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Background Kinesiophobia may hinder physical performance measures and functional quality of life in children with juvenile idiopathic arthritis (JIA). This study aims to quantify differences in physical function in patients with JIA compared to healthy controls, and determine the effects of kinesiophobia on physical function and physical activity. Methods This was a comparative study of participants with JIA and healthy controls (JIA n = 26, control n = 17). All children with JIA had lower extremity joint involvement. Performance-based measures included gait speed, chair and stair navigation performance. Self-reported measures included Patient Reported Outcome Measurement Information System (PROMIS®) Physical Function Mobility, and Pain Interference and the Pediatric Functional Activity Brief Scale (Pedi-FABS). The Tampa Scale of Kinesiophobia (TSK-11) assessed patient fear of movement due to pain. Linear regression models were used to determine the contribution of TSK-11 scores on performance test and Pedi-FABS scores. Results Gait speeds were 11–15% slower, chair rise repetitions were 28% fewer, and stair ascent and descent times were 26–31% slower in JIA than controls (p < .05). PROMIS® Physical Function Mobility scores were 10% lower and Pain Interference scores were 2.6 times higher in JIA than healthy controls (p = .003). TSK-11 scores were higher in JIA than controls (p < .0001). After controlling for covariates, TSK-11 scores explained 11.7–26.5% of the variance of regression models for stair climb time, chair rise performance and Pedi-FABS scores (p < .05). Conclusions Children with JIA experience difficulty with tasks related to body transfers. Kinesiophobia is a significant contributor to the functional task performance and may impact clinical outcomes.

Objective The clinical decision-making process in pediatric arthritis lacks an objective, reliable bedside imaging tool. The aim of this study was to develop an ultrasound (US) scanning protocol and assess the reliability of B-Mode and Doppler scoring systems for inflammatory lesions of the pediatric ankle. Methods As part of the Childhood Arthritis and Rheumatology Research Alliance (CARRA) US group, 19 pediatric rheumatologists through a comprehensive literature review developed a set of standardized views and scoring systems to assess inflammatory lesions of the synovial recesses as well as tendons of the pediatric ankle. Three rounds of scoring of still-images were followed by one practical exercise. Agreement among raters was assessed using two-way single score intraclass correlation coefficients (ICC). Results Of the thirty-seven initially identified views to assess the presence of ankle synovitis and tenosynovitis, nine views were chosen for each B-mode and Doppler mode semi-quantitative evaluation. Several scoring exercises and iterative modifications resulted in a final highly reliable scoring system: anterior tibiotalar joint ICC: 0.93 (Confidence Interval, CI, 0.92–0.94), talonavicular joint ICC: 0.86 (CI 0.81–0.90), subtalar joint ICC: 0.91 (CI 0.88–0.93), tendons ICC: 0.96 (CI 0.95–0.97). Conclusion A comprehensive and reliable pediatric ankle US scanning protocol and scoring system for the assessment of synovitis and tenosynovitis were successfully developed. Further validation of this scoring system may allow its use as an outcome measure for both clinical and research applications.

Objective Musculoskeletal ultrasound (MSUS) is increasingly being utilized in the evaluation of pediatric musculoskeletal diseases. In order to provide objective assessments of arthritis, reliable MSUS scoring systems are needed. Recently, joint-specific scoring systems for arthritis of the pediatric elbow, wrist and finger joints were proposed by the Childhood Arthritis and Rheumatology Research Alliance (CARRA) MSUS workgroup. This study aims to assess reliability of these scoring systems when used by sonographers with different levels of expertise. Methods Members of the CARRA MSUS workgroup attended training sessions for scoring the elbow, wrist and finger. Subsequently, scoring exercises of B-mode and Power Doppler (PD)-mode still-images for each joint were performed. Inter-reader reliability was determined using two-way single score intra-class correlation coefficients (ICC) for synovitis and Cohen's kappa for tenosynovitis. Results Seventeen pediatric rheumatologists with different levels of MSUS expertise (1 – 15 years) completed a 2-hour training session and calibration exercise for each joint. Excellent reliability (ICC>0.75) was found after the first scoring exercise for all of the finger and elbow views evaluated on B-mode and PD-mode, and for all of the wrist views on B-mode. After a second training session and a scoring exercise the wrist PD-mode views reached excellent reliability as well. Conclusion The preliminary CARRA MSUS scoring systems for assessing arthritis of the pediatric elbow, wrist and finger joints demonstrate excellent reliability among pediatric MSUS sonographers with different levels of expertise. This reliable joint-specific scoring system could serve as a clinical tool and scientific outcome measure with further validation.