Comparison of clinical versus ultrasound-determined synovitis in juvenile idiopathic arthritis.

OBJECTIVE To compare clinical evaluation and ultrasonography (US) in the assessment of joint synovitis in children with juvenile idiopathic arthritis (JIA). METHODS Thirty-two patients underwent clinical evaluation of 52 joints by 2 pediatric rheumatologists. Joints were assessed for swelling, tenderness/pain on motion, and restricted motion. The same joints were scanned independently by an experienced sonographer for synovial hyperplasia, joint effusion, and power Doppler (PD) signal. RESULTS In total, 1,664 joints were assessed both clinically and with US. On clinical examination, 98 joints (5.9%) were swollen, 59 joints (3.5%) were tender, and 40 joints (2.4%) had restricted motion. On US evaluation, 125 joints (7.5%) had synovial hyperplasia, 153 joints (9.2%) had joint effusion, and 53 joints (3.2%) had PD signal. A total of 104 (6.3%) and 167 (10%) joints had clinical and US synovitis, respectively. Of the 1,560 clinically normal joints, 86 (5.5%) had subclinical synovitis (i.e., had synovitis on US). US led to classifying 5 patients as having polyarthritis who were classified as having oligoarthritis or were found to have no synovitis on clinical evaluation. US variables were moderately correlated with clinical measures of joint swelling, but poorly correlated with those of joint tenderness/pain on motion and restricted motion. Overall, correlations were lower for PD signal than for synovial hyperplasia and joint effusion. CONCLUSION We found that subclinical synovitis as detected by US is common in children with JIA. This finding may have important implications for patient classification and may affect the choice of the optimal therapeutic strategy in individual patients.

[1]  M. Beresford,et al.  Juvenile Idiopathic Arthritis , 2011, Paediatric drugs.

[2]  Alberto Martini,et al.  Development and validation of a composite disease activity score for juvenile idiopathic arthritis. , 2009, Arthritis and rheumatism.

[3]  A. Martini,et al.  Development and Testing of Reduced Joint Counts in Juvenile Idiopathic Arthritis , 2009, The Journal of Rheumatology.

[4]  S. Berney.  Abatacept in children with juvenile idiopathic arthritis: a randomised, double-blind, placebo-controlled withdrawal trial , 2009 .

[5]  S. Berney.  Adalimumab with or without Methotrexate in Juvenile Rheumatoid Arthritis , 2009 .

[6]  A. Martini,et al.  Assessing current outcomes of juvenile idiopathic arthritis: a cross-sectional study in a tertiary center sample. , 2008, Arthritis and rheumatism.

[7]  C. Peterfy,et al.  An explanation for the apparent dissociation between clinical remission and continued structural deterioration in rheumatoid arthritis. , 2008, Arthritis and rheumatism.

[8]  Salmon L Wright,et al.  The correlation between clinical and ultrasonographic findings of ankle disease in JIA , 2008, Pediatric Rheumatology Online Journal.

[9]  M. Rooney,et al.  Knee disease in juvenile idiopathic arthritis (JIA): correlation between clinical and ultrasonographic findings , 2008, Pediatric Rheumatology Online Journal.

[10]  E. Naredo,et al.  Validity, reproducibility, and responsiveness of a twelve-joint simplified power doppler ultrasonographic assessment of joint inflammation in rheumatoid arthritis. , 2008, Arthritis and rheumatism.

[11]  Ann M. Johnson,et al.  High prevalence of temporomandibular joint arthritis at disease onset in children with juvenile idiopathic arthritis, as detected by magnetic resonance imaging but not by ultrasound. , 2008, Arthritis and rheumatism.

[12]  A. Ravelli.  The time has come to include assessment of radiographic progression in juvenile idiopathic arthritis clinical trials. , 2008, The Journal of rheumatology.

[13]  C. Wouters,et al.  A randomized, placebo-controlled trial of infliximab plus methotrexate for the treatment of polyarticular-course juvenile rheumatoid arthritis. , 2007, Arthritis and rheumatism.

[14]  A. Martini,et al.  Development and validation of a new short and simple measure of physical function for juvenile idiopathic arthritis. , 2007, Arthritis and rheumatism.

[15]  Esperanza Naredo,et al.  Longitudinal power Doppler ultrasonographic assessment of joint inflammatory activity in early rheumatoid arthritis: predictive value in disease activity and radiologic progression. , 2007, Arthritis and rheumatism.

[16]  J. McDonagh,et al.  Clinical assessment and core outcome variables are poor predictors of hip arthritis diagnosed by MRI in juvenile idiopathic arthritis. , 2006, Rheumatology.

[17]  C. Peterfy,et al.  Presence of significant synovitis in rheumatoid arthritis patients with disease-modifying antirheumatic drug-induced clinical remission: evidence from an imaging study may explain structural progression. , 2006, Arthritis and rheumatism.

[18]  Franz Kainberger,et al.  Musculoskeletal ultrasound including definitions for ultrasonographic pathology. , 2005, The Journal of rheumatology.

[19]  P. Conaghan.  Musculoskeletal ultrasonography: improving our senses. , 2005, Arthritis and rheumatism.

[20]  E. Giannini,et al.  Preliminary criteria for clinical remission for select categories of juvenile idiopathic arthritis. , 2004, The Journal of rheumatology.

[21]  R. Saurenmann,et al.  A randomized trial of parenteral methotrexate comparing an intermediate dose with a higher dose in children with juvenile idiopathic arthritis who failed to respond to standard doses of methotrexate. , 2004, Arthritis and rheumatism.

[22]  D. Cosgrove,et al.  Comparison of ultrasonographic assessment of synovitis and joint vascularity with radiographic evaluation in a randomized, placebo-controlled study of infliximab therapy in early rheumatoid arthritis. , 2004, Arthritis and rheumatism.

[23]  Michael J. Green,et al.  Should oligoarthritis be reclassified? Ultrasound reveals a high prevalence of subclinical disease , 2004, Annals of the rheumatic diseases.

[24]  M. Suarez‐Almazor,et al.  International League of Associations for Rheumatology: International League of Associations for Rheumatology classification of juvenile idiopathic arthritis: second revision, Edmonton, 2001 , 2004 .

[25]  A. Martini.  Are the number of joints involved or the presence of psoriasis still useful tools to identify homogeneous disease entities in juvenile idiopathic arthritis? , 2003, The Journal of rheumatology.

[26]  D. Kane,et al.  Ultrasonography is superior to clinical examination in the detection and localization of knee joint effusion in rheumatoid arthritis. , 2003, The Journal of rheumatology.

[27]  W. Grassi.  Clinical evaluation versus ultrasonography: who is the winner? , 2003, The Journal of rheumatology.

[28]  P. Emery,et al.  The impact of ultrasonography on diagnosis and management of patients with musculoskeletal conditions. , 2001, Arthritis and rheumatism.

[29]  W. Grassi,et al.  Guidelines for musculoskeletal ultrasound in rheumatology , 2001, Annals of the rheumatic diseases.

[30]  F. Breedveld,et al.  The development of clinical signs of rheumatoid synovial inflammation is associated with increased synthesis of the chemokine CXCL8 (interleukin-8) , 2000, Arthritis research.

[31]  Andre Peeters,et al.  Etanercept in children with polyarticular juvenile rheumatoid arthritis , 2000 .

[32]  N. Villari,et al.  Correlation between clinical and ultrasound assessment of the knee in children with mono-articular or pauci-articular juvenile rheumatoid arthritis , 1999, Pediatric Radiology.

[33]  A. Martini,et al.  Correlation between conventional disease activity measures in juvenile chronic arthritis , 1997, Annals of the rheumatic diseases.

[34]  J M Rubin,et al.  Power Doppler: it's a good thing. , 1997, Seminars in ultrasound, CT, and MR.

[35]  E. Giannini,et al.  Redundancy of conventional articular response variables used in juvenile chronic arthritis clinical trials. , 1996, Annals of the rheumatic diseases.

[36]  R. Burgos-Vargas,et al.  Reliability of the articular examination in children with juvenile rheumatoid arthritis: interobserver agreement and sources of disagreement. , 1995, The Journal of rheumatology.

[37]  P. White.  Methotrexate in resistant juvenile rheumatoid arthritis , 1993 .

[38]  J. Cassidy,et al.  Methotrexate in resistant juvenile rheumatoid arthritis. Results of the U.S.A.-U.S.S.R. double-blind, placebo-controlled trial. The Pediatric Rheumatology Collaborative Study Group and The Cooperative Children's Study Group. , 1992, The New England journal of medicine.

[39]  R A Deyo,et al.  Reproducibility and responsiveness of health status measures. Statistics and strategies for evaluation. , 1991, Controlled clinical trials.

[40]  J. Fleiss.  The design and analysis of clinical experiments , 1987 .

[41]  J. R. Landis,et al.  An application of hierarchical kappa-type statistics in the assessment of majority agreement among multiple observers. , 1977, Biometrics.

[42]  J. R. Landis,et al.  The measurement of observer agreement for categorical data. , 1977, Biometrics.

[43]  Jacob Cohen,et al.  The Equivalence of Weighted Kappa and the Intraclass Correlation Coefficient as Measures of Reliability , 1973 .

[44]  I. F. Duff,et al.  Juvenile Rheumatoid Arthritis. , 1964 .

[45]  Jacob Cohen.  A Coefficient of Agreement for Nominal Scales , 1960 .

[46]  A. N. Franzblau,et al.  A primer of statistics for non-statisticians. , 1958 .