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Development and preliminary validation of a paediatric-targeted MRI scoring system for the assessment of disease activity and damage in juvenile idiopathic arthritis
  1. Clara Malattia1,
  2. Maria Beatrice Damasio2,
  3. Angela Pistorio3,
  4. Maka Ioseliani1,
  5. Iris Vilca1,
  6. Maura Valle2,
  7. Nicolino Ruperto1,
  8. Stefania Viola1,
  9. Antonella Buoncompagni1,
  10. Gian Michele Magnano2,
  11. Angelo Ravelli1,4,
  12. Paolo Tomà2,
  13. Alberto Martini1,4
  1. 1Pediatria II, Istituto G Gaslini, Genova, Italy
  2. 2UO di Radiologia, Istituto G Gaslini, Genova, Italy
  3. 3Servizio di Epidemiologia e Biostatistica, Istituto G Gaslini, Genova, Italy
  4. 4Pediatria II and Dipartimento di Pediatria, Istituto G. Gaslini, Università di Genova Genova, Italy
  1. Correspondence to Dr Clara Malattia, Pediatria II, irccs G Gaslini, Largo G Gaslini 5, 16147 Genova, Italy; claramalattia{at}


Objectives To develop and validate a paediatric-targeted MRI scoring system for the assessment of disease activity and damage in juvenile idiopathic arthritis (JIA). To compare the paediatric MRI score with the adult-designed. Outcome Measures in Rheumatology Clinical Trials—Rheumatoid Arthritis MRI Score (RAMRIS), whose suitability for assessing growing joints was tested.

Methods In 66 patients with JIA the clinically more affected wrist was studied. Thirty-nine patients had a 1-year MRI follow-up. Two readers independently assigned the paediatric score and the RAMRIS to all studies. Validation procedures included analysis of reliability, construct validity and responsiveness to change. A reduced version of the bone erosion score was also developed and tested.

Results The paediatric score showed an excellent reproducibility (interclass correlation coefficient >0.9). The interobserver agreement of RAMRIS was moderate for bone erosions and excellent for bone marrow oedema (BMO). The paediatric score and RAMRIS provided similar results for construct validity. The responsiveness to change of the paediatric score was moderate for synovitis and bone erosion, and poor for BMO and did not improve when RAMRIS was applied. The reduced version of the bone erosion was valuable for the assessment of joint damage, and provided time-saving advantages.

Conclusion The results demonstrate that the paediatric MRI score is a reliable and valid method for assessing disease activity and damage in JIA. Unexpectedly, the RAMRIS provides acceptable suitability for use in the paediatric age group. Further work, especially in a longitudinal setting, is required before defining the most suitable MRI scale for assessing growing joints.

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  • CM and MBD contributed equally to this article.

  • Funding This study was supported by a grant from the European Union, Health-e-Child Integrated Project (IST-2004-027749). IV and MI were recipients of the European League Against Rheumatism (EULAR) scientific training bursaries.

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval This study was conducted with the approval of the local ethics committee of the Istituto G Gaslini, Genova, Italy.

  • Provenance and peer review Not commissioned; externally peer reviewed.