Reduced joint assessment vs comprehensive assessment for ultrasound detection of synovitis in juvenile idiopathic arthritis

Collado, Paz; Naredo, Esperanza; Calvo, Cristina; Gámir, M.L. Gámir; Calvo, Inmaculada; García, María Luz; Merino, Rosa; Gil, Jenaro Graña; Bustabab, Sagrario; Garrido, Jesús

doi:10.1093/rheumatology/ket148

Cited by 65 publications

(57 citation statements)

References 19 publications

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“…The group agreed to examine 4 joints: knee, ankle, wrist, and second metacarpophalangeal (MCP) joint. Joint selection was based mainly on the fact that these are the most common peripheral joints involved in JIA (3,6). Since many MSUS publications focused on pediatrics have included the hip joint, we decided not to include it in the present study (7,8).…”

Section: Methodsmentioning

confidence: 99%

Toward Standardized Musculoskeletal Ultrasound in Pediatric Rheumatology: Normal Age‐Related Ultrasound Findings

Collado

Vojinović

Nieto

et al. 2016

Arthritis Care & Research

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Objective. The Outcome Measures in Rheumatology Ultrasound Task Force has recently started to work on the validation and standardization of musculoskeletal ultrasound (MSUS) examination in children in order to improve its applicability to joint examination. Methods. This was a prospective multicenter study performed by 4 experts in pediatric MSUS, who independently collected representative images using predefined scanning procedures of 4 joints (knee, ankle, wrist, and second metacarpophalangeal joint) in different predefined age groups. Researchers were allowed to use their own settings (B-mode and Doppler) in order to get the best quality image and highest sensitivity for low blood flow. Images were evaluated for quality parameters and an atlas was created with the best images. An equipment comparative study was performed by a single examiner using 2 different types of machines. Results. Sixty-four healthy children were scanned. The quality of evaluated images, obtained by predefined scanning positions, was highly comparable among the examiners. The B-mode images clearly showed age-related variations of joint findings, while Doppler images showed the presence of blood flow, particularly within the epiphyseal cartilage of the children at a younger age. There was a high to good level of consistency between images obtained from the 2 different ultrasound machines. Conclusion. The study shows a systematic method for ultrasound examination of children at different age groups. Additionally, a baseline collection of images was developed, showing blood vessels in the joints examined. The present study could provide a framework for ongoing MSUS studies as well as for clinical practice in pediatric rheumatology.

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Section: Methodsmentioning

confidence: 99%

Toward Standardized Musculoskeletal Ultrasound in Pediatric Rheumatology: Normal Age‐Related Ultrasound Findings

Collado

Vojinović

Nieto

et al. 2016

Arthritis Care & Research

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“…An abundant number of studies have emerged in the literature over the past 2 decades for adult rheumatology, which included validation of the US detection of synovitis with histology and magnetic resonance imaging (MRI), standardization of the scanning technique, normative data acquisition, as well as documenting the responsiveness to change (11)(12)(13)(14)(15). These aspects have nevertheless only been partially addressed for pediatric patients (2,10,16); very few publications have started to collect information (16,17).…”

Section: Introductionmentioning

confidence: 99%

Definitions for the Sonographic Features of Joints in Healthy Children

Roth

Jousse‐Joulin

Magni‐Manzoni

et al. 2014

Arthritis Care & Research

100

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Objective. Musculoskeletal ultrasonography (US) has potential in the assessment of disease activity and structural damage in childhood arthritides. In order to assess pathology, the US characteristics of joints in healthy children need to be defined first. The aim of this study was to develop definitions for the various components of the normal pediatric joint. Methods. The definitions were developed by an expert group and applicability was assessed on a collection of standardized scans of the knee and ankle joints by scoring the scans on a Likert scale. The definitions were then modified and applicability was reassessed before sending the definitions for approval to a larger panel of experts. A final scoring on stored images of all relevant joints at different ages followed. Results. Five definitions were developed addressing the articular bone, cartilage, joint capsule, epiphyseal ossification center, and synovial membrane. In total, 224 US images of knees and ankles were acquired, of which 172 were selected for scoring. An agreement of >80% was not met for any of the definitions, but after modifications, 81-97% agreement was reached. This version of the definitions was approved by 15 US experts. In the final validation exercise, all definitions reached an agreement of >80% for the shoulder, elbow, wrist, metacarpophalangeal hip, knee, ankle and metatarsophalangeal joint. Conclusion. US definitions for the normal pediatric joint were successfully developed through a Delphi process and validated in a practical exercise. These results provide the basis to develop definitions for pathology and to support the standardized use of US in pediatric rheumatology.

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“…There are several cohort studies that have shown that treatment of RA patients with TNFα antagonist results in significant improvement in disease when measured by ultrasound (27,30–32). An evaluation of TNFα receptor antagonist efficacy in the treatment of RA patients revealed that the synovial color Doppler scoring of 28 joints was parallel to the changes in DAS28.…”

Section: Discussionmentioning

confidence: 99%

“…An evaluation of TNFα receptor antagonist efficacy in the treatment of RA patients revealed that the synovial color Doppler scoring of 28 joints was parallel to the changes in DAS28. Therefore, the ultrasonic inflammatory joints number and synovial color Doppler scoring was predictive of X-ray bone erosion (32). Scirè et al (33) performed a 2-year follow-up of 106 cases of early-stage RA patients, and showed that the exploration of color Doppler ultrasound towards the joint residual inflammation was much more sensitive than the clinical and laboratory indexes.…”

Section: Discussionmentioning

confidence: 99%

Application of high frequency color Doppler ultrasound in the monitoring of rheumatoid arthritis treatment

Zheng

Wang

Xing

et al. 2014

Experimental and Therapeutic Medicine

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The aim of the present study was to explore the use of high frequency color Doppler ultrasound to measure synovial thickness and blood flow to assess the therapeutic value of the recombinant human tumor necrosis factor (TNF) II receptor antibody fusion protein in rheumatoid arthritis (RA) treatment. A total of 36 clinically-diagnosed patients with RA were treated with methotrexate tablets or the recombinant TNF-receptor antibody fusion protein for 24 weeks. Joint synovial thickness and synovial blood flow integrity were monitored by high frequency color Doppler in the second metacarpophalangeal joint in one hand. The correlation of the erythrocyte sedimentation rate, C-reactive protein (CRP) and 28-joint disease activity score (DAS28) with the ultrasound parameters were analyzed. Metacarpophalangeal second joint 2 (MCP2) synovial thickness, wrist joint synovial thickness and MCP2 synovial blood flow, prior and subsequent to the treatment, have a high correlation with DAS28 (P<0.05), and the MCP2 synovial blood flow integral has a strong correlation with CRP. Evaluating the wrist joint synovial thickness and synovial integrity of the second metacarpophalangeal joint using high frequency ultrasound detection can effectively evaluate the disease status in patients with RA. This procedure is potentially valuable as a means of evaluating the curative effects of RA treatments.

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Reduced joint assessment vs comprehensive assessment for ultrasound detection of synovitis in juvenile idiopathic arthritis

Abstract: The 10-joint PDUS assessment is valid and feasible for assessment of synovitis in JIA in clinical practice.

Cited by 65 publications

References 19 publications

Toward Standardized Musculoskeletal Ultrasound in Pediatric Rheumatology: Normal Age‐Related Ultrasound Findings

Toward Standardized Musculoskeletal Ultrasound in Pediatric Rheumatology: Normal Age‐Related Ultrasound Findings

Definitions for the Sonographic Features of Joints in Healthy Children

Application of high frequency color Doppler ultrasound in the monitoring of rheumatoid arthritis treatment

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