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Rheumatology Advance Access originally published online on December 7, 2006
Rheumatology 2007 46(4):699-702; doi:10.1093/rheumatology/kel401
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© The Author 2006. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Clinical assessment and core outcome variables are poor predictors of hip arthritis diagnosed by MRI in juvenile idiopathic arthritis

K. Nistala, J. Babar, K. Johnson, P. Campbell-Stokes, K. Foster, C. Ryder and J. E. McDonagh1

Birmingham Children's Hospital and 1Institute of Child Health, Diana, Princess of Wales Children's Hospital, Steelhouse Lane, Birmingham B4 6NH, UK.

Correspondence to: K. Nistala, Paediatric Rheumatology Department, Birmingham Children's Hospital, Steelhouse Lane, Birmingham B4 6NH, UK. E-mail: K.Nistala{at}ich.ucl.ac.uk


  Abstract

Objectives. To compare the diagnostic performance of clinical assessment against magnetic resonance imaging (MRI) diagnosed hip arthritis in a juvenile idiopathic arthritis (JIA) population. To determine the clinical and serological predictors of MRI diagnosed hip arthritis.

Methods. A total of 34 JIA patients with established disease (mean disease duration 6.3 yrs) had their hip MRIs scored for features of active hip arthritis and hip damage. Results were compared with clinical variables (disease subtype, history of hip pain, core outcome variables (COV)) and the clinician's assessment of active hip arthritis.

Results. MRI features of active hip arthritis were found in 45 hips (70%) and hip damage in 36 hips (56%). Clinical assessment had fair agreement with MRI scoring of active arthritis in patients with disease duration <4 yrs ({kappa} score 0.38, P = 0.045). Clinical assessment had a sensitivity of 25.7% and specificity of 91% for detecting MRI diagnosed arthritis. Of the core outcome variables only erythrocyte sedimentation rate predicted inflammation detected on MRI (r = 0.44, P = 0.014).

Conclusions. The association between the clinician's assessment, core outcome variables and MRI findings in this study was limited. This indicates that clinical and laboratory findings are inadequate diagnostic tools for the assessment of hip arthritis when compared with MRI as the gold standard.

KEY WORDS: Coxitis, Magnetic resonance imaging, Juvenile idiopathic arthritis, Hip joint, Clinical examination

Submitted 30 March 2006; revised version accepted 27 October 2006.
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