Advanced Bone Age in the Affected Side is Associated with Greater Radiographic Progression in Patients w/ JIA & Unilateral Wrist Disease

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Presentation Number:904

Poster Board Number:136

Presentation Time:11/9/2007 8:00:00 AM

Title:Advanced Bone Age in the Affected Side is Associated with Greater

Radiographic Progression in Patients with Juvenile Idiopathic Arthritis and

Unilateral Wrist Disease

Category:11. Pediatric rheumatology clinical and therapeutic disease

Author(s):Nicola Ullmann1, Clara Malattia1, Silvia Magni-Manzoni2,

Alessandro Consolaro1, o Gastaldi1, Mohamad Maghnie1, Natasha Di

Iorgi1, Michela Mocchi1, Giovanni Filocamo1, Cristina Ferrari1, Alberto

i3, Angelo Ravelli4. 1IRCCS G Gaslini, Genova, Italy; 2IRCCS

Policlinico San Matteo, Pavia, Italy; 3IRCCS G Gaslini and Università di

Genova, Genova, Italy; 4IRCCS G Gaslini and Unversità di Genova, Genova,

Italy

Objective. To verify our clinical impression that JIA patients with

unilateral wrist disease often have an advanced bone age in the affected

side and that advancement in skeletal maturation is associated with more

severe radiographic progression.

Methods. 21 patients with unilateral wrist disease and 21 patients with

bilateral wrist disease who underwent a bilateral hand/wrist radiograph were

evaluated. Bone age in each wrist was assessed on radiograph made at first

observation by an experienced pediatric endocrinologist according to

Greulich & Pyle atlas. Radiographic damage was assessed at baseline and last

follow-up visit by measuring carpo-metacarpal ratio (Poznanski score). The

lower the Poznanski score is the more severe the radiographic damage.

Results. Bone age in affected side was advanced by > 6 months in 12/21

patients (57.1%) with unilateral wrist disease and in 8/21 (38.1%) and 7/21

(33.3%) patients with bilateral wrist disease in right and left side,

respectively. Comparison of chronological-bone age lag and radiographic

damage on baseline and follow-up films in patients with unilateral and

bilateral wrist disease is shown in table.

Chronological-bone

age lag (years)Baseline

Poznanski scoreFollow-up

Poznanski score

Unilateral-affected side1.06#-1.94$£-4.4§

Unilateral-unaffected side0.67-0.47£-1.9§

Bilateral-average L/R wrist0.23#-0.62$-2.7

#p=0.05; $P=0.006; £p=0.004; §p=0.02

Conclusion. Our results confirm that JIA patients with unilateral wrist

disease often have advanced skeletal maturation in the affected side and

that this is accompanied by a greater destructive course.

This indicates that these patients deserve a careful radiographic follow-up

and an early aggressive therapy aimed at suppressing joint inflammation in

the wrist to prevent progression of joint damage.

Disclosures: N. Ullmann, None.