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Pediatric Rheumatology

Open Access

Joint inflammation assessed by physical examination and MRI of the knee in juvenile idiopathic arthritis: low predictive value for synovitis

  • Charlotte M Nusman1, 2,
  • Robert Hemke1,
  • Dieneke Schonenberg3,
  • Koert Dolman4,
  • Marion van Rossum5, 6,
  • Merlijn van den Berg3,
  • Mario Maas1 and
  • Taco Kuijpers3
Pediatric Rheumatology201412(Suppl 1):P2

Published: 17 September 2014


Physical ExaminationDiagnostic AccuracyClinical AssessmentJuvenile Idiopathic ArthritisSynovitis


The presence of joint inflammation in juvenile idiopathic arthritis (JIA) patients can be made by physical examination and confirmed by imaging. The discrepancy between physical examination and MRI for evaluation of synovitis in a target joint is possibly explained by the fact that clinical measures mostly reflect overall disease activity instead of measures specific for the joint imaged by MRI.


To compare clinical disease activity of the major target joint upon physical examination with a validated MRI score for the knee in JIA.


MRI datasets and corresponding clinical parameters of disease activity of the knee were analyzed in 167 JIA patients (61.7% female, mean age 12.8 years, SD 3.4 years). Local physical examination of the knee included absence or presence of swelling, warmth, pain or limitation-of-motion (LOM) as assessed by experienced pediatric rheumatologists. A blinded radiologist (6 years of experience in MRI in JIA) analyzed synovial hypertrophy (SH) on a scale from 0-12 on all MRI datasets following the validated Juvenile Arthritis MRI Scoring system (JAMRIS). SH was ‘present’ when the total JAMRIS score was >2. Diagnostic accuracy of the local physical examination parameters for detection of arthritis was determined with MRI as reference standard.


Sensitivity and specificity of the parameters scored by local physical examination compared with MRI varied from 39-71%. The overall positive predictive value for synovitis was very low (21-28%), while the negative predictive value was relatively good (71-74%). Median time between the clinical assessment and the MRI was 38 days (IQR 28-53 days). Subgroup analysis on 51 patients with <31 days (median 25 days) between clinical assessment and MRI did not improve the diagnostic accuracy.


The presence of swelling, warmth, pain or LOM on physical examination did not predict the presence of synovitis upon MRI. The time between clinical assessment and MRI appeared to have no influence on the diagnostic accuracy of the physical examination inflammation parameters. While the discrepancy between physical examination and MRI persists, follow-up studies are warranted to unravel the difficulties in assessment of disease activity.

Disclosure of interest

None declared.

Authors’ Affiliations

Radiology, Academic Medical Center, Netherlands
Pediatric Hematology, Immunology, Rheumatology and Infectious Diseases, Emma Children's Hospital, AMC, Netherlands
Pediatric Hematology, Immunology, Rheumatology and Infectious Disease, Emma Children's Hospital AMC, Netherlands
Pediatrics, Sint Lucas Andreas Hospital, Netherlands
Pediatric Rheumatology, Reade Institute, location Jan van Breemen, Netherlands
Pediatrics, Emma Children's Hospital AMC, Amsterdam, Netherlands


© Nusman et al; licensee BioMed Central Ltd. 2014

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.