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Wittoek R, Decock C, Dewaele N, Arnold L, Baeyens P, De Schrijver I, Pardaens L, Raftakis I, Renson T, Rinkin C, Thooft ADJ, Vanhaverbeke T, Verbist C. Structural ultrasound of joints and tendons in healthy children: development of normative data. Pediatr Rheumatol Online J 2023; 21:105. [PMID: 37726757 PMCID: PMC10508001 DOI: 10.1186/s12969-023-00895-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 09/07/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Musculoskeletal ultrasound is a well accessible technique to assess disease activity in children with juvenile idiopathic arthritis. Knowledge of reference values of joint structures is indispensable to differentiate between physiological and pathological finding. The aim of this study was to assess the structural sonographic features of joints and tendons in healthy children from several age groups (0.2-18 year), and develop a set of normative data. METHODS Greyscale ultrasound was performed in 500 healthy children (age 0.2-18 years) according to a predefined scanning protocol (Additional file 1) including the shoulder, elbow, wrist, second metacarpophalangeal joint, hip, knee, ankle, and first metatarsophalangeal joint). Demographic data and values of cartilage thickness, tendon diameters, and the degree of capsular distention measured by bone-capsular distance (BCD) were collected. Differences according to the sex were assessed by unpaired t-test. Single and multiple regression analyses were performed between the ultrasound outcomes and covariates such as age, height, weight and body mass index. Growth charts and tables were developed with respect to age. Nonparametric quantile regression was applied using the R-packages quantreg and quantregGrowth. RESULTS A total of 195 male and 305 female volunteers were included between the age of 0 and 18 years (mean age 8.9; range: 0.2-17.9 years). Cartilage diminished markedly as children aged, and cartilage of the boys was significantly thicker compared to the girls in all joints (p < 0.001). In addition, cartilage became thinner as children's height and weight increased (beta regression coefficients between - 0.27 and - 0.01, p < 0.0001). Capsular distention (i.e., BCD > 0 mm) was uncommon in the ankle, wrist and MCP2 (resp. in 3, 6, and 3% of cases). It was more common in the suprapatellar and parapatellar knee, MTP1 and posterior recess of the elbow (resp. in 34, 32, 46, and 39% of cases). In the hip, some capsular distention was always present. Age was found to be the best predictor for BCD (beta regression coefficients between 0.05 and 0.13, p < 0.0001). Height was, in addition to age, a good predictor of tendon diameter (beta regression coefficients between 0.03 and 0.14, p < 0.0001). Growth curves and tables for each variable were developed. CONCLUSIONS Reference values of sonographic cartilage thickness, BCD and diameters of tendons at several joints were established from 500 healthy children, aged between 0.2 and 18 years. Growth charts and tables were developed to distinguish normal findings from pathology in children with complaints suspicious of arthritis.
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Affiliation(s)
- Ruth Wittoek
- Rheumatology, Ghent University Hospital, Ghent, Belgium.
- Faculty of Medicine and Health Sciences, Dept. of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium.
| | - Céline Decock
- Faculty of Medicine and Health Sciences, Dept. of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
| | - Nele Dewaele
- Faculty of Medicine and Health Sciences, Dept. of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
| | - Lara Arnold
- Rheumatology, AZ Sint-Lucas Gent, Ghent, Belgium
| | - Pieter Baeyens
- Radiology, Clinique de Flandre, Coudekerque-Branche, France
| | | | - Lisa Pardaens
- Rheumatology, Ghent University Hospital, Ghent, Belgium
- Faculty of Medicine and Health Sciences, Dept. of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
| | | | - Thomas Renson
- Faculty of Medicine and Health Sciences, Dept. of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
- RITA, European Reference Networks, Brussels, Belgium
| | | | - Alexander D J Thooft
- Faculty of Medicine and Health Sciences, Dept. of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
| | - Tine Vanhaverbeke
- Rheumatology, Ghent University Hospital, Ghent, Belgium
- Faculty of Medicine and Health Sciences, Dept. of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
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Trauzeddel R, Lehman H, Trauzeddel RF, Haller M, Palm-Beden K, Ganser G, Berendes R, Nirschl C, Nimtz-Talaska A, Krumrey-Langkammerer M, Schoof P, Windschall D. Age dependent ultrasound B-mode findings of the elbow joint in healthy children and adolescents. Rheumatol Int 2019; 39:1007-1018. [PMID: 31006048 DOI: 10.1007/s00296-018-4233-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Accepted: 12/18/2018] [Indexed: 11/25/2022]
Abstract
Due to maturation of joints, various changes take place, not only in the field of paediatric rheumatology but also in paediatric orthopaedics musculoskeletal ultrasound plays an important role in both the diagnosis and the follow-up of diseases in this field. To differentiate between physiological and pathological findings, the knowledge of reference values of joint structures is indispensable. The objective was to define B-mode ultrasound age- and sex-related reference values for the elbow joint in healthy children and adolescents during maturation. In a cross-sectional, multicentre ultrasound study we examined both sides of the elbow joints of 437 healthy children and adolescents (194 boys/243 girls) being between one and less than 18 years old. The children were classified into six equal age groups and divided according to their gender. We measured the distance between the outer margin of the joint capsule and the bone surface to define the bone-capsule distance (BCD), the thickness of the joint cartilage as well as the thickness of the joint capsule. The bone-capsule junction zone and the shape of the joint capsule were analysed qualitatively. The bone capsule distance and the capsule thickness increased with age. In contrast, the joint cartilage thickness decreased. In most cases the junction zone was peaked. The joint capsule showed mostly a concave shape. Intra- and interobserver reliabilities were good. We propose B-mode ultrasound age- and sex-related reference values for the elbow joint in a large number of healthy children and adolescents for the first time. By applying these standard values to the ultrasound examination of the elbow joint, it may be possible to achieve greater certainty in the diagnosis of pathological processes.
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Affiliation(s)
- Ralf Trauzeddel
- Department of Pediatric and Adolescent Medicine, Helios Hospital Berlin-Buch, Schwanebecker Chaussee 50, 13125, Berlin, Germany.
| | - Hartwig Lehman
- Department of Pediatrics, University Medicine Gießen, Feulgenstrasse 10-12, 35392, Giessen, Germany
| | - Ralf Felix Trauzeddel
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charite Platz 1, 10117, Berlin, Germany
| | | | - Katharina Palm-Beden
- Department of Paediatric and Adolescent Rheumatology, North-Western German Centre for Rheumatology, St. Josef-Stift Sendenhorst, Westtor 7, 48324, Sendenhorst, Germany
| | - Gerd Ganser
- Department of Paediatric and Adolescent Rheumatology, North-Western German Centre for Rheumatology, St. Josef-Stift Sendenhorst, Westtor 7, 48324, Sendenhorst, Germany
| | - Rainer Berendes
- St. Marien Children's Hospital, Grillparzerstrasse 9, 84036, Landshut, Germany
| | - Christine Nirschl
- Klinikum Burgenlandkreis GmbH Naumburg, Humboldtstrasse 33, 06618, Naumburg, Germany
| | | | - Manuela Krumrey-Langkammerer
- German Center for Pediatric and Adolescent Rheumatology, Gehfeldstrasse 24, 82467, Garmisch-Partenkirchen, Germany
| | | | - Daniel Windschall
- Department of Pediatrics, Asklepios Hospital Weißenfels, Naumburger Strasse 76, 06667, Weissenfels, Germany
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Zhao Y, Rascoff NE, Iyer RS, Thapa M, Reichley L, Oron AP, Wallace CA. Flares of Disease in Children with Clinically Inactive Juvenile Idiopathic Arthritis Were Not Correlated with Ultrasound Findings. J Rheumatol 2018; 45:851-857. [PMID: 29606669 DOI: 10.3899/jrheum.170681] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The validity of our current definitions for clinically inactive disease (CID) in juvenile idiopathic arthritis (JIA) based on physical examination is challenged by the development of advanced musculoskeletal imaging tools. We aimed to prospectively determine the prevalence of abnormal ultrasound (US) findings in children with CID in JIA and their clinical significance. METHODS Children aged ≥ 4 years with CID and a history of arthritis from a single tertiary center were approached over 1 year. Standard US of knees, tibiotalar joints, subtalar joints, and wrists were performed at baseline and at a followup visit. US images were scored by 2 pediatric musculoskeletal radiologists. RESULTS Forty children with CID were enrolled and followed clinically. The median duration of inactive disease was 1 year. The most common International League of Associations for Rheumatology JIA categories were extended oligoarticular JIA (30%) and rheumatoid factor-negative polyarthritis (38%). At baseline, among a total of 289 joints scanned, 24 joints (8%) had at least 1 abnormal finding in 18 (45%) of 40 subjects. When evaluated at the individual joint level against flares identified during followup exams, these baseline US findings had a sensitivity of 15% and a positive predictive value of 12%. The predictive performance of the second US was even less. CONCLUSION Our study demonstrates that nearly half of children with CID had abnormal US findings in 1 of 8 commonly affected joints. These findings did not correlate with subsequent clinical flares in up to 2 years of followup.
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Affiliation(s)
- Yongdong Zhao
- From Pediatric Rheumatology, Department of Pediatrics, the Center for Clinical and Translational Research (CCTR), and Pediatric Radiology, Seattle Children's Hospital, University of Washington, Seattle, Washington, USA. .,Y. Zhao, MD, PhD, Pediatric Rheumatology, Department of Pediatrics, and CCTR, Seattle Children's Hospital, University of Washington; N.E. Rascoff, MD, MPH, Pediatric Rheumatology, Department of Pediatrics, Seattle Children's Hospital, University of Washington; R.S. Iyer, MD, Pediatric Radiology, Seattle Children's Hospital, University of Washington; M. Thapa, MD, Pediatric Radiology, Seattle Children's Hospital, University of Washington; L. Reichley, BA, Pediatric Rheumatology, Department of Pediatrics, Seattle Children's Hospital, University of Washington; A.P. Oron, PhD, Epidemiology Section, Institute for Disease Modeling, Bellevue, Washington, USA; C.A. Wallace, MD, Pediatric Rheumatology, Department of Pediatrics, Seattle Children's Hospital, University of Washington. Drs. Zhao and Rascoff contributed equally to the project.
| | - Nanci E Rascoff
- From Pediatric Rheumatology, Department of Pediatrics, the Center for Clinical and Translational Research (CCTR), and Pediatric Radiology, Seattle Children's Hospital, University of Washington, Seattle, Washington, USA.,Y. Zhao, MD, PhD, Pediatric Rheumatology, Department of Pediatrics, and CCTR, Seattle Children's Hospital, University of Washington; N.E. Rascoff, MD, MPH, Pediatric Rheumatology, Department of Pediatrics, Seattle Children's Hospital, University of Washington; R.S. Iyer, MD, Pediatric Radiology, Seattle Children's Hospital, University of Washington; M. Thapa, MD, Pediatric Radiology, Seattle Children's Hospital, University of Washington; L. Reichley, BA, Pediatric Rheumatology, Department of Pediatrics, Seattle Children's Hospital, University of Washington; A.P. Oron, PhD, Epidemiology Section, Institute for Disease Modeling, Bellevue, Washington, USA; C.A. Wallace, MD, Pediatric Rheumatology, Department of Pediatrics, Seattle Children's Hospital, University of Washington. Drs. Zhao and Rascoff contributed equally to the project
| | - Ramesh S Iyer
- From Pediatric Rheumatology, Department of Pediatrics, the Center for Clinical and Translational Research (CCTR), and Pediatric Radiology, Seattle Children's Hospital, University of Washington, Seattle, Washington, USA.,Y. Zhao, MD, PhD, Pediatric Rheumatology, Department of Pediatrics, and CCTR, Seattle Children's Hospital, University of Washington; N.E. Rascoff, MD, MPH, Pediatric Rheumatology, Department of Pediatrics, Seattle Children's Hospital, University of Washington; R.S. Iyer, MD, Pediatric Radiology, Seattle Children's Hospital, University of Washington; M. Thapa, MD, Pediatric Radiology, Seattle Children's Hospital, University of Washington; L. Reichley, BA, Pediatric Rheumatology, Department of Pediatrics, Seattle Children's Hospital, University of Washington; A.P. Oron, PhD, Epidemiology Section, Institute for Disease Modeling, Bellevue, Washington, USA; C.A. Wallace, MD, Pediatric Rheumatology, Department of Pediatrics, Seattle Children's Hospital, University of Washington. Drs. Zhao and Rascoff contributed equally to the project
| | - Mahesh Thapa
- From Pediatric Rheumatology, Department of Pediatrics, the Center for Clinical and Translational Research (CCTR), and Pediatric Radiology, Seattle Children's Hospital, University of Washington, Seattle, Washington, USA.,Y. Zhao, MD, PhD, Pediatric Rheumatology, Department of Pediatrics, and CCTR, Seattle Children's Hospital, University of Washington; N.E. Rascoff, MD, MPH, Pediatric Rheumatology, Department of Pediatrics, Seattle Children's Hospital, University of Washington; R.S. Iyer, MD, Pediatric Radiology, Seattle Children's Hospital, University of Washington; M. Thapa, MD, Pediatric Radiology, Seattle Children's Hospital, University of Washington; L. Reichley, BA, Pediatric Rheumatology, Department of Pediatrics, Seattle Children's Hospital, University of Washington; A.P. Oron, PhD, Epidemiology Section, Institute for Disease Modeling, Bellevue, Washington, USA; C.A. Wallace, MD, Pediatric Rheumatology, Department of Pediatrics, Seattle Children's Hospital, University of Washington. Drs. Zhao and Rascoff contributed equally to the project
| | - Lucas Reichley
- From Pediatric Rheumatology, Department of Pediatrics, the Center for Clinical and Translational Research (CCTR), and Pediatric Radiology, Seattle Children's Hospital, University of Washington, Seattle, Washington, USA.,Y. Zhao, MD, PhD, Pediatric Rheumatology, Department of Pediatrics, and CCTR, Seattle Children's Hospital, University of Washington; N.E. Rascoff, MD, MPH, Pediatric Rheumatology, Department of Pediatrics, Seattle Children's Hospital, University of Washington; R.S. Iyer, MD, Pediatric Radiology, Seattle Children's Hospital, University of Washington; M. Thapa, MD, Pediatric Radiology, Seattle Children's Hospital, University of Washington; L. Reichley, BA, Pediatric Rheumatology, Department of Pediatrics, Seattle Children's Hospital, University of Washington; A.P. Oron, PhD, Epidemiology Section, Institute for Disease Modeling, Bellevue, Washington, USA; C.A. Wallace, MD, Pediatric Rheumatology, Department of Pediatrics, Seattle Children's Hospital, University of Washington. Drs. Zhao and Rascoff contributed equally to the project
| | - Assaf P Oron
- From Pediatric Rheumatology, Department of Pediatrics, the Center for Clinical and Translational Research (CCTR), and Pediatric Radiology, Seattle Children's Hospital, University of Washington, Seattle, Washington, USA.,Y. Zhao, MD, PhD, Pediatric Rheumatology, Department of Pediatrics, and CCTR, Seattle Children's Hospital, University of Washington; N.E. Rascoff, MD, MPH, Pediatric Rheumatology, Department of Pediatrics, Seattle Children's Hospital, University of Washington; R.S. Iyer, MD, Pediatric Radiology, Seattle Children's Hospital, University of Washington; M. Thapa, MD, Pediatric Radiology, Seattle Children's Hospital, University of Washington; L. Reichley, BA, Pediatric Rheumatology, Department of Pediatrics, Seattle Children's Hospital, University of Washington; A.P. Oron, PhD, Epidemiology Section, Institute for Disease Modeling, Bellevue, Washington, USA; C.A. Wallace, MD, Pediatric Rheumatology, Department of Pediatrics, Seattle Children's Hospital, University of Washington. Drs. Zhao and Rascoff contributed equally to the project
| | - Carol A Wallace
- From Pediatric Rheumatology, Department of Pediatrics, the Center for Clinical and Translational Research (CCTR), and Pediatric Radiology, Seattle Children's Hospital, University of Washington, Seattle, Washington, USA.,Y. Zhao, MD, PhD, Pediatric Rheumatology, Department of Pediatrics, and CCTR, Seattle Children's Hospital, University of Washington; N.E. Rascoff, MD, MPH, Pediatric Rheumatology, Department of Pediatrics, Seattle Children's Hospital, University of Washington; R.S. Iyer, MD, Pediatric Radiology, Seattle Children's Hospital, University of Washington; M. Thapa, MD, Pediatric Radiology, Seattle Children's Hospital, University of Washington; L. Reichley, BA, Pediatric Rheumatology, Department of Pediatrics, Seattle Children's Hospital, University of Washington; A.P. Oron, PhD, Epidemiology Section, Institute for Disease Modeling, Bellevue, Washington, USA; C.A. Wallace, MD, Pediatric Rheumatology, Department of Pediatrics, Seattle Children's Hospital, University of Washington. Drs. Zhao and Rascoff contributed equally to the project
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