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

Stefano Lanni, E H Pieter van Dijkhuizen, Federica Vanoni, Stefania Viola, Francesca Magnaguagno, Gian Michele Magnano, Carlo Gandolfo, Angelo Ravelli, Clara Malattia

Research output: Contribution to journalArticle

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

Keywords

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

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