Power Color Doppler and Spectral Doppler Ultrasonography to Evaluate Response to Intra-articular Steroid Injection in Knee Joints in Juvenile Idiopathic Arthritis

Evaluation of enthesitis in patients with juvenile idiopathic arthritis by power color and spectral Doppler ultrasonography

OBJECTIVE

Ultrasonography in patients with juvenile idiopathic arthritis (JIA) could potentially be useful for evaluation of enthesitis. The aim of this study was to evaluate enthesitis in patients with JIA quantitatively by power color and spectral Doppler ultrasonography by determining color fraction (CF) and resistive index (RI).

METHODS

A cross-sectional single-center study was performed in 15 (61 entheseal sites) patients with JIA with clinical enthesitis. A total of 9 age and sex matched healthy controls (53 entheseal sites) were also examined and compared. Entheseal sites (quadriceps tendon, patellar tendon, tendo-Achilles, medial and lateral epicondyles of humerus) were examined on USG B mode for tendon thickening, hypo- and hyper-echogenicity, enthesophytes, and cortical erosions/irregularities by power Doppler ultrasound for the presence of Doppler signal and by power color Doppler and spectral Doppler ultrasonography to derive CF and RI respectively.

RESULTS

The mean thickness of entheseal site in patients and controls were 3.55±0.82 mm and 2.8±0.37 mm, respectively (p<0.001). The power Doppler signal was present in 93.4% of patients (p<0.001). The pooled data of all entheseal sites revealed a significantly higher CF in patients (0.08±0.03) than in controls (0.006±0.008) (p<0.001). The mean RI in patients (0.61±0.09) was significantly lower than that in controls (0.92±0.12) (p<0.001). The cut-off of RI (0.7) and CF (0.029) determined by receiver operating curve analysis revealed a diagnostic accuracy of 94.7% and 96.5%, respectively.

CONCLUSION

Evaluation of enthesitis by determining CF and RI via power color Doppler and spectral Doppler is possible in JIA patients.

Musculoskeletal ultrasound in children: Current state and future directions

Juvenile idiopathic arthritis (JIA) is a heterogeneous group of chronic inflammatory arthritides that if inadequately treated, may be associated with chronic disability and deformity. Early diagnosis and treatment initiation is essential in the management of patients with JIA. Conventional means of evaluation of disease presence, disease activity and response to therapy including physical exam, labs and x-rays are at times limited and may be insufficient in making an accurate assessment. Musculoskeletal ultrasound (MSUS) is a well-established modality that is patient and family-friendly, non-invasive, does not require sedation and can be performed at the bedside in real-time. MSUS offers information that cannot be attained by standard outcome measures, and may help to advance both diagnosis and treatment of patients with JIA ultimately improving patient outcomes. This review explores the background of MSUS and the current evidence to support its potential role as a diagnostic, disease activity monitoring and interventional tool.

Current status and recent advances on the use of ultrasonography in pediatric rheumatic diseases

BACKGROUND

Ultrasonography has become a useful tool in the clinical rheumatology settings in the last two decades, but its use has only recently been explored by pediatric rheumatologists. The aim of this article is to review the literature on the current status and recent advances on the use of ultrasound in pediatric rheumatic diseases.

DATA SOURCES

We have retrieved and reviewed the relevant articles from MEDLINE/PubMed databases published so far, on the applications of ultrasound in juvenile idiopathic arthritis (JIA), systemic lupus erythematosus, dermatomyositis, enthesitis, Sjogren's syndrome, and other rheumatic diseases. In addition, articles on novel ultrasound imaging technology of potential use in pediatric rheumatology are also reviewed.

RESULTS

In JIA, ultrasound can be used to detect subclinical synovitis, to improve the classification of patients in JIA subtypes, to capture early articular damage, to monitor treatment response, and to guide intraarticular injections. Ultrasound is also considered useful in other rheumatic disorders for the evaluation of musculoskeletal symptoms, assessment of parotid gland pathology, and measurement of skin thickness and pathology. Novel ultrasound techniques developed to augment the functionality of ultrasonography may also be applicable in pediatric rheumatic disorders.

CONCLUSIONS

Ultrasound shows great promise in the assessment and management of children with rheumatologic disorders. However, standardization and validation of ultrasound in healthy children and in patients with rheumatic diseases are still needed.