Ultrasonography and color Doppler in juvenile idiopathic arthritis: diagnosis and follow-up of ultrasound-guided steroid injection in the wrist region. A descriptive interventional study

Abstract

BackgroundThe wrist region is one of the most complex joints of the human body. It is prone to deformity and functional impairment in juvenile idiopathic arthritis (JIA), and is difficult to examine clinically. The aim of this study was to evaluate the role of ultrasonography (US) with Doppler in diagnosis of synovitis, guidance of steroid injections, and follow-up examinations of the wrist in JIA.MethodsIn 11 patients (median age 12.5 years, range 2-16), 15 wrists with clinically active arthritis were assessed clinically by US and color Doppler (Logiq 9, GE, 16-4 MHz linear transducer) prior to and 1 and 4 weeks after US-guided steroid injection.ResultsUS detected synovitis in the radio-carpal joints, the midcarpal joints, and the tendon sheaths in 87%, 53% and 33% of the wrists, respectively. Multiple compartments were involved in 67%. US-guidance allowed accurate placement of steroid in all 21 injected compartments, with a low rate of subcutaneous atrophy. Synovial hypertrophy was normalized in 86% of the wrists, hyperemia in 91%, and clinically active arthritis in 80%.ConclusionsUS enabled detection of synovial inflammation in compartments that are difficult to evaluate clinically and exact guidance of injections, and it was valuable for follow-up examinations. Normalization of synovitis was achieved in most cases, which supports the notion that US is an important tool in management of wrist involvement in JIA.

Comparison of ultrasonography with Doppler and MRI for assessment of disease activity in juvenile idiopathic arthritis: a pilot study

“…In our present study, Doppler flow was detected in 86% of the 22 diseased areas with synovial hypertrophy on US. Those observations are comparable to our previous findings, using the same definitions of synovial hyperemia, the same US equipment and Doppler settings, in the ankle (89%, [18]) and wrist (88%) regions [19]. Other studies in JIA patients have shown hyperemia in 93% of symptomatic MCP joints [20] and 77% of symptomatic knees [21].…”

Juvenile idiopathic arthritis: what is the utility of ultrasound?

“…On follow-up, ultrasound can demonstrate normalization or regression of hyperaemia and synovial hypertrophy. 20,51 Similar findings have been shown when ultrasound is used to follow up disease response to antirheumatic drugs 52 and biologic therapies 53 in adults.…”

What’s new in musculoskeletal ultrasound in pediatric rheumatology?

“…MSUS in monitoring the disease activity and response to treatment MSUS imaging can also play a key role in guiding steroid injections into joints, tendon sheathsand even tendon insertions (entheses) [46][47][48]. Local corticosteroid (preferably triamcinolone hexacetonide) injections are a common treatment for young patients with JIA, well tolerated and effective for several months, used particularly in the oligoarthritis subset of JIA.…”

“…They can also be used when systemic anti-inflammatory treatment fails to control isolated arthritis or tenosynovitis. The benefits and safety of MSUS with PD as guidance of steroid injections has been demonstrated in the symptomatic wrist and ankle regions of JIA patients by Laurell et al [46,47]. Using US guidance allows full needle visualization in real-time, including the needle tip.…”