Comparison of Clinical & Ultrasonographic Evaluations for Peripheral Synovitis in JIA

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Article in Press:

Comparison of Clinical and Ultrasonographic Evaluations for Peripheral

Synovitis in Juvenile Idiopathic Arthritis

http://www.semarthritisrheumatism.com/article/PIIS0049017211000023/abstract?rss=\

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Sylvain Breton, MD,

Sandrine Jousse-Joulin, MD,

Cangemi, MD,

Loic de Parscau, PhD,

le Colin, MD,

Luc Bressolette, PhD,

Alain Saraux, PhD,

Valérie Devauchelle-Pensec, PhD

published online 07 March 2011.

Corrected Proof

Objectives

The characteristics of synovitis in juvenile idiopathic arthritis (JIA) are

important to evaluate, as they define several clinical categories. The

metacarpophalangeal (MCP) and metatarsophalangeal (MTP) joints are

frequently involved. Few studies have investigated peripheral joint

evaluation using ultrasonography, a sensitive tool for detecting subclinical

synovitis. Our objectives here were to compare clinical and ultrasound

evaluations of MCP and MTP joint synovitis and to determine the prevalence

of predefined ultrasound abnormalities in JIA patients and healthy controls.

Methods

Standardized physical and ultrasound assessments of the same joints were

done in 31 consecutive patients with JIA and 41 healthy volunteers. Joint

pain, motion limitation, and swelling were recorded. Ultrasonography was

performed on the same joints by 2 trained sonographers who recorded synovial

fluid, synovial hypertrophy, erosion, and power Doppler signal.

Intraobserver reproducibility of ultrasonography was assessed.

Results

Of 558 peripheral joints examined in JIA patients, 69 (12.5%) had

ultrasonographic synovitis and 83 (15%) had abnormal physical findings. All

the physical abnormalities were significantly associated with

ultrasonographic synovitis (P < 0.0001) but agreement was low between

ultrasonographic and physical findings. Ultrasonographic synovitis was most

common at the feet (59.4%), where it was detected clinically in only 25% of

cases. Ultrasonographic synovitis was associated with the presence of

synovial fluid. Cartilage vascularization was found in 2 (4.2%) healthy

controls.

Conclusion

Ultrasonography is useful for monitoring synovitis in JIA. Subclinical

involvement of the MTP joints is common. Clinicians should be aware of the

specific ultrasonographic findings in children.

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