Ultrasound changes in synovial abnormalities induced by treatment in juvenile idiopathic arthritis

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Abstract

OBJECTIVES: To investigate the capacity of ultrasound (US) to detect improvement of synovial abnormalities induced by treatment in juvenile idiopathic arthritis (JIA).

METHODS: Eighty-three joints (33 knees, 22 tibiotalar, 10 wrists, 9 elbows, 9 subtalar joints) of 33 patients with new-onset JIA were assessed by US at study entry and 6 months after a therapeutic intervention. Each joint was scored for grey-scale (GS) and power Doppler (PD) abnormalities according to a 4-point semiquantitative scale. Pre- and post-treatment US scores were compared and the sensitivity to change of GSUS and PDUS was estimated. Clinical response was assessed using the ACR paediatric (ACRp) response criteria.

RESULTS: Seventeen patients (51.5%) underwent intra-articular corticosteroid injection (IACI) only, 15 (45.5%) were given IACI and systemic medications, and 1 (3.0%) was started with systemic therapy alone. Both GSUS and PDUS scores improved significantly (p<0.0001) from baseline to follow-up. US revealed strong sensitivity to change with standardised response mean for GSUS and PDUS of 2.44 and 1.23, respectively. At the follow-up visit, 13/20 (65.0%) joints with residual US abnormalities were judged in remission on clinical grounds. Six/21 (28.6%) patients who were ACRp90 responders did not display complete resolution of synovial abnormalities on US.

CONCLUSIONS: US is a sensitive tool to assess therapeutic response in patients with JIA. Subclinical disease on US is common in joints with clinically-defined remission. An ACRp90 response may not be coupled with complete resolution of synovial abnormalities on US. Further studies are needed to establish the impact of US on therapeutic decision-making in JIA.

Original languageEnglish
Pages (from-to)329-334
Number of pages6
JournalClinical and Experimental Rheumatology
Volume36
Issue number2
Publication statusPublished - Dec 1 2017

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Juvenile Arthritis
Intra-Articular Injections
Joints
Therapeutics
Adrenal Cortex Hormones
Subtalar Joint
Elbow
Knee Joint
Wrist
Decision Making
Pediatrics

Keywords

  • Adrenal Cortex Hormones/administration & dosage
  • Arthritis, Juvenile/diagnostic imaging
  • Child, Preschool
  • Female
  • Humans
  • Injections, Intra-Articular
  • Male
  • Synovial Membrane/diagnostic imaging
  • Ultrasonography, Doppler

Cite this

@article{9724e1ed2b1f4700b1926ed87a20e188,
title = "Ultrasound changes in synovial abnormalities induced by treatment in juvenile idiopathic arthritis",
abstract = "OBJECTIVES: To investigate the capacity of ultrasound (US) to detect improvement of synovial abnormalities induced by treatment in juvenile idiopathic arthritis (JIA).METHODS: Eighty-three joints (33 knees, 22 tibiotalar, 10 wrists, 9 elbows, 9 subtalar joints) of 33 patients with new-onset JIA were assessed by US at study entry and 6 months after a therapeutic intervention. Each joint was scored for grey-scale (GS) and power Doppler (PD) abnormalities according to a 4-point semiquantitative scale. Pre- and post-treatment US scores were compared and the sensitivity to change of GSUS and PDUS was estimated. Clinical response was assessed using the ACR paediatric (ACRp) response criteria.RESULTS: Seventeen patients (51.5{\%}) underwent intra-articular corticosteroid injection (IACI) only, 15 (45.5{\%}) were given IACI and systemic medications, and 1 (3.0{\%}) was started with systemic therapy alone. Both GSUS and PDUS scores improved significantly (p<0.0001) from baseline to follow-up. US revealed strong sensitivity to change with standardised response mean for GSUS and PDUS of 2.44 and 1.23, respectively. At the follow-up visit, 13/20 (65.0{\%}) joints with residual US abnormalities were judged in remission on clinical grounds. Six/21 (28.6{\%}) patients who were ACRp90 responders did not display complete resolution of synovial abnormalities on US.CONCLUSIONS: US is a sensitive tool to assess therapeutic response in patients with JIA. Subclinical disease on US is common in joints with clinically-defined remission. An ACRp90 response may not be coupled with complete resolution of synovial abnormalities on US. Further studies are needed to establish the impact of US on therapeutic decision-making in JIA.",
keywords = "Adrenal Cortex Hormones/administration & dosage, Arthritis, Juvenile/diagnostic imaging, Child, Preschool, Female, Humans, Injections, Intra-Articular, Male, Synovial Membrane/diagnostic imaging, Ultrasonography, Doppler",
author = "Stefano Lanni and {van Dijkhuizen}, {E H Pieter} and Federica Vanoni and Stefania Viola and Francesca Magnaguagno and Magnano, {Gian Michele} and Carlo Gandolfo and Angelo Ravelli and Clara Malattia",
year = "2017",
month = "12",
day = "1",
language = "English",
volume = "36",
pages = "329--334",
journal = "Clinical and Experimental Rheumatology",
issn = "0392-856X",
publisher = "Clinical and Experimental Rheumatology S.A.S.",
number = "2",

}

TY - JOUR

T1 - Ultrasound changes in synovial abnormalities induced by treatment in juvenile idiopathic arthritis

AU - Lanni, Stefano

AU - van Dijkhuizen, E H Pieter

AU - Vanoni, Federica

AU - Viola, Stefania

AU - Magnaguagno, Francesca

AU - Magnano, Gian Michele

AU - Gandolfo, Carlo

AU - Ravelli, Angelo

AU - Malattia, Clara

PY - 2017/12/1

Y1 - 2017/12/1

N2 - OBJECTIVES: To investigate the capacity of ultrasound (US) to detect improvement of synovial abnormalities induced by treatment in juvenile idiopathic arthritis (JIA).METHODS: Eighty-three joints (33 knees, 22 tibiotalar, 10 wrists, 9 elbows, 9 subtalar joints) of 33 patients with new-onset JIA were assessed by US at study entry and 6 months after a therapeutic intervention. Each joint was scored for grey-scale (GS) and power Doppler (PD) abnormalities according to a 4-point semiquantitative scale. Pre- and post-treatment US scores were compared and the sensitivity to change of GSUS and PDUS was estimated. Clinical response was assessed using the ACR paediatric (ACRp) response criteria.RESULTS: Seventeen patients (51.5%) underwent intra-articular corticosteroid injection (IACI) only, 15 (45.5%) were given IACI and systemic medications, and 1 (3.0%) was started with systemic therapy alone. Both GSUS and PDUS scores improved significantly (p<0.0001) from baseline to follow-up. US revealed strong sensitivity to change with standardised response mean for GSUS and PDUS of 2.44 and 1.23, respectively. At the follow-up visit, 13/20 (65.0%) joints with residual US abnormalities were judged in remission on clinical grounds. Six/21 (28.6%) patients who were ACRp90 responders did not display complete resolution of synovial abnormalities on US.CONCLUSIONS: US is a sensitive tool to assess therapeutic response in patients with JIA. Subclinical disease on US is common in joints with clinically-defined remission. An ACRp90 response may not be coupled with complete resolution of synovial abnormalities on US. Further studies are needed to establish the impact of US on therapeutic decision-making in JIA.

AB - OBJECTIVES: To investigate the capacity of ultrasound (US) to detect improvement of synovial abnormalities induced by treatment in juvenile idiopathic arthritis (JIA).METHODS: Eighty-three joints (33 knees, 22 tibiotalar, 10 wrists, 9 elbows, 9 subtalar joints) of 33 patients with new-onset JIA were assessed by US at study entry and 6 months after a therapeutic intervention. Each joint was scored for grey-scale (GS) and power Doppler (PD) abnormalities according to a 4-point semiquantitative scale. Pre- and post-treatment US scores were compared and the sensitivity to change of GSUS and PDUS was estimated. Clinical response was assessed using the ACR paediatric (ACRp) response criteria.RESULTS: Seventeen patients (51.5%) underwent intra-articular corticosteroid injection (IACI) only, 15 (45.5%) were given IACI and systemic medications, and 1 (3.0%) was started with systemic therapy alone. Both GSUS and PDUS scores improved significantly (p<0.0001) from baseline to follow-up. US revealed strong sensitivity to change with standardised response mean for GSUS and PDUS of 2.44 and 1.23, respectively. At the follow-up visit, 13/20 (65.0%) joints with residual US abnormalities were judged in remission on clinical grounds. Six/21 (28.6%) patients who were ACRp90 responders did not display complete resolution of synovial abnormalities on US.CONCLUSIONS: US is a sensitive tool to assess therapeutic response in patients with JIA. Subclinical disease on US is common in joints with clinically-defined remission. An ACRp90 response may not be coupled with complete resolution of synovial abnormalities on US. Further studies are needed to establish the impact of US on therapeutic decision-making in JIA.

KW - Adrenal Cortex Hormones/administration & dosage

KW - Arthritis, Juvenile/diagnostic imaging

KW - Child, Preschool

KW - Female

KW - Humans

KW - Injections, Intra-Articular

KW - Male

KW - Synovial Membrane/diagnostic imaging

KW - Ultrasonography, Doppler

M3 - Article

C2 - 29185965

VL - 36

SP - 329

EP - 334

JO - Clinical and Experimental Rheumatology

JF - Clinical and Experimental Rheumatology

SN - 0392-856X

IS - 2

ER -