Baseline ultrasound examination as possible predictor of relapse in patients affected by juvenile idiopathic arthritis (JIA)

Orazio De Lucia, Viviana Ravagnani, Francesca Pregnolato, Arvena Hila, Irene Pontikaki, Maurizio Gattinara, Micol Romano, Valeria Gerloni, Sara Pieropan, Antonella Murgo, Maurizio Rossini, Rolando Cimaz, Pier Luigi Meroni

Research output: Contribution to journalArticle

Abstract

OBJECTIVES: To define the correlation between joint ultrasonography and clinical examination in patients with juvenile idiopathic arthritis (JIA) and to assess whether synovitis detected by ultrasonography in clinically inactive patients predicts arthritis flares.

METHODS: 88 consecutive patients with JIA-46 (52%) with persistent oligoarthritis, 15 (17%) with extended oligoarthritis, 15 (17%) with rheumatoid factor-negative polyarthritis and 12 (14%) with other forms of JIA, all clinically inactive for a minimum of 3 months-underwent ultrasound (US) assessment of 44 joints. Joints were scanned at study entry for synovial hyperplasia, joint effusion and power Doppler (PD) signal. Patients were followed clinically for 4 years.

RESULTS: US was abnormal in 20/88 (22.7%) patients and in 38/3872 (0.98%) joints. Extended oligoarthritis and rheumatoid factor-negative polyarthritis were more frequent in US-positive than in US-negative patients (35.0% vs 11.8% and 30.0% vs 13.2%, respectively; P=0.005). During 4 years of follow-up, 41/88 (46.6%) patients displayed a flare; 26/68 (38.2%) were US-negative and 15/20 (75%) were US-positive at baseline. Abnormality on US examination, after correction for therapy modification, significantly increased the risk of flare (OR=3.8, 95% CI 1.2 to 11.5). The combination of grey scale and PD abnormalities displayed a much higher predictive value of relapse (65%, 13/20) than grey scale alone (33%, 6/18).

CONCLUSIONS: US abnormalities are a strong predictor of relapse at individual patient level. Irrespective of treatment, the risk of flare in US-positive versus US-negative patients was almost four times higher. In case of US abnormalities, patients should be carefully followed regardless of both the International League of Associations for Rheumatology and Wallace categories.

Original languageEnglish
Pages (from-to)1426-1431
Number of pages6
JournalAnnals of the Rheumatic Diseases
Volume77
Issue number10
DOIs
Publication statusPublished - Oct 2018

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Juvenile Arthritis
Ultrasonics
Recurrence
Joints
Ultrasonography
Rheumatoid Factor
Synovitis
Rheumatology
Arthritis
Hyperplasia

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Baseline ultrasound examination as possible predictor of relapse in patients affected by juvenile idiopathic arthritis (JIA). / De Lucia, Orazio; Ravagnani, Viviana; Pregnolato, Francesca; Hila, Arvena; Pontikaki, Irene; Gattinara, Maurizio; Romano, Micol; Gerloni, Valeria; Pieropan, Sara; Murgo, Antonella; Rossini, Maurizio; Cimaz, Rolando; Meroni, Pier Luigi.

In: Annals of the Rheumatic Diseases, Vol. 77, No. 10, 10.2018, p. 1426-1431.

Research output: Contribution to journalArticle

De Lucia, O, Ravagnani, V, Pregnolato, F, Hila, A, Pontikaki, I, Gattinara, M, Romano, M, Gerloni, V, Pieropan, S, Murgo, A, Rossini, M, Cimaz, R & Meroni, PL 2018, 'Baseline ultrasound examination as possible predictor of relapse in patients affected by juvenile idiopathic arthritis (JIA)', Annals of the Rheumatic Diseases, vol. 77, no. 10, pp. 1426-1431. https://doi.org/10.1136/annrheumdis-2017-211696
De Lucia, Orazio ; Ravagnani, Viviana ; Pregnolato, Francesca ; Hila, Arvena ; Pontikaki, Irene ; Gattinara, Maurizio ; Romano, Micol ; Gerloni, Valeria ; Pieropan, Sara ; Murgo, Antonella ; Rossini, Maurizio ; Cimaz, Rolando ; Meroni, Pier Luigi. / Baseline ultrasound examination as possible predictor of relapse in patients affected by juvenile idiopathic arthritis (JIA). In: Annals of the Rheumatic Diseases. 2018 ; Vol. 77, No. 10. pp. 1426-1431.
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title = "Baseline ultrasound examination as possible predictor of relapse in patients affected by juvenile idiopathic arthritis (JIA)",
abstract = "OBJECTIVES: To define the correlation between joint ultrasonography and clinical examination in patients with juvenile idiopathic arthritis (JIA) and to assess whether synovitis detected by ultrasonography in clinically inactive patients predicts arthritis flares.METHODS: 88 consecutive patients with JIA-46 (52{\%}) with persistent oligoarthritis, 15 (17{\%}) with extended oligoarthritis, 15 (17{\%}) with rheumatoid factor-negative polyarthritis and 12 (14{\%}) with other forms of JIA, all clinically inactive for a minimum of 3 months-underwent ultrasound (US) assessment of 44 joints. Joints were scanned at study entry for synovial hyperplasia, joint effusion and power Doppler (PD) signal. Patients were followed clinically for 4 years.RESULTS: US was abnormal in 20/88 (22.7{\%}) patients and in 38/3872 (0.98{\%}) joints. Extended oligoarthritis and rheumatoid factor-negative polyarthritis were more frequent in US-positive than in US-negative patients (35.0{\%} vs 11.8{\%} and 30.0{\%} vs 13.2{\%}, respectively; P=0.005). During 4 years of follow-up, 41/88 (46.6{\%}) patients displayed a flare; 26/68 (38.2{\%}) were US-negative and 15/20 (75{\%}) were US-positive at baseline. Abnormality on US examination, after correction for therapy modification, significantly increased the risk of flare (OR=3.8, 95{\%} CI 1.2 to 11.5). The combination of grey scale and PD abnormalities displayed a much higher predictive value of relapse (65{\%}, 13/20) than grey scale alone (33{\%}, 6/18).CONCLUSIONS: US abnormalities are a strong predictor of relapse at individual patient level. Irrespective of treatment, the risk of flare in US-positive versus US-negative patients was almost four times higher. In case of US abnormalities, patients should be carefully followed regardless of both the International League of Associations for Rheumatology and Wallace categories.",
author = "{De Lucia}, Orazio and Viviana Ravagnani and Francesca Pregnolato and Arvena Hila and Irene Pontikaki and Maurizio Gattinara and Micol Romano and Valeria Gerloni and Sara Pieropan and Antonella Murgo and Maurizio Rossini and Rolando Cimaz and Meroni, {Pier Luigi}",
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TY - JOUR

T1 - Baseline ultrasound examination as possible predictor of relapse in patients affected by juvenile idiopathic arthritis (JIA)

AU - De Lucia, Orazio

AU - Ravagnani, Viviana

AU - Pregnolato, Francesca

AU - Hila, Arvena

AU - Pontikaki, Irene

AU - Gattinara, Maurizio

AU - Romano, Micol

AU - Gerloni, Valeria

AU - Pieropan, Sara

AU - Murgo, Antonella

AU - Rossini, Maurizio

AU - Cimaz, Rolando

AU - Meroni, Pier Luigi

N1 - © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

PY - 2018/10

Y1 - 2018/10

N2 - OBJECTIVES: To define the correlation between joint ultrasonography and clinical examination in patients with juvenile idiopathic arthritis (JIA) and to assess whether synovitis detected by ultrasonography in clinically inactive patients predicts arthritis flares.METHODS: 88 consecutive patients with JIA-46 (52%) with persistent oligoarthritis, 15 (17%) with extended oligoarthritis, 15 (17%) with rheumatoid factor-negative polyarthritis and 12 (14%) with other forms of JIA, all clinically inactive for a minimum of 3 months-underwent ultrasound (US) assessment of 44 joints. Joints were scanned at study entry for synovial hyperplasia, joint effusion and power Doppler (PD) signal. Patients were followed clinically for 4 years.RESULTS: US was abnormal in 20/88 (22.7%) patients and in 38/3872 (0.98%) joints. Extended oligoarthritis and rheumatoid factor-negative polyarthritis were more frequent in US-positive than in US-negative patients (35.0% vs 11.8% and 30.0% vs 13.2%, respectively; P=0.005). During 4 years of follow-up, 41/88 (46.6%) patients displayed a flare; 26/68 (38.2%) were US-negative and 15/20 (75%) were US-positive at baseline. Abnormality on US examination, after correction for therapy modification, significantly increased the risk of flare (OR=3.8, 95% CI 1.2 to 11.5). The combination of grey scale and PD abnormalities displayed a much higher predictive value of relapse (65%, 13/20) than grey scale alone (33%, 6/18).CONCLUSIONS: US abnormalities are a strong predictor of relapse at individual patient level. Irrespective of treatment, the risk of flare in US-positive versus US-negative patients was almost four times higher. In case of US abnormalities, patients should be carefully followed regardless of both the International League of Associations for Rheumatology and Wallace categories.

AB - OBJECTIVES: To define the correlation between joint ultrasonography and clinical examination in patients with juvenile idiopathic arthritis (JIA) and to assess whether synovitis detected by ultrasonography in clinically inactive patients predicts arthritis flares.METHODS: 88 consecutive patients with JIA-46 (52%) with persistent oligoarthritis, 15 (17%) with extended oligoarthritis, 15 (17%) with rheumatoid factor-negative polyarthritis and 12 (14%) with other forms of JIA, all clinically inactive for a minimum of 3 months-underwent ultrasound (US) assessment of 44 joints. Joints were scanned at study entry for synovial hyperplasia, joint effusion and power Doppler (PD) signal. Patients were followed clinically for 4 years.RESULTS: US was abnormal in 20/88 (22.7%) patients and in 38/3872 (0.98%) joints. Extended oligoarthritis and rheumatoid factor-negative polyarthritis were more frequent in US-positive than in US-negative patients (35.0% vs 11.8% and 30.0% vs 13.2%, respectively; P=0.005). During 4 years of follow-up, 41/88 (46.6%) patients displayed a flare; 26/68 (38.2%) were US-negative and 15/20 (75%) were US-positive at baseline. Abnormality on US examination, after correction for therapy modification, significantly increased the risk of flare (OR=3.8, 95% CI 1.2 to 11.5). The combination of grey scale and PD abnormalities displayed a much higher predictive value of relapse (65%, 13/20) than grey scale alone (33%, 6/18).CONCLUSIONS: US abnormalities are a strong predictor of relapse at individual patient level. Irrespective of treatment, the risk of flare in US-positive versus US-negative patients was almost four times higher. In case of US abnormalities, patients should be carefully followed regardless of both the International League of Associations for Rheumatology and Wallace categories.

U2 - 10.1136/annrheumdis-2017-211696

DO - 10.1136/annrheumdis-2017-211696

M3 - Article

C2 - 29437586

VL - 77

SP - 1426

EP - 1431

JO - Annals of the Rheumatic Diseases

JF - Annals of the Rheumatic Diseases

SN - 0003-4967

IS - 10

ER -