Successful treatment in a child with enthesitis-related arthritis involving the sternoclavicular joint: a case report

Diagnostic accuracy of the American College of Rheumatology-1997, the Systemic Lupus International Collaborating Clinics-2012, and the European League Against Rheumatism-2019 criteria for juvenile systemic lupus erythematosus: A systematic review and network meta-analysis

IMPORTANCE/BACKGROUND

Several diagnostic criteria have been developed to effectively diagnose systemic lupus erythematosus (SLE). Three criteria are most common, namely the American College of Rheumatology (ACR)-1997, the Systemic Lupus International Collaborating Clinics (SLICC)-2012, and the European League Against Rheumatism (EULAR/ACR)-2019. Whether they also apply to juvenile SLE is unclear.

OBJECTIVE

To examine the diagnostic accuracy of ACR-1997, SLICC-2012, and EULAR/ACR-2019 for juvenile SLE.

DATA SOURCES

A comprehensive search of PubMed, Cochrane, and Embase was conducted up to 26 March 2022.

STUDY SELECTION

We included all study designs in which patients had any index tests for ACR-1997, SLICC-2012, or EULAR/ACR-2019; both full-text papers and conference abstracts published in English were used. Exclusion criteria were as follows: (1) case reports; (2) adult subjects; or (3) did not report sufficient information to acquire true positive, false positive, true negative, and false negative values of diagnostic criteria.

DATA EXTRACTION AND SYNTHESIS

Two authors independently screened studies, extracted relevant data, and assessed the risk of bias.

MAIN OUTCOMES AND MEASURES

First, a meta-analysis of the diagnostic accuracy of EULAR/ACR-2019 and a hierarchical summary receiver operating characteristic (HSROC) model was performed to estimate sensitivity and specificity with 95% confidence intervals (CIs). We then carried out a network meta-analysis to compare the performances of these three diagnostic criteria.

RESULTS

In total, 17 relevant studies that included 2339 juvenile SLE patients were eligible to analyze pooled accuracy. In the meta-analysis, 10 studies (1613 cases) reported the diagnostic performance of EULAR/ACR-2019, showing a pooled sensitivity of 0.92 (95% CI, 0.89-0.95), pooled specificity of 0.89 (0.77-0.95), and area under HSROC of 0.96 (0.94-0.97). In the network meta-analysis, the SLICC-2012 (0.94, 0.92-0.96) had the highest sensitivity, followed by EULAR/ACR-2019 (0.93, 0.90-0.95), and ACR-1997 (0.78, 0.72-0.82); the ACR-1997 (0.96, 0.92-0.98) demonstrated the highest specificity. EULAR/ACR-2019 (0.92, 0.87-0.96) and SLICC-2012 (0.92, 0.86-0.96) had the similar specificity.

CONCLUSIONS AND RELEVANCE

We found that the applicability of the new EULAR/ACR-2019 criteria in juvenile SLE is not yet the best diagnostic tool.

TRIAL REGISTRATION

PROSPERO CRD42022321514.

Magnetic resonance imaging findings in the sternoclavicular joint in juvenile idiopathic arthritis and comparison with clinical examination

OBJECTIVE

The sternoclavicular joint (SCJ), an important link between the appendicular and axial skeleton, though involved in 41% of rheumatoid arthritis patients, has not been studied in juvenile idiopathic arthritis (JIA). Hence, this cross-sectional study was done to delineate the magnetic resonance imaging (MRI) findings in SCJ in JIA and compare with the clinical examination to diagnose SCJ arthritis.

METHODS

Of the 116 JIA patients attending the pediatric rheumatology clinic, twenty-one patients (42 SC joints) were evaluated by 1.5 T MRI using the four components of early and late inflammatory changes-synovial hypertrophy, bone marrow edema (BME), cartilage lesions, and bone erosions. Results were compared with clinical assessment of SCJ arthritis.

RESULTS

Of the 42 SCJ evaluated (21/116 patients), MRI changes were seen in 27 SCJs (15 patients, 12.9% of 116 JIA patients). Early MRI changes were seen in 60% of joints found normal on clinical examination, with as much as 1/4th of them revealing late destructive changes. Synovial hypertrophy, BME, cartilage lesions, and bone erosions were seen in 5, 15, 4, and 10 patients, respectively. Sensitivity and specificity of clinical examinations to evaluate SC joint involvement were 55.5% and 53.3%, respectively.

CONCLUSION

MRI evaluation of the SCJ in JIA revealed findings in 15/21 enrolled patients. BME, bone erosions, synovial hypertrophy, and cartilage lesions were seen in 15, 10, 5, and 4 enrolled patients, respectively. Clinical examination was found to be neither sensitive nor specific. Key Points • MRI could delineate both early and late inflammatory changes in SCJ in JIA. BME, bone erosions, synovial hypertrophy, and cartilage lesions were seen in 15, 10, 5, and 4 enrolled patients, respectively. • The frequency of SC joint involvement in JIA was at least 12.9% of patients in our study. • Clinical examination for evaluating SC joint arthritis has low sensitivity (55.5%) and specificity (53.3%).