Paediatric Rheumatology
Can ultrasound help to overcome uncertainty in clinical joint assessment in juvenile idiopathic arthritis?
Š. Fingerhutová1, R. Srp2, J. Hurňáková3, H. Hrdinová4, D. Němcová5, N. Vinšová6, N. Sladká Švestková7, P. Doležalová8
- Centre for Paediatric Rheumatology and Autoinflammatory Diseases, Department of Paediatrics and Inherited Metabolic Disorders, General University Hospital and 1st Faculty of Medicine, Charles University, Prague, Czech Republic.
- Centre for Paediatric Rheumatology and Autoinflammatory Diseases, Department of Paediatrics and Inherited Metabolic Disorders, General University Hospital and 1st Faculty of Medicine, Charles University, Prague, and Department of Paediatrics, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic.
- Department of Paediatric and Adult Rheumatology, Motol University Hospital, Prague, Czech Republic.
- Department of Paediatric and Adult Rheumatology, Motol University Hospital, Prague, Czech Republic
- Centre for Paediatric Rheumatology and Autoinflammatory Diseases, Department of Paediatrics and Inherited Metabolic Disorders, General University Hospital and 1st Faculty of Medicine, Charles University, Prague, Czech Republic.
- Centre for Paediatric Rheumatology and Autoinflammatory Diseases, Department of Paediatrics and Inherited Metabolic Disorders, General University Hospital and 1st Faculty of Medicine, Charles University, Prague, Czech Republic.
- Centre for Paediatric Rheumatology and Autoinflammatory Diseases, Department of Paediatrics and Inherited Metabolic Disorders, General University Hospital and 1st Faculty of Medicine, Charles University, Prague, Czech Republic.
- Centre for Paediatric Rheumatology and Autoinflammatory Diseases, Department of Paediatrics and Inherited Metabolic Disorders, General University Hospital and 1st Faculty of Medicine, Charles University, Prague, Czech Republic. pavla.dolezalova@vfn.cz
CER15800
2023 Vol.41, N°1
PI 0177, PF 0185
Paediatric Rheumatology
PMID: 35930492 [PubMed]
Received: 25/04/2022
Accepted : 24/06/2022
In Press: 05/08/2022
Published: 23/01/2023
Abstract
OBJECTIVES:
Assessment of active synovitis is crucial for the management of juvenile idiopathic arthritis (JIA). We aimed to investigate the correlation of musculoskeletal ultrasound (MSUS) and clinical examination results and relate them to arthritis relapse rate.
METHODS:
JIA patients with questionable presence of active arthritis (Q-joints) and controls (JIA and healthy children) were recruited. MSUS of Q-joints, active joints and their inactive counterparts was performed at study entry. Standard disease activity parameters were prospectively recorded.
RESULTS:
Of 481 joints of 138 JIA patients, 99 joints (20.6%) of 58 patients had one or more Q-joints with 54/99 (54.5%) having MSUS features of active disease. Clinically inactive joints had lower proportion of MSUS synovitis (78/253, 30.8%) while MSUS activity was present in 114/129 (88.4%) of clinically active joints and in 2/105 (1.9%) joints of 36 healthy controls. Within the 15-month follow-up 23/99 (22%) Q-joints and 31/253 (12%) clinically inactive joints relapsed. Joints with subclinical synovitis relapsed more frequently than MSUS inactive ones (p<0.001). The relapse rate was higher in MSUS-active Q-joints (19/23, 82%) than in clinically inactive ones (16/31, 52%) with MSUS synovial hypertrophy as the main relapse predictor in multivariate analysis. Ankle and knee joints relapsed most frequently.
CONCLUSIONS:
Acknowledgement of joints with questionable synovitis may contribute to the assessment of disease activity in JIA. Presence of MSUS synovitis carries a clinically meaningful risk of disease recurrence in these joints. In clinical practice, our findings encourage timely MSUS assessment of the joints in question, especially in patients without any other features of active disease.
