Reliability of ultrasonography to detect inflammatory lesions and structural damage in juvenile idiopathic arthritis

Abstract

BackgroundMusculoskeletal Ultrasonography (MSUS) is an important tool for the clinical assessment in Juvenile Idiopathic Arthritis (JIA). The objective of this study was to evaluate the reliability of MSUS to detect elementary lesions: synovitis, tenosynovitis, cartilage damage and bone erosions in the wrist and metacarpal (MCP) joints of patients with JIA.MethodsThirty children in various subgroups of JIA according to ILAR criteria, were included in this cross-sectional study. Clinical data including painful, swollen and limited joints were recorded. Five rheumatologist ultrasonographers, blinded to the clinical evaluation, evaluated the presence of elementary lesions in the wrist and MCP 2 and 3 joints bilaterally. The synovitis was graded in B-Mode and Power Doppler (PD). In addition to descriptive statistics intra- and inter-observer reliability was calculated using Cohen’s kappa according to Landis and Koch.ResultsUS detected more synovitis than the clinical examination (62% vs 28%, 30% vs 23% and 22% vs 17% in the wrist, second and third MCP joints respectively). The intra-observer concordance for synovitis in all joints was excellent in B-Mode (k 0.84 .63–1.0 p = 0.001), except for MCP 2, where it was good (0.61, IC 95% .34–89, p = 0.001). For both modalities (PD, B-Mode) tenosynovitis, cartilage damage and bone erosions it was also excellent. Regarding synovitis grading the concordance was excellent for all grades (0.83–1.0, IC 95% 0.51.1.0, p = 0.001), except for grade 1 where it was good (0.61, IC 95% 0.43–.83, p = 0.001). Reliability inter-observer for grayscale synovitis (0.67–0.95, IC 95% 0.67–1.0, p = 0.001), tenosynovitis grayscale (0.89, IC 95% 0.78–0.99, p.001), damage cartilage (0.89, IC 95% 0.78–0.99, p = 0.001), PD (0.66, IC 95% 0.39–1.0, p = 0.001). The concordance for grading synovitis was excellent, but for grayscale grade 1 and 2 (.66, IC 95% .53–.74, p = 0.007) and PD grade 1 and 2 (0.63, IC 95% .58–.91, p = 004) was good.ConclusionsThe intra- and inter-observer reliability of MSUS for inflammatory and structural lesions is good to excellent for the wrist and MCP in patients with JIA.

Evaluation of Periarticular Soft Tissues in Patients With Juvenile Idiopathic Arthritis by Superb Microvascular Imaging and Shear Wave Elastography

“…Reliability of the B mode US and PD US has been discussed in several recent studies. One study 11 concluded that more synovitis, tenosynovitis, cartilage damage and bone erosions could be detected via US compared to clinical examination and there has been good to excellent inter-and intraobserver reliability of US for the wrist and metacarpophalangeal joints. Furthermore, the superiority of SMI to PD in terms of diagnostic accuracy has been recently published without significant interobserver variability when measuring only synovial vascularity.…”

No radiographic wrist damage after treatment to target in recent-onset juvenile idiopathic arthritis

“…We stopped using the modified Sharp van der Heijde for pediatric assessment of joint damage [5] as it proved too difficult to uniformly score subtle changes in joint space narrowing, bony erosions and bone deformity, as was recognized previously [35]. Magnetic resonance imaging (MRI) and ultrasound (US) are suitable for monitoring disease activity for evaluating treatment response, and may also detect damage [36]. However, interpretation of MRI findings of the osteochondral domain in JIA patients is challenging due to characteristics of the growing skeleton, in particular in hand and wrist joints.…”

Correlation of ultrasonography synovitis with disease activity and clinical response to etanercept treatment in juvenile idiopathic arthritis patients

“…Because US was not provided for free after treatment for 24 weeks due to lack of sufficient funds, only a proportion of patients (n=39) underwent US detection after 24 weeks. US synovitis was defined as a joint that presented with greyscale abnormalities (joint effusion and hypertrophied synovium) or PD abnormalities according to several reports (7,12). The number of joints showing synovitis on US were calculated for further analysis.…”

“…Ultrasonography (US), initially applied and recommended for evaluation of subclinical synovitis, disease activity, and treatment response in rheumatoid arthritis, has been introduced for JIA examination recently (7,8). US presents several advantages compared to other imaging technologies such as easy accessibility, fast imaging, dynamic feature, no exposure to radiation, and sedation-free (9).…”