Implementation of musculoskeletal ultrasonography in detection of early juvenile idiopathic arthritis

Darwish, Ayman F.; ismael, faten; Ell-Laban, Abdou; Hamed, Ayman; Kader, Moustafa Abdel; Osman, Ashraf

doi:10.1016/j.ejro.2016.11.001

Cited by 11 publications

(12 citation statements)

References 18 publications

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“…In many instances, however, the presentation may be early during the course of illness,43 such as involvement of joints in an oligoarticular fashion without clinically apparent enthesitis or sacroiliitis. Keeping in mind such instances, it is important to discuss investigation modalities for the diagnosis of early disease or clinically inapparent disease.…”

Section: Diagnosismentioning

confidence: 99%

<p>Enthesitis-related arthritis: current perspectives</p>

Mistry¹,

Patro²,

Agarwal³

et al. 2019

OARRR

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In this narrative review, we overview the recent literature on enthesitis-related arthritis (ERA). For the purpose of our review, we searched Scopus for recent articles on this subject from 2013 onward, including some classic older articles for perspective. ERA is a juvenile idiopathic arthritis (JIA) subtype more common in males, associated in a majority with human leucocyte antigen B27. Such children generally present with asymmetric oligoarthritis or polyarthritis, predominantly of lower limb joints, associated with enthesitis or sacroiliitis. While diagnosis remains clinical, ultrasound is being increasingly used to detect subclinical enthesitis and for guiding entheseal site injections. Spine MRI can help detect sacroiliitis, inflammatory spinal changes, and pelvic sites of enthesitis in such patients. The recent juvenile spondyloarthropathy disease activity index recognizes the key clinical features of ERA, viz enthesitis and inflammatory back pain, which other disease activity indices used in JIA did not include. Management includes NSAIDs with physical therapy. Conventional disease-modifying agents like sulfasalazine and methotrexate may be used to minimize duration of NSAID use and in those with high inflammatory burden. In patients refractory to these drugs, biologics such as antitumor necrosis factor alpha agents have proven useful, based on evidences from randomized controlled trials and retrospective registry analyses. Factors predicting a poorer outcome in such children include hip or ankle involvement or restricted spinal mobility. Considering that children with ERA have overall poorer long-term outcomes than other subtypes of JIA, there is a need to further optimize therapeutic strategies for such patients.

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Section: Diagnosismentioning

confidence: 99%

<p>Enthesitis-related arthritis: current perspectives</p>

Mistry¹,

Patro²,

Agarwal³

et al. 2019

OARRR

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“…There has been remarkable progress in the management of JIA in the past decade with the use of newer therapeutic agents necessitating the need for early detection of arthritis in children . Although damage of joint cartilage is an important pathognomonic change in JIA, it is less extensively studied in India .…”

Section: Discussionmentioning

confidence: 99%

“…Hence, we used ultrasound in our study as the chief investigative tool to examine joint cartilage thickness in children suffering from JIA. Although musculoskeletal ultrasound is highly operator‐dependent, requires expertise, and the developing skeleton with underlying chronic inflammation poses unique challenges in interpreting the sonographic findings, it yields good results when done by a trained person following international guidelines …”

Section: Discussionmentioning

confidence: 99%

“…Table shows few studies on the use of ultrasound in detecting changes in joint cartilage in JIA and healthy children of which our study is the first of its kind from India. Although USG is a very popular method of investigation in adult rheumatology, it has not been given due importance in pediatric rheumatology.…”

Section: Discussionmentioning

confidence: 99%

“…USG enables visualization of the soft tissues and principal components of the joints and can detect the cartilage of unossified epiphyses and the osseous nuclei before they become visible on plain radiographs . According to the study by Darwish et al, USG is more sensitive than physical examination in detecting early joint cartilage damage as well as having an important role in detecting subclinical synovitis which is more common in children. Our aim in this study was to evaluate changes in cartilage thickness in knee, ankle and wrist joints by using USG in different subtypes of JIA and compare them with a healthy cohort, as well as to find out its relationship with disease duration and inflammatory parameters.…”

Section: Introductionmentioning

confidence: 99%

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Ultrasound detected changes in joint cartilage thickness in juvenile idiopathic arthritis

Mitra

Samui²,

Samanta

et al. 2019

Int J of Rheum Dis

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Aim:The purpose of this study was to investigate the changes in joint cartilage thickness in different subtypes of juvenile idiopathic arthritis (JIA) using ultrasound, comparing them with healthy children and to evaluate the relationship with disease duration and inflammatory markers. Methods:We conducted a cross-sectional study comprising of 27 cases of JIA and 54 age-and sex-matched healthy children. Bilateral wrist, knee and ankle joint cartilage thicknesses were measured by ultrasound as per European League Against Rheumatism standard guidelines and compared them between JIA subtypes as well as between cases and control.Results: Descriptive analysis of the whole cohort revealed the mean age of the study population was 8.3 ± 3.2 years with mean cartilage thicknesses at the wrist, knee and ankle being 1.40 ± 0.89 mm, 1.57 ± 0.78 mm and 1.41 ± 0.85 mm, respectively.The median cartilage thicknesses of wrist, knee and ankle joints of JIA cases (n = 27) and healthy controls (n = 54) were 1.01, 1.35, 1.05 and 1.95, 2.00, 1.95, respectively.

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Criteria Associated with Treatment Decisions in Juvenile Idiopathic Arthritis with a Focus on Ultrasonography: Results from the JIRECHO Cohort

Baydoun¹,

Jousse‐Joulin²,

Saraux

et al. 2022

Rheumatol Ther

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Background The treatment of children with juvenile idiopathic arthritis (JIA) to prevent disability is a major challenge in paediatric rheumatology. The presence of synovitis, which is difficult to detect in children, is associated with structural damage. Musculoskeletal ultrasonography (MSUS) can be used in patients with JIA to reveal subclinical synovitis. Objective The primary aim was to determine whether the use of MSUS was associated with therapeutic modification in patients with JIA. The secondary aim was to identify other factors associated with therapeutic decisions. Methods We conducted an observational study based on the JIRECHO multi-centre cohort, which was developed to provide a systematic MSUS follow-up for patients with JIA. Follow-up occurred every 6 months and included clinical and MSUS examinations. We included children who underwent MSUS of the elbows, wrists, second metacarpophalangeal joints, knees and ankles, which was performed by expert sonographers. Clinical and biological data, disease activity scores and information on therapeutics were collected. Results A total of 185 visits concerning 112 patients were recorded. Three groups were defined according to the therapeutic decision: escalation (22%, n = 40), de-escalation (14%, n = 26) or stable (64%, n = 119). In the “therapeutic escalation” group: the presence of ultrasonographic synovitis in B-mode and the presence of grade 2 or 3 synovitis in B-mode were not significantly more frequent than in the “stable therapeutic or de-escalation” group (80% versus 65%, p = 0.06; 33% versus 19%, p = 0.06), and the patient’s and physician’s visual analogue scale (VAS) scores, the clinical JADAS and the C-reactive protein level were significantly higher, but only physician’s VAS score remained in the model of logistic regression. In the “therapeutic de-escalation” group: there was no difference in the presence of US synovitis compared with the “stable therapeutic or escalation” group (62% versus 69%, p = 0.48). Conclusion Even though US synovitis tended to be more frequent in patients with therapeutic escalation, the study did not show that the presence of synovitis in MSUS was statistically associated with therapeutic modifications in patients with JIA. Treatment remained stable despite the presence of US synovitis.

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Implementation of musculoskeletal ultrasonography in detection of early juvenile idiopathic arthritis

Cited by 11 publications

References 18 publications

<p>Enthesitis-related arthritis: current perspectives</p>

<p>Enthesitis-related arthritis: current perspectives</p>

Ultrasound detected changes in joint cartilage thickness in juvenile idiopathic arthritis

Criteria Associated with Treatment Decisions in Juvenile Idiopathic Arthritis with a Focus on Ultrasonography: Results from the JIRECHO Cohort

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