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Significant radiographic progression over time in juvenile idiopathic arthritis

Patients with juvenile idiopathic arthritis experience a significant radiographic progression of disease over time, particularly during the first year of observation, report researchers from Italy.

Assessing normal carpal length in growing children, based on the Poznanski score, has been a useful radiographic way to examine the efficacy of therapy in patients with juvenile idiopathic arthritis (JIA).

In this study, Silvia Magni-Manzoni, MD, Instituto di Ricovero e Cura a Carattere Scientifico Policlinico S. Matteo, Pavia, and colleagues, prospectively examined 94 patients with polyarticular-course JIA to determine the rate of radiologic progression of disease as measured by carpal length and to assess prognostic factors for radiographic progression and damage as well as physical disability. Of the 94 patients, 35 had systemic arthritis, 30 had polyarthritis, 24 had extended olioarthritis, 2 had enthesitis-related arthritis, and 3 had psoriatic arthritis.

Outcomes measured were yearly radiographic progression of disease as measured by carpal length (Poznanski score) and the Childhood Health Assessment Questionnaire (C-HAQ) at the final visit. Mean follow-up was 4.5 years (range, 2 to 13.5 years) from baseline to final radiographic assessment.

Radiographic damage significantly increased over time for all patients, with a mean Poznanski score of -1.2 at baseline to -1.7 at 1 year and -1.9 at the final visit (<i>P</i> < .0001). During the first year of observation, the mean radiographic progression (-0.5) was greater than for any other period during the study (-0.2).

Based on univariate analyses, radiographic progression in the first year correlated the strongest with all 3 outcomes measured: yearly radiographic progression, final Poznanski score, and final C-HAQ score. Logistic regression analysis showed a strong correlation between yearly radiographic progression and degree of joint damage at the final visit (<i>P</i> < .0001) as measured by the Poznanski score, the level of physical disability at final visit (<i>P</i> = .0004) as measured by C-HAQ, and the number of joints with limited range-of-motion (<i>P</i> = .0003).

Overall, the study found that the Poznanski method was a reliable and sensitive way to evaluate progression of radiographic damage in JIA patients, and was simple, quick, reproducible, and required little training to implement. The downside of the method is that it can only be used in patients with disease involving the wrist, and is not reliable for detecting cases of advanced carpo-metacarpal erosions.

The authors conclude that patients with polyarticular-course JIA experience significant radiographic progression over time, particularly during the first year of observation. Based on the ability of the Poznanski score to consistently predict yearly radiographic progression, long-term joint damage, and physical disability, the authors also conclude that "the Poznanski score is a meaningful outcome measure in JIA and that its measurement early in the disease course can help to identify those patients who are at greater risk of joint destruction and poor functional outcome."
Arthritis Rheum. 2003 Dec;48:12:3509-3517. "Prognostic factors for radiographic progression, radiographic damage, and disability in juvenile idiopathic arthritis"

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