Juvenile idiopathic arthritis: what is the utility of ultrasound?

Basra, Hershernpal A S; Humphries, Paul

doi:10.1259/bjr.20160920

Cited by 23 publications

(30 citation statements)

References 55 publications

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“…A limitation is that it is highly operator dependent and may not be as reproducible from one technician to another, making it more difficult to follow disease involvement over time [21]. Another limitation is the lack of validated standards for assessing the implications of ultrasound findings in JIA and a complete lack of ultrasound studies in DA [21]. Fewer respondents reported MRI use, which is likely related to the high cost, limited availability, and risk of complications for children with DS requiring sedation [8].…”

Section: Discussionmentioning

confidence: 99%

“…Ultrasound was the second most used imaging modality as it has similar accessibility, is easily tolerated, and has the added benefit of avoiding radiation exposure as compared to X-rays. A limitation is that it is highly operator dependent and may not be as reproducible from one technician to another, making it more difficult to follow disease involvement over time [ 21 ]. Another limitation is the lack of validated standards for assessing the implications of ultrasound findings in JIA and a complete lack of ultrasound studies in DA [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

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Assessment and treatment of Down syndrome-associated arthritis: a survey of pediatric rheumatologists

et al. 2020

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Background: Inflammatory arthritis in children with Down syndrome (DS) was first described in 1984 and is now termed Down syndrome-associated arthritis (DA). Studies have shown that DA is under-recognized with a 19month average delay in diagnosis. Additionally, most patients present with polyarticular, rheumatoid factor (RF) and anti-nuclear antibody (ANA) negative disease. Current therapies for juvenile idiopathic arthritis (JIA) have been used, but appear to be poorly tolerated, more toxic and less effective in patients with DA. There is currently no standardized approach to the assessment or management of DA. The objective of this study was to describe provider perspectives toward diagnostic and treatment approach of DA, to provide baseline information upon which to design future studies. Methods: An electronic survey, organized into sections regarding individual practices of assessment and treatment approach of DA, was sent to the Pediatric Rheumatology electronic list-serv. Survey responses were voluntary and results were analyzed by descriptive statistics. Results: Of 90 survey responses received, 89 were included in the analysis (one was a duplicate response). The respondents were mostly pediatric rheumatologist (94%), with greater than 10 years of experience (55%). The majority (64%) currently see 1-3 patients with DA. Most view DA as the same disease as JIA (73%), and the majority (63%) use a combination of history, exam and imaging to diagnose DA. The most ordered diagnostic tests are CBC (97%) and ESR (96%). The most used treatments include NSAIDs (94%) and methotrexate (91%) followed by anti-TNF agents (90%). Methotrexate is most administered by subcutaneous route (84%) at a dose of 15 mg/m 2 (56%). Oral corticosteroids were only used in 19% of the patients with DA. Conclusion: This is the first study to evaluate provider perspectives towards the diagnostic and treatment approach of DA. Most pediatric rheumatologists feel that DA and JIA are synonymous, and similar approaches to diagnosis are employed, utilizing history, physical exam, laboratory tests, and imaging modalities. DA is treated similarly to JIA with initiation of NSAIDs, disease-modifying anti-rheumatic drugs and biologic therapy. More research is needed to determine optimal screening and therapeutic approach specific to DA.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Assessment and treatment of Down syndrome-associated arthritis: a survey of pediatric rheumatologists

et al. 2020

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“…High cost, limited accessibility, and lack of experi ence in MRI assessment of children affected by JIA are putative causes for underuse of MRI diagnosis in this group of patients. Moreover, the assessment involves one joint, with no possibility of comparing the contrala teral side or performing a dynamic examination, which is possible in ultrasound [9,30]. Table III.…”

Section: Limitations Of Magnetic Resonance Imagingmentioning

confidence: 99%

Magnetic resonance imaging of the knee joint in juvenile idiopathic arthritis

E¹,

Ostrowska²,

Gietka³

et al. 2020

Reumatologia

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Juvenile idiopathic arthritis (JIA) is an umbrella term for a group of diseases in children younger than 16 years old lasting six weeks or longer. Synovitis may lead to destructive and irreversible joint changes with subsequent functional impairment. Prompt diagnosis is essential to prevent permanent joint damage and preserve joint functionality. In the course of JIA both the axial and peripheral skeleton may be involved in the inflammatory process, but the knee joint is most frequently affected. New drugs and treatment protocols have forced the need for diagnosis at the earliest possible stage. Magnetic resonance imaging (MRI) allows early detection of lesions and constitutes a superior diagnostic imaging method. Synovitis, tenosynovitis, enthesitis, bursitis, osteitis, cartilage loss, bone cysts, and erosions are lesions diagnosed in JIA, and they can be precisely imaged in MRI. <br /> This article aims to present MRI inflammatory features of the knee in children with JIA based on the literature.

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“…To our knowledge, US has not been used for forensic age estimation of the knee. Based on systematic studies in healthy children and clinical experiences in traumatology and rheumatology, it is known that the bony and soft tissue structures of the knee are clearly visible and well defined in US images [60,61].…”

Section: Introductionmentioning

confidence: 99%

Forensic age assessment of the knee: proposal of a new classification system using two-dimensional ultrasound volumes and comparison to MRI

et al. 2020

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Objectives To assess epiphyseal growth plate closure of the knee for forensic age estimation using an ultrasound (US)-based method and to compare the findings with MRI. Methods Thirty-three healthy male individuals (age, 14.4–19.3 years) were prospectively evaluated for epiphyseal growth plate closure of the right knee by recordings of two-dimensional US volumes and a high-resolution T1-weighted MRI sequence. The degree of epiphyseal growth plate closure was rated independently by two readers for each method using a modality specific three-point scale that differentiates between an open physis (S1), a partially closed physis (S2), and a closed physis (S3). Results The inter-rater agreement was high for the US (Cohen’s kappa (CK): femur 95.2%, tibia 81.3%, fibula 86.3%) and the MRI method (CK: femur 70.2%, tibia 90.8%, fibula 79.8%). The degree of growth plate closure associated positively with advancing age. The US system showed a clearer separation of median ages with lower overlap than the MRI system. Open growth plates on minors (< S3 on femur and tibia) were identified by US with higher sensitivity (1.0 vs. 0.7) and slightly lower specificity (0.7 vs. 0.85) compared with MRI. The examination time was substantially shorter on US than on MRI (2.65 ± 0.91 min vs. 24.72 ± 2.72 min; p < 0.001). Conclusions The US method for evaluation of growth plate closure of the knee can reliably assign male individuals to different ossification stages and identifies minors with high accuracy. More studies with larger numbers are needed to further evaluate this method. Key Points • US is feasible to determine the degree of epiphyseal growth plate closure of the knee, shows a high degree of reliability, and is comparable to MRI. • US of the knee can detect open growth plates on male minors with high accuracy. • US of the knee may be used as a fast, non-invasive imaging tool for forensic age estimation to identify male minors.

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Juvenile idiopathic arthritis: what is the utility of ultrasound?

Cited by 23 publications

References 55 publications

Assessment and treatment of Down syndrome-associated arthritis: a survey of pediatric rheumatologists

Assessment and treatment of Down syndrome-associated arthritis: a survey of pediatric rheumatologists

Magnetic resonance imaging of the knee joint in juvenile idiopathic arthritis

Forensic age assessment of the knee: proposal of a new classification system using two-dimensional ultrasound volumes and comparison to MRI

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