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Loredo C, Yañez P, Hernández-Díaz C, Cruz-Arenas E, Ventura-Ríos L. Low prevalence of subclinical synovitis in patients with juvenile idiopathic arthritis (JIA) in long-term clinical remission on medication. Clin Rheumatol 2024; 43:393-398. [PMID: 37542584 DOI: 10.1007/s10067-023-06729-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 07/25/2023] [Accepted: 07/26/2023] [Indexed: 08/07/2023]
Abstract
Subclinical synovitis is highly prevalent in patients with JIA in clinical remission (CR) with a short duration. The objective was to evaluate its prevalence by ultrasound (US) in patients with JIA in long CR during a one-year follow-up. In this prospective and longitudinal study, we included 76 patients with JIA according to ILAR with CR by the Wallace modified criteria and JADAS27 and compared them with 22 patients with active disease. Clinical and demographic characteristics were recorded. US evaluation was by 10-joint count. Differences in US evaluations were analyzed by the Mann-Whitney U test. There were no differences among the two group with regard to disease duration at enrollment, and age (p = 0.540 and p = 0.080, respectively), but JADAS 27, CHAQ, and acute phase reactants were significantly higher (p < 0.001) in the clinically active group. The prevalence of subclinical synovitis at baseline and the end of the study in the CR group was 18.4% and 11.8%, respectively, while it was 100% and 40.9% in the active disease group. Subclinical synovitis at baseline was significantly more prevalent in the clinically active group (elbow, p = 0.01; wrist, p = 0.001; MCP 2, p = 0.001; knee, p = 0.001 and ankle p = 0.001; and PD only in the ankle, p = 0.002). The concordance of inter-reader reliability in all evaluated joints was excellent (p = 0.001). Although the prevalence of subclinical synovitis is low in patients with JIA with long-term clinical remission on medication, a percentage of patients continue to have subclinical involvement that could predict the risk of relapse and structural damage. Key Points • Subclinical synovitis is less prevalent in JIA in long-term clinical remission compared to patients in short-term remission. • The persistence of imaging signs of inflammation in a significant percentage of patients may indicate the need for ongoing medication.
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Affiliation(s)
- Claudia Loredo
- Department of Pediatric Rheumatology, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | - Patricia Yañez
- Department of Pediatric Rheumatology, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | | | - Esteban Cruz-Arenas
- Hospital Epidemiological Surveillance Unit-Sociomedical Research, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - Lucio Ventura-Ríos
- Division of Rheumatology, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Calzada Mexico-Xochimilco 289, Mexico City, Mexico.
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Esteban Y, Rodriguez-Smith J, Tominna M, Cassedy A, Meyers AB, Henrickson M, Ting TV, Vega-Fernandez P. Dissemination of a Pediatric Musculoskeletal POCUS Scoring System via Virtual Education: A Proof-of-Concept Study. POCUS JOURNAL 2023; 8:146-152. [PMID: 38099160 PMCID: PMC10721286 DOI: 10.24908/pocus.v8i2.16229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
Abstract
Point of care pediatric musculoskeletal POCUS scanning and scoring protocols for childhood arthritis have emerged in recent years. However, pediatric musculoskeletal POCUS curricula in rheumatology fellowship programs are limited due to availability of trained faculty and resources. This proof-of-concept study investigated the effectiveness of educational methods for a pediatric musculoskeletal POCUS scoring protocol among fellows and physicians of differing subspecialties. Educational methods assessed included recorded videos and virtual review sessions. Effectiveness was assessed by calculating interrater reliability for the musculoskeletal POCUS scoring systems using the intra-class correlation coefficient (ICC). Following training sessions, participants then underwent scoring exercise(s) until the goal of an excellent ICC ≥ 0.75 was reached. Four participants completed two rounds of virtual education, review, and scoring sessions. Excellent interrater reliability was achieved for most views. This proof-of-concept study demonstrated virtual education covering advanced concepts of pediatric musculoskeletal POCUS provides a knowledge base for physicians from different subspecialties and various experience.
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Affiliation(s)
- Ysabella Esteban
- Division of Rheumatology, Nationwide Children's HospitalColumbus, OHUSA
| | - Jackeline Rodriguez-Smith
- Department of Pediatrics, Division of Rheumatology, University of Cincinnati, Cincinnati Children's Hospital Medical CenterCincinnati, OHUSA
| | | | - Amy Cassedy
- Department of Pediatrics, Division of Biostatistics and Epidemiology, University of Cincinnati, Cincinnati Children's Hospital Medical CenterCincinnati, OHUSA
| | - Arthur B Meyers
- Department of Radiology, Division of Radiology and Medical Imaging, University of Cincinnati, Cincinnati Children's Hospital Medical CenterCincinnati, OHUSA
| | - Michael Henrickson
- Department of Pediatrics, Division of Rheumatology, University of Cincinnati, Cincinnati Children's Hospital Medical CenterCincinnati, OHUSA
| | - Tracy V Ting
- Department of Pediatrics, Division of Rheumatology, University of Cincinnati, Cincinnati Children's Hospital Medical CenterCincinnati, OHUSA
| | - Patricia Vega-Fernandez
- Department of Pediatrics, Division of Rheumatology, University of Cincinnati, Cincinnati Children's Hospital Medical CenterCincinnati, OHUSA
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Averill LW, Kraft DB, Sabado JJ, Atanda A, Long SS, Nazarian LN. Ultrasonography of the pediatric elbow. Pediatr Radiol 2023; 53:1526-1538. [PMID: 36869262 DOI: 10.1007/s00247-023-05623-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 01/27/2023] [Accepted: 01/30/2023] [Indexed: 03/05/2023]
Abstract
Ultrasound of the elbow can be incorporated into routine pediatric practice in the radiology department, emergency department, orthopedic clinic, and interventional suite. Ultrasound is complementary to radiography and magnetic resonance imaging for the evaluation of elbow pain in athletes with overhead activities or valgus stress, focusing on the ulnar collateral ligament medially and capitellum laterally. As a primary imaging modality, ultrasound can be used for a variety of indications including inflammatory arthritis, fracture diagnosis, and ulnar neuritis/subluxation. Ultrasound is also well-suited to guide diagnostic and therapeutic elbow joint interventions with precise localization of anatomic landmarks and needle placement. Here, we describe technical aspects of elbow ultrasound and illustrate its application in pediatric patients from infants to teen athletes.
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Affiliation(s)
- Lauren W Averill
- Department of Radiology, Nemours Children's Health, 1600 Rockland Road, Wilmington, DE, 19803, USA.
| | - Denver B Kraft
- Department of Orthopaedic Surgery, Georgetown University Hospital, Washington, DC, USA
| | - Jeremiah J Sabado
- Department of Radiology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Alfred Atanda
- Department of Orthopaedic Surgery, Nemours Children's Health, Wilmington, DE, USA
| | - Suzanne S Long
- Department of Radiology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
| | - Levon N Nazarian
- Department of Radiology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
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Sande NK, Lilleby V, Aga AB, Kirkhus E, Flatø B, Bøyesen P. Associations between power Doppler ultrasound findings and B-mode synovitis and clinical arthritis in juvenile idiopathic arthritis using a standardised scanning approach and scoring system. RMD Open 2023; 9:rmdopen-2022-002937. [PMID: 36963783 PMCID: PMC10040011 DOI: 10.1136/rmdopen-2022-002937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 03/02/2023] [Indexed: 03/26/2023] Open
Abstract
OBJECTIVES To describe power Doppler (PD) ultrasound findings in joint regions with B-mode (BM) synovitis using a standardised scanning protocol and scoring system in patients with juvenile idiopathic arthritis (JIA). Further, to examine associations between PD findings and BM synovitis, clinical arthritis, patient characteristics and disease activity. METHODS In this cross-sectional study, one experienced ultrasonographer, blinded to clinical findings, performed ultrasound examinations in 27 JIA patients with suspected clinical arthritis. The elbow, wrist, metacarpophalangeal 2-3, proximal interphalangeal 2-3, knee, ankle and metatarsophalangeal 2-3 joints were assessed bilaterally and scored semiquantitatively (grades 0-3) for BM and PD findings using a joint-specific scoring system with reference atlas. Multilevel mixed-effects ordered regression models were used to explore associations between PD findings and BM synovitis, clinical arthritis, age, sex, JIA subgroups, disease duration and 10-joint Juvenile Arthritis Disease Activity Score (JADAS10). RESULTS Twenty-one girls and six boys, median age (IQR) 8 years (6-12 years) were included. Overall, 971 joint regions were evaluated by ultrasound, 129 had BM synovitis and were assessed for PD. PD findings were detected in 45 joint regions (34.9%), most frequently in the parapatellar recess of the knee (24.4%). Increasing PD grades were associated with higher BM grades (OR=5.0,p<0.001) and with clinical arthritis (OR=7.4,p<0.001) but not with age, sex, JIA subgroups, disease duration or JADAS10. CONCLUSION Increasing severity of PD findings were significantly associated with BM synovitis and with clinical arthritis. This suggests that PD signals detected using a standardised ultrasound examination and scoring system can reflect active disease in JIA patients.
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Affiliation(s)
- Nina Krafft Sande
- Department of Rheumatology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Vibke Lilleby
- Department of Rheumatology, Oslo University Hospital, Oslo, Norway
| | | | - Eva Kirkhus
- Department of Radiology, Oslo University Hospital, Oslo, Norway
| | - Berit Flatø
- Department of Rheumatology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Pernille Bøyesen
- Department of Rheumatology, Oslo University Hospital, Oslo, Norway
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Vega-Fernandez P, Esteban Y, Oberle E, Proulx-Gauthier JP, Clark M, Shenoi S, Thatayatikom A, Benham H, Brunner EJ, Woolnough L, Henrickson M, Pratt LR, De Ranieri D, Hoffmann S, Janow G, Bukulmez H, Altaye M, Cassedy A, Ting TV, Roth J. Reliability of the Pediatric Specific Musculoskeletal Ultrasound Scoring Systems for the Elbow, Wrist, and Finger Joints. J Rheumatol 2023; 50:236-239. [PMID: 36182106 PMCID: PMC9898106 DOI: 10.3899/jrheum.220382] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Musculoskeletal ultrasound (MSUS) is increasingly being used in the evaluation of pediatric musculoskeletal diseases. In order to provide objective assessments of arthritis, reliable MSUS scoring systems are needed. Recently, joint-specific scoring systems for arthritis of the pediatric elbow, wrist, and finger joints were proposed by the Childhood Arthritis and Rheumatology Research Alliance (CARRA) MSUS workgroup. This study aimed to assess the reliability of these scoring systems when used by sonographers with different levels of expertise. METHODS Members of the CARRA MSUS workgroup attended training sessions for scoring the elbow, wrist, and finger. Subsequently, scoring exercises of B mode and power Doppler (PD) mode still images for each joint were performed. Interreader reliability was determined using 2-way single-score intraclass correlation coefficients (ICCs) for synovitis and Cohen [Formula: see text] for tenosynovitis. RESULTS Seventeen pediatric rheumatologists with different levels of MSUS expertise (1-15 yrs) completed a 2-hour training session and calibration exercise for each joint. Excellent reliability (ICC > 0.75) was found after the first scoring exercise for all the finger and elbow views evaluated on B mode and PD mode, and for all of the wrist views on B mode. After a second training session and a scoring exercise, the wrist PD mode views reached excellent reliability as well. CONCLUSION The preliminary CARRA MSUS scoring systems for assessing arthritis of the pediatric elbow, wrist, and finger joints demonstrate excellent reliability among pediatric MSUS sonographers with different levels of expertise. With further validation, this reliable joint-specific scoring system could serve as a clinical tool and scientific outcome measure.
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Affiliation(s)
- Patricia Vega-Fernandez
- P. Vega-Fernandez, MD, MSc, Y. Esteban, MD, M. Henrickson, MD, MPH, T.V. Ting, MD, MSc, Department of Pediatrics, University of Cincinnati, Division of Rheumatology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA;
| | - Ysabella Esteban
- P. Vega-Fernandez, MD, MSc, Y. Esteban, MD, M. Henrickson, MD, MPH, T.V. Ting, MD, MSc, Department of Pediatrics, University of Cincinnati, Division of Rheumatology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Edward Oberle
- E. Oberle, MD, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Jean-Philippe Proulx-Gauthier
- J.P. Proulx-Gauthier, MD, FRCPC, Department of Pediatrics, CHU de Québec-Université Laval, Quebec City, Quebec, Canada
| | - Matthew Clark
- M. Clark, MD, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Susan Shenoi
- S. Shenoi, MBBS, MS, Seattle Children's Hospital and Research Center University of Washington, Seattle, Washington, USA
| | | | - Heather Benham
- H. Benham, DNP, APRN, Scottish Rite for Children Dallas, Dallas, Texas, USA
| | - Emily J Brunner
- E.J. Brunner, DO, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Leandra Woolnough
- L. Woolnough, MD, MSCS, Department of Pediatrics, UFHealth, Gainesville, Florida, USA
| | - Michael Henrickson
- P. Vega-Fernandez, MD, MSc, Y. Esteban, MD, M. Henrickson, MD, MPH, T.V. Ting, MD, MSc, Department of Pediatrics, University of Cincinnati, Division of Rheumatology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Laura R Pratt
- L.R. Pratt, MD, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Deirdre De Ranieri
- D. De Ranieri, MD, Department of Pediatrics, Northwestern Feinberg School of Medicine, Division of Rheumatology, Ann and Robert H. Lurie Children's Hospital, Chicago, Illinois, USA
| | - Sarah Hoffmann
- S. Hoffmann, MD, Children's Hospital of Richmond, Virginia, USA
| | - Ginger Janow
- G. Janow, MD, MPH, Joseph M. Sanzari Children's Hospital, Hackensack, New Jersey, USA
| | - Hulya Bukulmez
- H. Bukulmez, MD, Department of Pediatrics, Division of Pediatric Rheumatology, Metro Health Medical System, Case Western Reserve University, Cleveland, Ohio, USA
| | - Mekibib Altaye
- M. Altaye, PhD, A. Cassedy, PhD, Department of Pediatrics, University of Cincinnati, Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Amy Cassedy
- M. Altaye, PhD, A. Cassedy, PhD, Department of Pediatrics, University of Cincinnati, Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Tracy V Ting
- P. Vega-Fernandez, MD, MSc, Y. Esteban, MD, M. Henrickson, MD, MPH, T.V. Ting, MD, MSc, Department of Pediatrics, University of Cincinnati, Division of Rheumatology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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Borocco C, Anselmi F, Rossi-Semerano L. Contribution of Ultrasound in Current Practice for Managing Juvenile Idiopathic Arthritis. J Clin Med 2022; 12:91. [PMID: 36614888 PMCID: PMC9821589 DOI: 10.3390/jcm12010091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 12/16/2022] [Accepted: 12/21/2022] [Indexed: 12/24/2022] Open
Abstract
The interest and application of musculoskeletal ultrasound (MSUS) in juvenile idiopathic arthritis (JIA) are increasing. Numerous studies have shown that MSUS is more sensitive than clinical examination for detecting subclinical synovitis. MSUS is a well-accepted tool, easily accessible and non-irradiating. Therefore, it is a useful technique throughout JIA management. In the diagnostic work-up, MSUS allows for better characterizing the inflammatory involvement. It helps to define the disease extension, improving the classification of patients into JIA subtypes. Moreover, it is an essential tool for guiding intra-articular and peritendinous procedures. Finally, during the follow-up, in detecting subclinical disease activity, MSUS can be helpful in therapeutic decision-making. Because of several peculiarities related to the growing skeleton, the MSUS standards defined for adults do not apply to children. During the last decade, many teams have made large efforts to define normal and pathological US features in children in different age groups, which should be considered during the US examination. This review describes the specificities of MSUS in children, its applications in clinical practice, and its integration into the new JIA treat-to-target therapeutic approach.
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Affiliation(s)
- Charlotte Borocco
- Department of Paediatric Rheumatology, National Reference Centre for Auto-Inflammatory Diseases and Amyloidosis of Inflammatory Origin (CEREMAIA), Bicêtre Hospital (AP-HP), 94270 Le Kremlin-Bicêtre, France
| | - Federica Anselmi
- Department of Paediatric Rheumatology, National Reference Centre for Auto-Inflammatory Diseases and Amyloidosis of Inflammatory Origin (CEREMAIA), Bicêtre Hospital (AP-HP), 94270 Le Kremlin-Bicêtre, France
- Unit of Paediatric Rheumatology, Department of Translational Medicine, Section of Paediatrics, University of Naples Federico II, 80138 Naples, Italy
| | - Linda Rossi-Semerano
- Department of Paediatric Rheumatology, National Reference Centre for Auto-Inflammatory Diseases and Amyloidosis of Inflammatory Origin (CEREMAIA), Bicêtre Hospital (AP-HP), 94270 Le Kremlin-Bicêtre, France
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Criteria Associated with Treatment Decisions in Juvenile Idiopathic Arthritis with a Focus on Ultrasonography: Results from the JIRECHO Cohort. Rheumatol Ther 2022; 10:225-238. [PMID: 36427176 PMCID: PMC9702887 DOI: 10.1007/s40744-022-00512-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 11/07/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The treatment of children with juvenile idiopathic arthritis (JIA) to prevent disability is a major challenge in paediatric rheumatology. The presence of synovitis, which is difficult to detect in children, is associated with structural damage. Musculoskeletal ultrasonography (MSUS) can be used in patients with JIA to reveal subclinical synovitis. OBJECTIVE The primary aim was to determine whether the use of MSUS was associated with therapeutic modification in patients with JIA. The secondary aim was to identify other factors associated with therapeutic decisions. METHODS We conducted an observational study based on the JIRECHO multi-centre cohort, which was developed to provide a systematic MSUS follow-up for patients with JIA. Follow-up occurred every 6 months and included clinical and MSUS examinations. We included children who underwent MSUS of the elbows, wrists, second metacarpophalangeal joints, knees and ankles, which was performed by expert sonographers. Clinical and biological data, disease activity scores and information on therapeutics were collected. RESULTS A total of 185 visits concerning 112 patients were recorded. Three groups were defined according to the therapeutic decision: escalation (22%, n = 40), de-escalation (14%, n = 26) or stable (64%, n = 119). In the "therapeutic escalation" group: the presence of ultrasonographic synovitis in B-mode and the presence of grade 2 or 3 synovitis in B-mode were not significantly more frequent than in the "stable therapeutic or de-escalation" group (80% versus 65%, p = 0.06; 33% versus 19%, p = 0.06), and the patient's and physician's visual analogue scale (VAS) scores, the clinical JADAS and the C-reactive protein level were significantly higher, but only physician's VAS score remained in the model of logistic regression. In the "therapeutic de-escalation" group: there was no difference in the presence of US synovitis compared with the "stable therapeutic or escalation" group (62% versus 69%, p = 0.48). CONCLUSION Even though US synovitis tended to be more frequent in patients with therapeutic escalation, the study did not show that the presence of synovitis in MSUS was statistically associated with therapeutic modifications in patients with JIA. Treatment remained stable despite the presence of US synovitis.
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Baksa G, Czeibert K, Sharp V, Handschuh S, Gyebnar J, Barany L, Benis S, Nyiri G, Mandl P, Petnehazy O, Balint PV. Vascular supply of the metacarpophalangeal joint. Front Med (Lausanne) 2022; 9:1015895. [PMID: 36341235 PMCID: PMC9630748 DOI: 10.3389/fmed.2022.1015895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 10/03/2022] [Indexed: 12/02/2022] Open
Abstract
Objective To describe in detail the arterial vasculature of metacarpophalangeal joints 2–5 on cadaver specimens and to compare it to ultrasound imaging of healthy subjects. Methods Eighteen hands of donated human cadavers were arterially injected and investigated with either corrosion casting or cryosectioning. Each layer of cryosectioned specimens was photographed in high-resolution. Images were then segmented for arterial vessels of the metacarpophalangeal (MCP) joints 2–5. The arterial pattern of the joints was reconstructed from the segmented images and from the corrosion cast specimens. Both hands of ten adult healthy volunteers were scanned focusing on the vasculature of the same joints with high-end ultrasound imaging, including color Doppler. Measurements were made on both cryosectioned arteries and Doppler images. Results The arterial supply of MCP joints 2–5 divides into a metacarpal and a phalangeal territory, respectively. The metacarpal half receives arteries from the palmar metacarpal arteries or proper palmar digital arteries, while the phalangeal half is supplied by both proper and common palmar digital arteries. Comparing anatomical and ultrasonographic results, we determined the exact anatomic location of normal vessels using Doppler images acquired of healthy joints. All, except three branches, were found with less than 50% frequency using ultrasound. Doppler signals were identified significantly more frequently in MCP joints 2–3 than on 4–5 (p < 0.0001). Similarly, Doppler signals differed in the number of detectable small, intraarticular vessels (p < 0.009), but not that of the large extraarticular ones (p < 0.1373). When comparing measurements acquired by ultrasound and on cadaver vessels, measurements using the former technique were found to be larger in all joints (p < 0.0001). Conclusion Using morphological and ultrasonographic techniques, our study provides a high-resolution anatomical maps and an essential reference data set on the entire arterial vasculature of healthy human MCP 2–5 joints. We found that Doppler signal could be detected in less than 50% of the vessels of healthy volunteers except three locations. Intraarticular branches were detected with ultrasound imaging significantly more frequently on healthy MCP 2–3 joints, which should be taken into account when inflammatory and normal Doppler signals are evaluated. Our study also provides reference data for future, higher-resolution imaging techniques.
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Affiliation(s)
- Gabor Baksa
- Laboratory for Applied and Clinical Anatomy, Department of Anatomy, Histology and Embryology, Semmelweis University, Budapest, Hungary
- *Correspondence: Gabor Baksa,
| | - Kalman Czeibert
- Department of Ethology, Institute of Biology, Eötvös Loránd University, Budapest, Hungary
| | - Veronika Sharp
- Division of Rheumatology, Department of Medicine, Santa Clara Valley Medical Center, San Jose, CA, United States
| | - Stephan Handschuh
- VetCore Facility for Research, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Janos Gyebnar
- Medical Imaging Centre, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Laszlo Barany
- Laboratory for Applied and Clinical Anatomy, Department of Anatomy, Histology and Embryology, Semmelweis University, Budapest, Hungary
- Department of Neurosurgery, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Szabolcs Benis
- Department of Orthopedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium
| | - Gabor Nyiri
- Laboratory of Cerebral Cortex Research, Institute of Experimental Medicine, Budapest, Hungary
| | - Peter Mandl
- Division of Rheumatology, Department of Internal Medicine III, Medical University Vienna, Vienna, Austria
| | - Ors Petnehazy
- Medicopus Non-profit Ltd, Kaposvar, Hungary
- Justanatomy Ltd, Kaposvar, Hungary
| | - Peter Vince Balint
- Károly Rácz Doctoral School of Clinical Medicine, Semmelweis University, Budapest, Hungary
- 3rd Department of Rheumatology, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary
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9
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Vega-Fernandez P, Ting TV, Pratt L, Bacha CM, Oberle EJ. Ultrasonography in Pediatric Rheumatology. Rheum Dis Clin North Am 2021; 48:217-231. [PMID: 34798948 DOI: 10.1016/j.rdc.2021.09.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This review highlights the increasing evidence from the last few years supporting the use of musculoskeletal ultrasonography (MSUS) in the evaluation and management of patients with pediatric rheumatic diseases, particularly focusing on juvenile idiopathic arthritis. Recently developed definitions for the sonographic appearance of healthy and pathologic joints in children are discussed. Further topics explored include how MSUS enhances the diagnosis of inflammatory joint disease (synovitis, enthesitis, tenosynovitis), including the detection of subclinical synovitis. There is a brief summary on the use of ultrasonography in the evaluations of myositis, Sjögren syndrome, and scleroderma.
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Affiliation(s)
- Patricia Vega-Fernandez
- Department of Pediatrics, Division of Rheumatology, University of Cincinnati, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue MLC 4010, Cincinnati, OH 45229, USA
| | - Tracy V Ting
- Department of Pediatrics, Division of Rheumatology, University of Cincinnati, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue MLC 4010, Cincinnati, OH 45229, USA
| | - Laura Pratt
- University of Nebraska Medical Center, 985520 Nebraska Medical Center, Omaha, NE 68198-5520, USA
| | - Christine M Bacha
- Division of Rheumatology, Nationwide Children's Hospital, 700 Children's Drive, ED 3013, Columbus, OH 43205, USA
| | - Edward J Oberle
- University of Nebraska Medical Center, 985520 Nebraska Medical Center, Omaha, NE 68198-5520, USA.
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