Abstract：Objective To explore the characteristic manifestations of magnetic resonance imaging (MRI) in patients with juvenile idiopathic arthritis (JIA) , and to explore its significance in clinical diagnosis and treatment of JIA. Methods The children patients who were diagnosed as JIA in our hospital from December 2012 to February 2017 were enrolled in the study, including 47 cases of systemic onset JIA, 25 cases of polyarticular JIA, 13 cases of pauciarticular JIA, 11 cases of enthesitis related arthritis and 1 case of psoriatic JIA. The serum levels of C reactive protein (CRP) , erythrocyte sedimentation rate (ESR) , rheumatoid factor (RF) , antistreptolysin-O (ASO) and antinuclear antibody (ANA) were detected. The followup examination of the knee joint by MRI and MRI scores of the severe side of knee joint were performed before treatment, at3 m, 6 m, 1 y, 2 y after treatment. Then the patients were divided into three grades according to the prognosis after treatment:complete remission (CR) , partial remission (PR) and non-remission. In this follow-up study, there were 71 cases of CR, 19 cases of PR and 7 cases of non-remission. MRI scores in different outcomes were analyzed and compared. Results There were47 cases of systemic onset JIA, among them, 45 cases with fever being the first symptom, 39 cases with arthritis, and 12 cases with liver or spleen enlargement and 7 cases with morning stiffness. There were 25 cases of polyarticular JIA, among them, 23 with fever being the first symptom, 13 cases with arthritis, 9 cases with liver or spleen enlargement and 20 cases with morning stiffness. There were 13 cases of pauciarticular JIA, among them, 7 cases with fever being the first symptom, 5 cases with arthritis, 4 cases with liver or spleen enlargement and 6 cases with morning stiffness. There were 11 cases of enthesitis related arthritis, among them, 9 with fever being the first symptom, 3 cases with arthritis, 3 cases with liver or spleen enlargement and 5 cases with morning stiffness. The levels of CRP and ESR were increased in the early stage, and MRI scores were increased. The levels of CRP and ESR were decreased to normal range after 3-month treatment, however, MRI scores showed there was no significant change of disease condition. Moreover the levels of CRP and ESR were decreased to normal range after 1-year and2-year treatm ent, and M R I score show ed good prognosis of knee joint. The differences of MRI scores were significant in CR patients during follow-up (P <0. 0 5) , however, the differences of MRI were not significant in PR patients and non-remission patients (P > 0. 05) . Conclusion MRI can accurately assess the involvement range and invasion degree of JIA lesions, which can provide important references for the follow-up of patients with JIA after treatment.

　　Keyword：juvenile idiopathic arthritis; prognosis; follow up; MRI scoring;

　　幼年特发性关节炎 (juvenile idiopathic arthritis, JIA) 是儿童时期的慢性全身免疫性疾病, 主要以关节滑膜炎为主要特征, 最终引起关节损伤和功能丧失[1]。国际风湿病学联盟儿科常委专家组 (ILAR) 将JIA分为全身型、少关节型、多关节型 (RF阴性) 、多关节型 (RF阳性) 、银屑病型、附着点相关型和未分化型, JIA无特征性临床表现, 亦无特征性的实验室指标, 因此, 该病的诊断具有较大的困难[2,3]。关节核磁共振成像 (MRI) 是目前对JIA诊断和治疗最佳的方法, 尤其是对滑膜增生及软骨损伤具有较高的灵敏度[4]。在疾病的活动期或缓解期, 较之各项炎症指标更为敏感, 对治疗方案更具有指导价值。JIA常常表现为多个关节受累, 其中膝关节是最常见的受累关节, 本研究通过观察JIA患儿治疗前后的膝关节MRI变化, 了解MRI在JIA患儿诊疗和随访过程中的意义。
　　1、资料与方法

　　1.1、一般资料

　　收集2012年12月至2017年2月经本院儿科诊治的JIA患儿97例, 其中男51例, 女46例;年龄3~13岁, 平均年龄 (9.8±1.2) 岁。本研究对象中全身型共47例、多关节型25例、少关节型13例、附着点相关炎性11例和银屑病型1例。

　　1.2、方法

　　1.2.1、观察指标:

　　所有患儿测定C-反应蛋白 (CRP) 、血沉 (ESR) 、类风湿因子 (RF) 、ASO和抗核抗体 (ANA) 检查。JIA诊断标准按照ILAR标准[5], 并排除肿瘤、感染或其他风湿性疾病, 所有患者治疗前及治疗后3个月、半年、1年及2年进行膝关节MRI随访观察, 将治疗后转归情况分为3级:完全缓解 (CR) 、部分缓解 (PR) 和未缓解, 本研究随访中CR 71例, PR 19例和未缓解7例。

　　1.2.2、JIA活动性评估:

　　采用美国风湿病学会ACR评分, 包括6项指标: (1) 关节炎数目; (2) 活动受限关节数目; (3) 医师评价 (VAS视觉模拟评分法) ; (4) 父母评价; (5) 患儿生活质量评价 (采用儿童健康评价量表) ; (6) ESR。30%好转被定义为3项以上超过30%好转, 并且≤1项出现恶化, 以此类推50%, 70%好转的定义。疾病非活动状态定义为: (1) 关节无肿痛; (2) 无发热、皮疹、浆膜炎、脾肿大或淋巴结肿大; (3) 无活动性色素膜炎; (4) ESR和CRP正常 (本研究中正常值为ESR≤20 mm/h, CRP≤8 mg/L) ; (5) 医师评价无活动性病变。完全缓解是患儿保持非活动状态连续6个月以上;部分缓解指符合ACR 30%、50%、70%好转标准, 而又未达到临床缓解的患者;未缓解指经过治疗后未达到30%的好转。

　　1.2.3、MRI检查设备:

　　采用西门子1.5TMRI磁共振扫描仪对疼痛较重侧膝关节进行MRI扫描, 采用膝关节线圈, 进行矢状位T1WI、T2WI, 矢状位抑脂T2WI、冠状面抑脂T2WI、横断面抑脂T2WI序列扫描。见表1。
表1 膝关节MRI扫描参数

 

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