Role of imaging in evaluation and management of juvenile idiopathic arthritis: a prospective cohort study

Abstract

Background: This study was aimed to evaluate the role of imaging in diagnosis and management of juvenile idiopathic arthritis by comparing the evaluation findings of clinical and ultrasound of all 14 joints in arthritis affected patients under 16 years of age.Methods: Prospectively study was done on patients in age group of 0-16years, who referred to radiology department based on clinical assessment. USG is done in both shoulder, elbow, wrist, hip, knee, ankle and subtalar joints of each patient to assess the following parameters Synovial hypertrophy, joint effusion, power doppler signal, tenosynovitis, enthesitis, cartilage thinning, bone erosions and bursitis.Results: Out of 980 joints assessed 344 joints (35.1% of all joints) had clinical synovitis, while USG evidence was in 382 joints (38.9% of all joints). Among the 344 clinically positive joints (35.1% of all joints), 223 joints (64.8%) had features of synovitis in USG and the rest 121 (35.2%) joints were clinically positive turned out to be ultrasound negative. Out of 980 joints 636 joints (64.8%) were clinically negative, of these 159 joints (25%) was found to have synovitis in ultrasound and 477 joints (75%) turned out to be negative on ultrasound examination.Conclusions: The sensitivity and specificity of ultrasound over clinical examination in shoulder joint was 47.6% and 89.1% respectively, in elbow joint 53.8% and 92.1%, in wrist joint 64.3% and 72.6%, in hip joint 65.1% and 64.9%, in knee joint 74.7% and 61.2%, in ankle joint 67.2% and 59.2% and in subtalar joint 56.7% and 71.8%, respectively.