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Article ; Online: Developing standards for MRI evaluation of joints in children with juvenile idiopathic arthritis utilizing the temporomandibular joint as a model.

Navallas, Maria / Tolend, Mirkamal / Otobo, Tarimobo M / Panwar, Jyoti / Clemente, Emilio J Inarejos / Hemke, Robert / van Rossum, Marion A / Doria, Andrea S

Japanese journal of radiology

2023 Volume 42, Issue 1, Page(s) 56–68

Abstract: The treatment of a patient with juvenile idiopathic arthritis (JIA) is best monitored with standardized and validated tools to measure joint changes over time. Treatment approaches are best indicated if the clinicians are aware of the structural status ... ...

Abstract	The treatment of a patient with juvenile idiopathic arthritis (JIA) is best monitored with standardized and validated tools to measure joint changes over time. Treatment approaches are best indicated if the clinicians are aware of the structural status of the joint at a given time, especially in anatomically deep joints for which clinical assessment is limited. Magnetic resonance imaging (MRI) is of utmost importance for assessment of deep joints and extra-articular soft tissue of the entire body for which ultrasound may be suboptimal. Because the distinction between pathologic and physiologic joint changes on MRI is key for proper diagnosis and treatment of patients with arthropathies, a comprehensive standardized approach is needed to effectively measure outcomes of growing joints of children with JIA. Such an approach is essential for both clinical assessment and to conduct clinical trials in patients with JIA treated in different centers around the world. To meet this need, several international imaging collaborative research groups have been developing MRI scales over the past years, including the MRI in JIA (JAMRI) special interest group within the Outcome Measures in Rheumatology (OMERACT) research network. This manuscript reviews the efforts of the OMERACT JAMRI working group to generate and validate pediatric MRI scoring systems for different joints in children with JIA that can have ubiquitous utilization anywhere in the world. In particular, it describes the different steps of development and validation of an MRI scale using the TMJ as a model.
MeSH term(s)	Humans ; Child ; Arthritis, Juvenile/diagnostic imaging ; Arthritis, Juvenile/drug therapy ; Arthritis, Juvenile/pathology ; Temporomandibular Joint/pathology ; Magnetic Resonance Imaging/methods
Language	English
Publishing date	2023-08-26
Publishing country	Japan
Document type	Journal Article
ZDB-ID	2488907-6
ISSN	1867-108X ; 1867-1071
ISSN (online)	1867-108X
ISSN	1867-1071
DOI	10.1007/s11604-023-01479-y
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Article ; Online: Pediatric joint hypermobility: a diagnostic framework and narrative review.

Tofts, Louise Jane / Simmonds, Jane / Schwartz, Sarah B / Richheimer, Roberto M / O'Connor, Constance / Elias, Ellen / Engelbert, Raoul / Cleary, Katie / Tinkle, Brad T / Kline, Antonie D / Hakim, Alan J / van Rossum, Marion A J / Pacey, Verity

Orphanet journal of rare diseases

2023 Volume 18, Issue 1, Page(s) 104

Abstract: Background: Hypermobile Ehlers-Danlos syndrome (hEDS) and hypermobility spectrum disorders (HSD) are debilitating conditions. Diagnosis is currently clinical in the absence of biomarkers, and criteria developed for adults are difficult to use in ... ...

Abstract	Background: Hypermobile Ehlers-Danlos syndrome (hEDS) and hypermobility spectrum disorders (HSD) are debilitating conditions. Diagnosis is currently clinical in the absence of biomarkers, and criteria developed for adults are difficult to use in children and biologically immature adolescents. Generalized joint hypermobility (GJH) is a prerequisite for hEDS and generalized HSD. Current literature identifies a large proportion of children as hypermobile using a Beighton score ≥ 4 or 5/9, the cut off for GJH in adults. Other phenotypic features from the 2017 hEDS criteria can arise over time. Finally, many comorbidities described in hEDS/HSD are also seen in the general pediatric and adolescent population. Therefore, pediatric specific criteria are needed. The Paediatric Working Group of the International Consortium on EDS and HSD has developed a pediatric diagnostic framework presented here. The work was informed by a review of the published evidence. Observations: The framework has 4 components, GJH, skin and tissue abnormalities, musculoskeletal complications, and core comorbidities. A Beighton score of ≥ 6/9 best identifies children with GJH at 2 standard deviations above average, based on published general population data. Skin and soft tissue changes include soft skin, stretchy skin, atrophic scars, stretch marks, piezogenic papules, and recurrent hernias. Two symptomatic groups were agreed: musculoskeletal and systemic. Emerging comorbid relationships are discussed. The framework generates 8 subgroups, 4 pediatric GJH, and 4 pediatric generalized hypermobility spectrum disorders. hEDS is reserved for biologically mature adolescents who meet the 2017 criteria, which also covers even rarer types of Ehlers-Danlos syndrome at any age. Conclusions: This framework allows hypermobile children to be categorized into a group describing their phenotypic and symptomatic presentation. It clarifies the recommendation that comorbidities should be defined using their current internationally accepted frameworks. This provides a foundation for improving clinical care and research quality in this population.
MeSH term(s)	Adult ; Adolescent ; Humans ; Child ; Joint Instability/diagnosis ; Ehlers-Danlos Syndrome/diagnosis ; Connective Tissue Diseases ; Skin
Language	English
Publishing date	2023-05-04
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2225857-7
ISSN	1750-1172 ; 1750-1172
ISSN (online)	1750-1172
ISSN	1750-1172
DOI	10.1186/s13023-023-02717-2
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Article ; Online: Patterns of clinical joint inflammation in juvenile idiopathic arthritis.

Heckert, Sascha L / Hissink-Muller, Petra C E / van den Berg, J Merlijn / Schonenberg-Meinema, Dieneke / van Suijlekom-Smit, Lisette W A / van Rossum, Marion A J / Koopman, Yvonne / Ten Cate, Rebecca / Brinkman, Danielle M C / Huizinga, Tom W J / Allaart, Cornelia F / Bergstra, Sytske Anne

RMD open

2023 Volume 9, Issue 1

Abstract: Objectives: We studied patterns of joint inflammation in juvenile idiopathic arthritis (JIA) to assess whether joint activity recurs locally in the same joints.: Methods: Joints of 91 patients of the BeSt for Kids study, a treat-to-target trial for ... ...

Abstract	Objectives: We studied patterns of joint inflammation in juvenile idiopathic arthritis (JIA) to assess whether joint activity recurs locally in the same joints. Methods: Joints of 91 patients of the BeSt for Kids study, a treat-to-target trial for children with recent-onset oligoarticular, rheumatoid factor-negative polyarticular and psoriatic JIA, were clinically assessed during 2 years (10 study visits). The association between joint inflammation at baseline and later inflammation in the same joint was assessed using a multilevel mixed-effects logistic regression model at joint level. With a Poisson model, the association between baseline joint inflammation and the number of study visits at which the same joint was recurrently inflamed was tested. Results: Of the 6097 joints studied, 15% (897) was clinically inflamed at baseline. In 42% (377/897) of those joints, inflammation recurred during follow-up. Joint inflammation at baseline was statistically significantly associated with joint inflammation during follow-up in the same joint (OR 3.9, 95% CI 3.5 to 4.4) and specifically with the number of episodes of recurrent joint inflammation (IRR 1.6, 95% CI 1.2 to 2.1). Conclusion: In JIA, joint inflammation has the tendency to recur multiple times in joints that are clinically inflamed at disease onset. This indicates that local factors might play a role in the processes contributing to the occurrence of JIA flares.
MeSH term(s)	Child ; Humans ; Arthritis, Juvenile/complications ; Arthritis, Juvenile/epidemiology ; Inflammation
Language	English
Publishing date	2023-03-16
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2812592-7
ISSN	2056-5933 ; 2056-5933
ISSN (online)	2056-5933
ISSN	2056-5933
DOI	10.1136/rmdopen-2022-002941
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Article ; Online: Significant pain decrease in children with non-systemic Juvenile Idiopathic Arthritis treated to target: results over 24 months of follow up.

Spekking, Katinka / Anink, Janneke / de Boer, Piroska / Bergstra, Sytske Anne / van den Berg, J Merlijn / Schonenberg-Meinema, Dieneke / van Suijlekom-Smit, Lisette W A / van Rossum, Marion A J / Koopman-Keemink, Yvonne / Cate, Rebecca Ten / Allaart, Cornelia F / Brinkman, Daniëlle M C / Muller, Petra C E Hissink

Pediatric rheumatology online journal

2023 Volume 21, Issue 1, Page(s) 90

Abstract: Background: The aim of this study was to compare pain-scores in three targeted treatment-strategies in JIA-patients and to identify characteristics predicting persistent pain.: Methods: In the BeSt-for-Kids-study 92 DMARD-naïve JIA-patients were ... ...

Abstract	Background: The aim of this study was to compare pain-scores in three targeted treatment-strategies in JIA-patients and to identify characteristics predicting persistent pain. Methods: In the BeSt-for-Kids-study 92 DMARD-naïve JIA-patients were randomized in 3 treatment-strategies: 1) initial sequential DMARD-monotherapy 2) initial methotrexate (MTX)/prednisolone-bridging or 3) initial MTX/etanercept. Potential differences in VAS pain scores (0-100 mm) over time between treatment-strategies were compared using linear mixed models with visits clustered within patients. A multivariable model was used to assess the ability of baseline characteristics to predict the chance of high pain-scores during follow-up. Results: Pain-scores over time reduced from mean 55.3 (SD 21.7) to 19.5 (SD 25.3) mm after 24 months. On average, pain-scores decreased significantly with β -1.37 mm (95% CI -1.726; -1.022) per month. No significant difference was found between treatment-strategies (interaction term treatment armtime (months) β (95% CI) arm 1: 0.13 (-0.36; 0.62) and arm 2: 0.37 (-0.12; 0.86) compared to arm 3). Correction for sex and symptom duration yielded similar results. Several baseline characteristics were predictive for pain over time. Higher VAS pain [β 0.44 (95% CI 0.25; 0.65)] and higher active joint count [0.77 (0.19; 1.34)] were predictive of higher pain over time, whereas, low VAS physician [ -0.34 (-0.55; -0.06)], CHQ Physical [ -0.42 (-0.72; -0.11)] and Psychosocial summary Score [ -0.42 (-0.77; -0.06)] were predictive of lower pain. Conclusions:* Treatment-to-target seems effective in pain-reduction in non-systemic JIA-patients irrespective of initial treatment-strategy. Several baseline-predictors for pain over time were found, which could help to identify patients with a high risk for development of chronic pain. Trial registration: Dutch Trial Registry number 1574.
MeSH term(s)	Humans ; Child ; Follow-Up Studies ; Arthritis, Juvenile/complications ; Arthritis, Juvenile/drug therapy ; Chronic Pain ; Antirheumatic Agents/therapeutic use ; Etanercept
Chemical Substances	Antirheumatic Agents ; Etanercept (OP401G7OJC)
Language	English
Publishing date	2023-08-26
Publishing country	England
Document type	Randomized Controlled Trial ; Journal Article
ZDB-ID	2279468-2
ISSN	1546-0096 ; 1546-0096
ISSN (online)	1546-0096
ISSN	1546-0096
DOI	10.1186/s12969-023-00874-z
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Article ; Online: Reliability assessment of the OMERACT whole-body magnetic resonance imaging scoring system for juvenile idiopathic arthritis.

Panwar, Jyoti / Tolend, Mirkamal / Kirkhus, Eva / Meyers, Arthur B / Redd, Bernadette / Sudol-Szopinska, Iwona / Varma, Nisha / Inarejos Clemente, Emilio J / Colbert, Robert A / Akikusa, Jonathan / Appenzeller, Simone / Carrino, John A / Herregods, Nele / Highmore, Kerri / Jans, Lennart / Jaremko, Jacob L / von Kalle, Thekla / van Rossum, Marion A / Rumsey, Dax G /

Srinivasalu, Hemalatha / Stimec, Jennifer / Tse, Shirley M / Twilt, Marinka / Tzaribachev, Nikolay / Doria, Andrea S

Seminars in arthritis and rheumatism

2024 Volume 66, Page(s) 152437

Abstract: Inter-reader reliability of a new scoring system for evaluating joint inflammation and enthesitis in whole body MRI (WBMRI) in juvenile idiopathic arthritis was tested. The scoring system grades 732 item-region combinations of bone marrow and soft tissue ...

Abstract	Inter-reader reliability of a new scoring system for evaluating joint inflammation and enthesitis in whole body MRI (WBMRI) in juvenile idiopathic arthritis was tested. The scoring system grades 732 item-region combinations of bone marrow and soft tissue changes for commonly involved joints and entheseal sites. Five radiologists rated 17 WBMRI scans through an online rating platform. Item-wise reliability was calculated for 117 items with non-zero scores in >10 % of readings. Interquartile ranges of the five-reader Kappa reliability coefficients were 0.58-0.73 (range: 0.36-0.88) for the joints, 0.65-0.81 (range: 0.39-0.95) for the entheses, and 0.62-0.75 (range: 0.60-0.76) for chronic nonbacterial osteomyelitis-like lesions.
Language	English
Publishing date	2024-03-16
Publishing country	United States
Document type	Journal Article
ZDB-ID	120247-9
ISSN	1532-866X ; 0049-0172
ISSN (online)	1532-866X
ISSN	0049-0172
DOI	10.1016/j.semarthrit.2024.152437
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Article ; Online: Pediatric joint hypermobility

Louise Jane Tofts / Jane Simmonds / Sarah B. Schwartz / Roberto M. Richheimer / Constance O’Connor / Ellen Elias / Raoul Engelbert / Katie Cleary / Brad T. Tinkle / Antonie D. Kline / Alan J. Hakim / Marion A. J. van Rossum / Verity Pacey

Orphanet Journal of Rare Diseases, Vol 18, Iss 1, Pp 1-

a diagnostic framework and narrative review

2023 Volume 10

Abstract: Abstract Background Hypermobile Ehlers–Danlos syndrome (hEDS) and hypermobility spectrum disorders (HSD) are debilitating conditions. Diagnosis is currently clinical in the absence of biomarkers, and criteria developed for adults are difficult to use in ... ...

Abstract	Abstract Background Hypermobile Ehlers–Danlos syndrome (hEDS) and hypermobility spectrum disorders (HSD) are debilitating conditions. Diagnosis is currently clinical in the absence of biomarkers, and criteria developed for adults are difficult to use in children and biologically immature adolescents. Generalized joint hypermobility (GJH) is a prerequisite for hEDS and generalized HSD. Current literature identifies a large proportion of children as hypermobile using a Beighton score ≥ 4 or 5/9, the cut off for GJH in adults. Other phenotypic features from the 2017 hEDS criteria can arise over time. Finally, many comorbidities described in hEDS/HSD are also seen in the general pediatric and adolescent population. Therefore, pediatric specific criteria are needed. The Paediatric Working Group of the International Consortium on EDS and HSD has developed a pediatric diagnostic framework presented here. The work was informed by a review of the published evidence. Observations The framework has 4 components, GJH, skin and tissue abnormalities, musculoskeletal complications, and core comorbidities. A Beighton score of ≥ 6/9 best identifies children with GJH at 2 standard deviations above average, based on published general population data. Skin and soft tissue changes include soft skin, stretchy skin, atrophic scars, stretch marks, piezogenic papules, and recurrent hernias. Two symptomatic groups were agreed: musculoskeletal and systemic. Emerging comorbid relationships are discussed. The framework generates 8 subgroups, 4 pediatric GJH, and 4 pediatric generalized hypermobility spectrum disorders. hEDS is reserved for biologically mature adolescents who meet the 2017 criteria, which also covers even rarer types of Ehlers–Danlos syndrome at any age. Conclusions This framework allows hypermobile children to be categorized into a group describing their phenotypic and symptomatic presentation. It clarifies the recommendation that comorbidities should be defined using their current internationally accepted frameworks. This ...
Keywords	Child ; Adolescent ; Joint hypermobility ; Ehlers–Danlos syndrome ; Medicine ; R
Subject code	360
Language	English
Publishing date	2023-05-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
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Article ; Online: Patterns of clinical joint inflammation in juvenile idiopathic arthritis

Danielle M C Brinkman / Dieneke Schonenberg-Meinema / J Merlijn van den Berg / Cornelia F Allaart / Tom W J Huizinga / Sytske Anne Bergstra / Lisette W A Van Suijlekom-Smit / Rebecca ten Cate / Marion A J van Rossum / Sascha L Heckert / Petra C E Hissink-Muller / Yvonne Koopman

RMD Open, Vol 9, Iss

2023 Volume 1

Abstract: Objectives We studied patterns of joint inflammation in juvenile idiopathic arthritis (JIA) to assess whether joint activity recurs locally in the same joints.Methods Joints of 91 patients of the BeSt for Kids study, a treat-to-target trial for children ... ...

Abstract	Objectives We studied patterns of joint inflammation in juvenile idiopathic arthritis (JIA) to assess whether joint activity recurs locally in the same joints.Methods Joints of 91 patients of the BeSt for Kids study, a treat-to-target trial for children with recent-onset oligoarticular, rheumatoid factor-negative polyarticular and psoriatic JIA, were clinically assessed during 2 years (10 study visits). The association between joint inflammation at baseline and later inflammation in the same joint was assessed using a multilevel mixed-effects logistic regression model at joint level. With a Poisson model, the association between baseline joint inflammation and the number of study visits at which the same joint was recurrently inflamed was tested.Results Of the 6097 joints studied, 15% (897) was clinically inflamed at baseline. In 42% (377/897) of those joints, inflammation recurred during follow-up. Joint inflammation at baseline was statistically significantly associated with joint inflammation during follow-up in the same joint (OR 3.9, 95% CI 3.5 to 4.4) and specifically with the number of episodes of recurrent joint inflammation (IRR 1.6, 95% CI 1.2 to 2.1).Conclusion In JIA, joint inflammation has the tendency to recur multiple times in joints that are clinically inflamed at disease onset. This indicates that local factors might play a role in the processes contributing to the occurrence of JIA flares.
Keywords	Medicine ; R
Subject code	796
Language	English
Publishing date	2023-03-01T00:00:00Z
Publisher	BMJ Publishing Group
Document type	Article ; Online
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Article: Determination of Relative Weightings for Sacroiliac Joint Pathologies in the OMERACT Juvenile Arthritis Magnetic Resonance Imaging Sacroiliac Joint Score.

Otobo, Tarimobo M / Tolend, Mirkamal / Meyers, Arthur B / Sudol-Szopinska, Iwona / Joshi, Sayali / Stimec, Jennifer / Herregods, Nele / Jaremko, Jacob L / Tse, Shirley M L / Haroon, Nigil / Moineddin, Rahim / Tzaribachev, Nikolay / Appenzeller, Simone / Znajdek, Michal / Perez, Manuela / Ligha, Aloysius E / Jans, Lennart / Inarejos Clemente, Emilio J / Weiss, Pamela /

Papakonstantinou, Olympia / Kirkhus, Eva / van Rossum, Marion A J / Rumsey, Dax G / Carrino, John / Akikusa, Jonathan D / Conaghan, Philip G / Doria, Andrea S

Journal of clinical medicine

2023 Volume 12, Issue 7

Abstract: This study aims to determine the relative weights (point value) of items of the juvenile idiopathic arthritis magnetic resonance imaging-sacroiliac joint scoring system (JAMRIS-SIJ). An adaptive multicriteria decision analysis was performed using the ... ...

Abstract	This study aims to determine the relative weights (point value) of items of the juvenile idiopathic arthritis magnetic resonance imaging-sacroiliac joint scoring system (JAMRIS-SIJ). An adaptive multicriteria decision analysis was performed using the 1000Minds web application to determine the relative weights of the items in the JAMRIS-SIJ inflammation and damage domains. Experts in imaging and rheumatology independently completed a conjoint analysis survey (CAS) to determine the point value of the measurement items of the JAMRIS-SIJ. Each CAS survey question asked the expert to compare two hypothetical patient profiles, which were otherwise similar but different at two items at a time, and to select which item showed a more severe stage of inflammation or osteochondral damage. In addition, experts ranked 14 JAMRIS-SIJ grade only or image + grade patient vignettes while blinded to the CAS-derived weights. The validity of the weighted JAMRIS-SIJ was tested by comparing the expert CAS-weighted score and the image + grade ranking method. Seventeen experts completed the CAS (11 radiologists and 6 rheumatologists). Considering the point value for inflammation domain items, osteitis (24.7%) and bone marrow edema (24.3%) had higher group-averaged percentage weights compared to inflammation in erosion cavity (16.9%), joint space enhancement (13.1%), joint space fluid (9.1%), capsulitis (7.3%), and enthesitis (4.6%). Similarly, concerning the damage domain, ankylosis (41.3%) and erosion (25.1%) showed higher group-averaged weights compared to backfill (13.9%), sclerosis (10.7%), and fat metaplasia lesion (9.1%). The Spearman correlation coefficients of the CAS-weighted vignette order and unweighted JAMRIS-SIJ grade only order vignettes for all experts were 0.79 for inflammation and 0.80 for damage. The correlations of image vignettes among imaging experts to CAS were 0.75 for inflammation and 0.90 for damage. The multicriteria decision analysis identified differences in relative weights among the JAMRIS-SIJ measurement items. The determination of the relative weights provided expert-driven score scaling and face validity for the JAMRIS-SIJ, enabling the future evaluation of its longitudinal construct validity.
Language	English
Publishing date	2023-04-06
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2662592-1
ISSN	2077-0383
ISSN	2077-0383
DOI	10.3390/jcm12072729
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Article ; Online: Improving domain definition and outcome instrument selection: Lessons learned for OMERACT from imaging.

Seminars in arthritis and rheumatism

2021 Volume 51, Issue 5, Page(s) 1125–1133

Abstract: Objectives: Imaging is one of the most rapidly evolving fields in medicine. Unfortunately, many imaging technologies have been applied as measurement instruments without rigorous evaluation of the evidence supporting their truth, discriminatory ... ...

Abstract	Objectives: Imaging is one of the most rapidly evolving fields in medicine. Unfortunately, many imaging technologies have been applied as measurement instruments without rigorous evaluation of the evidence supporting their truth, discriminatory capability and feasibility for that context of use. The Outcome Measures in Rheumatology (OMERACT) Filter 2.1 Instrument Selection Algorithm (OFISA) is used to evaluate such evidence for use of an instrument in a research setting. The objectives of this work are to: [1] define and describe the key conceptual aspects that are essential for the evaluation of imaging as an outcome measurement instrument and [2] describe how these aspects can be assessed through OFISA. Methods: Experts in imaging and/or methodology met to formalize concepts and define key steps. These concepts were discussed with a team of patient research partners with interest in imaging to refine technical and methodological aspects into comprehensible information. A workshop was held at OMERACT2020 and feedback was incorporated into existing OMERACT process for domain and instrument selection. Results: Three key lessons were identified: (1) a clear definition of the domain we want to measure is a necessary prerequisite to the selection of a good instrument, (2) the sources of variability that can directly influence the instrument should be clearly identified, (3) incorporating these first two lessons into OFISA improves the quality of every instrument selection process. Conclusions: The incorporation of these lessons in the updated OMERACT Filter (now 2.2) will improve the quality of the selection process for all types of outcome measurement instruments.
MeSH term(s)	Diagnostic Imaging ; Humans ; Rheumatology
Language	English
Publishing date	2021-08-20
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	120247-9
ISSN	1532-866X ; 0049-0172
ISSN (online)	1532-866X
ISSN	0049-0172
DOI	10.1016/j.semarthrit.2021.08.004
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Article ; Online: Consensus-driven conceptual development of a standardized whole body-MRI scoring system for assessment of disease activity in juvenile idiopathic arthritis: MRI in JIA OMERACT working group.

Panwar, Jyoti / Tolend, Mirkamal / Redd, Bernadette / Srinivasalu, Hemalatha / Colbert, Robert A / Akikusa, Jonathan / Appenzeller, Simone / Carrino, John A / Herregods, Nele / Jans, Lennart / Highmore, Kerri / von Kalle, Thekla / Kirkhus, Eva / Rumsey, Dax G / Jaremko, Jacob L / Clemente, Inarejos Emilio J / van Rossum, Marion A / Stimec, Jennifer / Tse, Shirley M /

Twilt, Marinka / Tzaribachev, Nikolay / Sudol-Szopinska, Iwona / Meyers, Arthur B / Doria, Andrea S

Seminars in arthritis and rheumatism

2021 Volume 51, Issue 6, Page(s) 1350–1359

Abstract: Objectives: Whole body-MRI is helpful in directing diagnostic and treatment approaches, and as a research outcome measure. We describe our initial consensus-driven phase towards developing a whole body-MRI scoring system for juvenile idiopathic ... ...

Abstract	Objectives: Whole body-MRI is helpful in directing diagnostic and treatment approaches, and as a research outcome measure. We describe our initial consensus-driven phase towards developing a whole body-MRI scoring system for juvenile idiopathic arthritis. Methods: An iterative approach using three rounds of anonymous Delphi surveys followed by a consensus meeting was used to draft the structure of the whole body-MRI scoring system, including the relevant anatomic joints and entheses for assessment, diagnostic item selection, definition and grading, and selection of appropriate MRI planes and sequences. The surveys were completed independently by an international expert group consisting of pediatric radiologists and rheumatologists. Results: Twenty-two experts participated in at least one of three rounds of Delphi surveys and a concluding consensus meeting. A first iteration scoring system was developed which ultimately included the assessment of 100 peripheral, 23 chest, and 76 axial joints, and 64 entheses, with 2-4 diagnostic items graded in each of the items, using binary (presence/absence) and 2-3-level ordinal scores. Recommendations on anatomic MRI planes and sequences were specified as the minimally necessary imaging protocol for the scoring system. Conclusion: A novel whole body-MRI scoring system for juvenile idiopathic arthritis was developed by consensus among members of MRI in JIA OMERACT working group. Further iterative refinements, reliability testing, and responsiveness are warranted in upcoming studies.
MeSH term(s)	Arthritis, Juvenile/diagnostic imaging ; Child ; Consensus ; Humans ; Magnetic Resonance Imaging/methods ; Reproducibility of Results ; Rheumatologists
Language	English
Publishing date	2021-08-15
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Intramural ; Research Support, Non-U.S. Gov't
ZDB-ID	120247-9
ISSN	1532-866X ; 0049-0172
ISSN (online)	1532-866X
ISSN	0049-0172
DOI	10.1016/j.semarthrit.2021.07.017
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