIA.

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Outcome in juvenile idiopathic arthritis: a population-based study from Sweden

Arthritis Research & Therapy ◽

10.1186/s13075-019-1994-8 ◽

2019 ◽

Vol 21 (1) ◽

Cited By ~ 5

Author(s):

Elisabet Berthold ◽

Bengt Månsson ◽

Robin Kahn

Keyword(s):

Juvenile Idiopathic Arthritis ◽

Disease Activity ◽

Orthopedic Surgery ◽

Population Based ◽

Annual Incidence ◽

Common Disease ◽

Necrosis Factor Alpha ◽

Systemic Jia ◽

Record Review

Abstract Background As the treatment arsenal for children with juvenile idiopathic arthritis (JIA) has expanded during the last decades, follow-up studies are needed on children diagnosed in the era of biological treatment to evaluate if this has improved the outcome. Our aim was to study the epidemiology and outcome of JIA in southern Sweden using a population-based cohort of children with a validated diagnosis of JIA collected over 9 years. Methods Potential cases of JIA between 2002 and 2010 were collected after a database search, using the ICD codes M08-M09. The study area was Skåne, the southernmost county of Sweden (population 1.24 million; 17.6% aged < 16 years). The JIA diagnosis was validated and subcategorized through medical record review based on the criteria defined by the International League of Associations for Rheumatism (ILAR). Parameters on disease activity and pharmacologic treatment were recorded annually until the end of the study period (December 31, 2015). Results In total, 251 cases of JIA were confirmed. The mean annual incidence rate for JIA was estimated to be 12.8/100,000 children < 16 years, with the highest age-specific annual incidence at the age of 2 years (36/100,000). Oligoarthritis was the largest subgroup (44.7%), and systemic JIA was the smallest subgroup (2.8%). Methotrexate was the most common disease-modifying anti-rheumatic drug prescribed (60.6%). Tumor necrosis factor alpha inhibitors were used as treatment for 23.9% of the children. Only 40.0% of the follow-up years, with a median follow-up time of 8 years, were free of arthritis or uveitis. Uveitis occurred in 10.8% of the children (8.0% chronic uveitis), and the need for joint corrective orthopedic surgery was 9.2%. Conclusions The incidence of JIA in this well-defined, population-based cohort is slightly lower than in previously published studies from Scandinavia. The need for orthopedic surgery and the presence of uveitis are diminished compared to studies with patients diagnosed more than 20 years ago. Children with JIA however still experience disease activity more than 50% of the time. In conclusion, we still have long-term challenges in the care for children with JIA, in spite of state-of-the-art treatment.

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