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Kian Ara H, Alemohammad N, Paymani Z, Ebrahimi M. Machine learning diagnosis of active Juvenile Idiopathic Arthritis on blood pool [ 99M Tc] Tc-MDP scintigraphy images. Nucl Med Commun 2024; 45:355-361. [PMID: 38312058 DOI: 10.1097/mnm.0000000000001822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2024]
Abstract
PURPOSE Neural network has widely been applied for medical classifications and disease diagnosis. This study employs deep learning to best discriminate Juvenile Idiopathic Arthritis (JIA), a pediatric chronic joint inflammatory disease, from healthy joints by exploring blood pool images of 2phase [ 99m Tc] Tc-MDP bone scintigraphy. METHODS Self-deigned multi-input Convolutional Neural Network (CNN) in addition to three available pre-trained models including VGG16, ResNet50 and Xception are applied on 1304 blood pool images of 326 healthy and known JIA children and adolescents (aged 1-16). RESULTS The self-designed model ROC analysis shows diagnostic efficiency with Area Under the Curve (AUC) 0.82 and 0.86 for knee and ankle joints, respectively. Among the three pertained models, VGG16 ROC analysis reveals AUC 0.76 and 0.81 for knee and ankle images, respectively. CONCLUSION The self-designed model shows best performance on blood pool scintigraph diagnosis of patients with JIA. VGG16 was the most efficient model rather to other pre-trained networks. This study can pave the way of artificial intelligence (AI) application in nuclear medicine for the diagnosis of pediatric inflammatory disease.
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Posadzy M, Ostrowska M, Michalski E, Gietka P, Mańczak M, Lanckoroński M, Leszkiewicz M, Sudoł-Szopińska I. Ultrasound and MRI of the foot in children and adolescents newly diagnosed with juvenile idiopathic arthritis. J Ultrason 2023; 23:e106-e113. [PMID: 37701052 PMCID: PMC10494807 DOI: 10.15557/jou.2023.0019] [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: 03/21/2023] [Accepted: 06/14/2023] [Indexed: 09/14/2023] Open
Abstract
Aim To evaluate the spectrum of inflammatory features in foot joints which may be detected on routinely performed ultrasound (US) and magnetic resonance imaging (MRI) in children newly diagnosed with juvenile idiopathic arthritis (JIA). Material and methods Two groups of children hospitalized in a reference center for rheumatology, newly diagnosed with JIA and suspected of foot involvement in the course of JIA were included in this retrospective study. In the first group of 47 patients aged 1-18 years, the imaging was restricted to US. The second group of 22 patients aged 5-18 years underwent only non-contrast MRI of the foot. Results The most frequent pathologies seen on US included effusion and synovial thickening in the first metatarsophalangeal joint (MTP1), followed by the tibiotalar joint. Synovial hyperemia on color Doppler US images was present most frequently in the Chopart and midtarsal joints (64%; 7/11 cases), followed by the tibiotalar joint (45%; 5/11), and MTP2-5 joint synovitis (40%; 4/10). Grade 3 hyperemia was present only in four cases; grades 1 and 2 were detected in the majority of cases. On MRI, bone marrow edema was the most frequent pathology, found mostly in the calcaneus (45%; 10/22 cases), while alterations of the forefoot were rare. No cases of bursitis, enthesitis, cysts, erosions or ankylosis were diagnosed in either of the analyzed groups. Conclusions Routine US of the foot is recommended for early detection of its involvement in JIA in daily clinical practice. Although MRI can identify features of various JIA stages, it is particularly useful for the detection of bone marrow alterations.
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Affiliation(s)
| | - Monika Ostrowska
- Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | - Emil Michalski
- Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | - Piotr Gietka
- Clinic of Pediatric Rheumatology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | - Małgorzata Mańczak
- Department of Gerontology, Public Health and Didactics, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | - Michał Lanckoroński
- Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | - Marek Leszkiewicz
- Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | - Iwona Sudoł-Szopińska
- Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
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Su J, Han X, Yang F, Song Y, Lei H, Wang X, Fan X, Li Y. Application of Automated Hand Ultrasound Scanning and a Simplified Three-Joint Scoring System for Assessment of Rheumatoid Arthritis Activity. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:2860-2868. [PMID: 34315618 DOI: 10.1016/j.ultrasmedbio.2021.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 05/30/2021] [Accepted: 06/16/2021] [Indexed: 06/13/2023]
Abstract
Ultrasound can be used to objectively diagnose and evaluate disease activity in patients with rheumatoid arthritis (RA). We aimed to determine the value of a new automated hand ultrasound (AHUS) scanning device and a simplified 3-joint ultrasound scoring system (US3) in detecting synovitis in RA. We compared AHUS and traditional ultrasound (US) scanning in detecting synovial hyperplasia (SH), joint effusion, bone erosion and power Doppler (PD) synovitis in 49 patients. In addition, we compared the value of US3 (in which 3 proximal interphalangeal [PIP] and/or metacarpophalangeal [MCP] joints with the highest scores for swelling and tenderness were evaluated) with the 22-joint ultrasound scoring system (US22) in 26 patients. Almost perfect κ coefficients (0.86-0.937) were obtained between AHUS and traditional US in detecting SH, joint effusion, bone erosion and PD synovitis (p < 0.001). The intra-class correlation coefficient (ICC) between AHUS and traditional US was 0.955-0.995. Of the US3 findings in AHUS, SH synovitis and PD synovitis were positively correlated with DAS28-CRP (adjusted R2 = 0.421, p < 0.0001; adjusted R2 = 0.365, p < 0.0001). US3 was highly correlated with US22 in detecting SH and PD synovitis (R = 0.792, p < 0.01; R = 0.948, p < 0.01). Compared with US22, a more significant correlation was identified between US3 scores and most clinical and laboratory values. In conclusion, AHUS performed comparably to traditional US in detecting synovitis in RA, and US3 was highly consistent with US22 in assessing synovitis and was positively correlated with RA disease activity.
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Affiliation(s)
- Jianling Su
- Department of Rheumatology and Immunology, Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xiaodong Han
- Global Research Center, General Electric, Shanghai, China
| | - Fan Yang
- Department of Rheumatology and Immunology, Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yan Song
- Department of Rheumatology and Immunology, Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Hongwei Lei
- Department of Rheumatology and Immunology, Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xiaoxue Wang
- Department of Rheumatology and Immunology, Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xuemei Fan
- Department of Rheumatology and Immunology, Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yang Li
- Department of Rheumatology and Immunology, Second Affiliated Hospital of Harbin Medical University, Harbin, China.
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Jones JT, Smith C, Talib N. Brief Musculoskeletal Screen and Patient Education for Down Syndrome-Associated Arthritis. Glob Pediatr Health 2021; 8:2333794X211045562. [PMID: 34527768 PMCID: PMC8436300 DOI: 10.1177/2333794x211045562] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 08/20/2021] [Indexed: 11/25/2022] Open
Affiliation(s)
- Jordan T Jones
- Children's Mercy Kansas City, Kansas City, MO, USA.,University of Missouri-Kansas City, Kansas City, MO, USA.,University of Kansas School of Medicine, Kansas City, KS, USA
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Xu D, Zhang Y, Zhang ZY, Tang XM. Association between high mobility group box 1 protein and juvenile idiopathic arthritis: a prospective longitudinal study. Pediatr Rheumatol Online J 2021; 19:112. [PMID: 34247641 PMCID: PMC8273958 DOI: 10.1186/s12969-021-00587-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 04/05/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To analyze the levels of high mobility group box 1 (HMGB1) protein on different courses of juvenile idiopathic arthritis (JIA). METHODS In our prospective longitudinal study, children with JIA were included with their blood samples collected at the first visit, 1-month, 3-month, and 6-month follow-up, respectively. Samples were also collected from healthy controls and children with reactive arthritis at the first visit. Levels of HMGB1 were determined using enzyme-linked immunosorbent assays. Clinical disease characteristics and routine laboratory findings were analyzed as well. RESULTS A total of 64 children were enrolled, of whom 31 (48.4%) were female. The median age at the first visit for participants with JIA was 9.25 years (range, 1.42-15.42) and the median duration of disease was 2.38 months (range, 1.53-49.31). Serum HMGB1 levels at the first visit were significantly elevated in children with systemic JIA compared with other groups, and so were in enthesitis-related arthritis versus healthy controls. Significant correlations were established at the first visit between HMGB1 levels and duration of disease, C-reactive protein, percentage of neutrophils, and ferritin. Data from all samples revealed that serum HMGB1 levels in JIA were significantly associated with erythrocyte sedimentation rates, C-reactive protein, percentage of neutrophils, and disease activity scores. CONCLUSIONS Serum HMGB1 may be associated with clinical disease activity of JIA and specifically increased at the first visit in children with systemic JIA, suggesting its function as a sensitive inflammatory marker. Further large-scale studies are warranted to explore its spectrum in JIA.
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Affiliation(s)
- Dan Xu
- grid.488412.3Department of Rheumatology and Immunology, Children’s Hospital of Chongqing Medical University, 136, Zhongshan 2nd Road, Yuzhong District, Chongqing, 400014 People’s Republic of China ,grid.488412.3Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Child Infection and Immunity, Children’s Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Yu Zhang
- grid.488412.3Department of Rheumatology and Immunology, Children’s Hospital of Chongqing Medical University, 136, Zhongshan 2nd Road, Yuzhong District, Chongqing, 400014 People’s Republic of China ,grid.488412.3Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Child Infection and Immunity, Children’s Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Zhi-Yong Zhang
- grid.488412.3Department of Rheumatology and Immunology, Children’s Hospital of Chongqing Medical University, 136, Zhongshan 2nd Road, Yuzhong District, Chongqing, 400014 People’s Republic of China ,grid.488412.3Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Child Infection and Immunity, Children’s Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Xue-Mei Tang
- Department of Rheumatology and Immunology, Children's Hospital of Chongqing Medical University, 136, Zhongshan 2nd Road, Yuzhong District, Chongqing, 400014, People's Republic of China. .,Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Child Infection and Immunity, Children's Hospital of Chongqing Medical University, Chongqing, People's Republic of China.
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Pracoń G, Aparisi Gómez MP, Simoni P, Gietka P, Sudoł-Szopińska I. Conventional Radiography and Ultrasound Imaging of Rheumatic Diseases Affecting the Pediatric Population. Semin Musculoskelet Radiol 2021; 25:68-81. [PMID: 34020469 DOI: 10.1055/s-0041-1726014] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Juvenile idiopathic arthritis is the most frequent rheumatic disease in the pediatric population, followed by systemic lupus erythematosus, juvenile scleroderma syndromes, juvenile dermatomyositis, chronic recurrent multifocal osteomyelitis, and juvenile vasculopathies. The imaging approach to inflammatory connective tissue diseases in childhood has not changed dramatically over the last decade, with radiographs still the leading method for bony pathology assessment, disease monitoring, and evaluation of growth disturbances. Ultrasonography is commonly used for early detection of alterations within the intra- and periarticular soft tissues, assessing their advancement and also disease monitoring. It offers several advantages in young patients including nonionizing radiation exposure, short examination time, and high resolution, allowing a detailed evaluation of the musculoskeletal system for the features of arthritis, tenosynovitis, enthesitis, bursitis, myositis, as well as pathologies of the skin, subdermis, vessels, and fasciae. In this pictorial essay we discuss radiographic and ultrasound inflammatory features of autoimmune pediatric inflammatory arthropathies: juvenile idiopathic arthritis, lupus erythematosus, juvenile scleroderma, juvenile dermatomyositis and polymyositis.
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Affiliation(s)
- Grzegorz Pracoń
- Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | - Maria Pilar Aparisi Gómez
- Department of Radiology, Auckland City Hospital, Auckland, New Zealand.,Department of Radiology, Hospital Vithas Nueve de Octubre, Valencia, Spain
| | - Paolo Simoni
- "Reine Fabiola" Children's University Hospital, Paediatric Imaging Department, Bruxelles, Belgium
| | - Piotr Gietka
- Clinics of Pediatric Rheumatology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | - Iwona Sudoł-Szopińska
- Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
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Jones JT, Smith C, Talib N. Assessment of Down Syndrome-Associated Arthritis: A Survey of Down Syndrome Clinic Providers. Glob Pediatr Health 2021; 8:2333794X21999134. [PMID: 33796632 PMCID: PMC7983412 DOI: 10.1177/2333794x21999134] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 02/04/2021] [Indexed: 12/17/2022] Open
Affiliation(s)
- Jordan T Jones
- Children's Mercy Kansas City, Kansas City, MO, USA.,University of Missouri, Kansas City, MO, USA
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8
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Magnetic resonance imaging of the knee joint in juvenile idiopathic arthritis. Reumatologia 2021; 58:416-423. [PMID: 33456085 PMCID: PMC7792535 DOI: 10.5114/reum.2020.102007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 11/30/2020] [Indexed: 11/17/2022] Open
Abstract
Juvenile idiopathic arthritis (JIA) is an umbrella term for a group of diseases in children younger than 16 years old lasting six weeks or longer. Synovitis may lead to destructive and irreversible joint changes with subsequent functional impairment. Prompt diagnosis is essential to prevent permanent joint damage and preserve joint functionality. In the course of JIA both the axial and peripheral skeleton may be involved in the inflammatory process, but the knee joint is most frequently affected. New drugs and treatment protocols have forced the need for diagnosis at the earliest possible stage. Magnetic resonance imaging (MRI) allows early detection of lesions and constitutes a superior diagnostic imaging method. Synovitis, tenosynovitis, enthesitis, bursitis, osteitis, cartilage loss, bone cysts, and erosions are lesions diagnosed in JIA, and they can be precisely imaged in MRI. This article aims to present MRI inflammatory features of the knee in children with JIA based on the literature.
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Herrmann J, Säring D, Auf der Mauer M, Groth M, Jopp-van Well E. Forensic age assessment of the knee: proposal of a new classification system using two-dimensional ultrasound volumes and comparison to MRI. Eur Radiol 2020; 31:3237-3247. [PMID: 33057780 PMCID: PMC8043935 DOI: 10.1007/s00330-020-07343-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 08/27/2020] [Accepted: 09/23/2020] [Indexed: 11/28/2022]
Abstract
Objectives To assess epiphyseal growth plate closure of the knee for forensic age estimation using an ultrasound (US)-based method and to compare the findings with MRI. Methods Thirty-three healthy male individuals (age, 14.4–19.3 years) were prospectively evaluated for epiphyseal growth plate closure of the right knee by recordings of two-dimensional US volumes and a high-resolution T1-weighted MRI sequence. The degree of epiphyseal growth plate closure was rated independently by two readers for each method using a modality specific three-point scale that differentiates between an open physis (S1), a partially closed physis (S2), and a closed physis (S3). Results The inter-rater agreement was high for the US (Cohen’s kappa (CK): femur 95.2%, tibia 81.3%, fibula 86.3%) and the MRI method (CK: femur 70.2%, tibia 90.8%, fibula 79.8%). The degree of growth plate closure associated positively with advancing age. The US system showed a clearer separation of median ages with lower overlap than the MRI system. Open growth plates on minors (< S3 on femur and tibia) were identified by US with higher sensitivity (1.0 vs. 0.7) and slightly lower specificity (0.7 vs. 0.85) compared with MRI. The examination time was substantially shorter on US than on MRI (2.65 ± 0.91 min vs. 24.72 ± 2.72 min; p < 0.001). Conclusions The US method for evaluation of growth plate closure of the knee can reliably assign male individuals to different ossification stages and identifies minors with high accuracy. More studies with larger numbers are needed to further evaluate this method. Key Points • US is feasible to determine the degree of epiphyseal growth plate closure of the knee, shows a high degree of reliability, and is comparable to MRI. • US of the knee can detect open growth plates on male minors with high accuracy. • US of the knee may be used as a fast, non-invasive imaging tool for forensic age estimation to identify male minors. Electronic supplementary material The online version of this article (10.1007/s00330-020-07343-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jochen Herrmann
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, Section of Pediatric Radiology, University Medical Center Hamburg-Eppendorf (UKE), Martinistrasse 52, 20246, Hamburg, Germany.
| | - Dennis Säring
- Department of Medical and Industrial Image Processing, University of Applied Sciences of Wedel, Feldstraße 143, 22880, Wedel, Germany
| | - Markus Auf der Mauer
- Department of Medical and Industrial Image Processing, University of Applied Sciences of Wedel, Feldstraße 143, 22880, Wedel, Germany
| | - Michael Groth
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, Section of Pediatric Radiology, University Medical Center Hamburg-Eppendorf (UKE), Martinistrasse 52, 20246, Hamburg, Germany
| | - Eilin Jopp-van Well
- Department of Legal Medicine, University Medical Center Hamburg-Eppendorf (UKE), Butenfeld 34, 22529, Hamburg, Germany
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Whyte A, Boeddinghaus R, Bartley A, Vijeyaendra R. Imaging of the temporomandibular joint. Clin Radiol 2020; 76:76.e21-76.e35. [PMID: 32709388 DOI: 10.1016/j.crad.2020.06.020] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 06/29/2020] [Indexed: 12/11/2022]
Abstract
Temporomandibular disorders are common, especially in young to middle-aged women, and most settle with supportive treatment. Imaging is indicated for the small percentage of cases that do not respond to conservative management and when the diagnosis is no doubt. The temporomandibular joint (TMJ) is a bilateral synovial articulation between the mandible and skull base. It has an intra-articular disc dividing the joint into superior and inferior compartments and the articular surfaces are lined with fibrocartilage. The normal imaging anatomy of the TMJ is described and illustrated. Different movements occur in each joint compartments: a hinge movement in the inferior joint space and translation or gliding in the superior joint space. Internal derangement is the commonest disorder affecting the TMJ and is most commonly due to disc displacement, followed by osteoarthritis and inflammatory arthritides. The imaging findings, primarily on magnetic resonance imaging (MRI) and computed tomography (CT), of internal derangement and less common disorders of the joint, are reviewed and illustrated. Optimal imaging protocols are discussed with detailed reporting guidelines.
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Affiliation(s)
- A Whyte
- Perth Radiological Clinic, 127 Hamersley Rd, Subiaco WA 6008, Australia; Department of Dentistry, University of Western Australia, Nedlands, WA 6009, Australia; Department of Medicine and Radiology, University of Melbourne, Carlton, Victoria 3000, Australia.
| | - R Boeddinghaus
- Perth Radiological Clinic, 127 Hamersley Rd, Subiaco WA 6008, Australia; Department of Surgery, University of Western Australia, Nedlands WA 6009, Australia
| | - A Bartley
- Perth Radiological Clinic, 127 Hamersley Rd, Subiaco WA 6008, Australia; Medical Imaging, Perth Children's Hospital, 15 Hospital Avenue, Nedlands WA 6009, Australia
| | - R Vijeyaendra
- Irwin Dental Clinic - Army Barracks, Samichon Road, Karrakatta WA 6010, Australia
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Assessment and treatment of Down syndrome-associated arthritis: a survey of pediatric rheumatologists. Pediatr Rheumatol Online J 2020; 18:57. [PMID: 32660497 PMCID: PMC7359260 DOI: 10.1186/s12969-020-00445-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 06/24/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Inflammatory arthritis in children with Down syndrome (DS) was first described in 1984 and is now termed Down syndrome-associated arthritis (DA). Studies have shown that DA is under-recognized with a 19-month average delay in diagnosis. Additionally, most patients present with polyarticular, rheumatoid factor (RF) and anti-nuclear antibody (ANA) negative disease. Current therapies for juvenile idiopathic arthritis (JIA) have been used, but appear to be poorly tolerated, more toxic and less effective in patients with DA. There is currently no standardized approach to the assessment or management of DA. The objective of this study was to describe provider perspectives toward diagnostic and treatment approach of DA, to provide baseline information upon which to design future studies. METHODS An electronic survey, organized into sections regarding individual practices of assessment and treatment approach of DA, was sent to the Pediatric Rheumatology electronic list-serv. Survey responses were voluntary and results were analyzed by descriptive statistics. RESULTS Of 90 survey responses received, 89 were included in the analysis (one was a duplicate response). The respondents were mostly pediatric rheumatologist (94%), with greater than 10 years of experience (55%). The majority (64%) currently see 1-3 patients with DA. Most view DA as the same disease as JIA (73%), and the majority (63%) use a combination of history, exam and imaging to diagnose DA. The most ordered diagnostic tests are CBC (97%) and ESR (96%). The most used treatments include NSAIDs (94%) and methotrexate (91%) followed by anti-TNF agents (90%). Methotrexate is most administered by subcutaneous route (84%) at a dose of 15 mg/m2 (56%). Oral corticosteroids were only used in 19% of the patients with DA. CONCLUSION This is the first study to evaluate provider perspectives towards the diagnostic and treatment approach of DA. Most pediatric rheumatologists feel that DA and JIA are synonymous, and similar approaches to diagnosis are employed, utilizing history, physical exam, laboratory tests, and imaging modalities. DA is treated similarly to JIA with initiation of NSAIDs, disease-modifying anti-rheumatic drugs and biologic therapy. More research is needed to determine optimal screening and therapeutic approach specific to DA.
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Brunner E, Ting T, Vega-Fernandez P. Musculoskeletal ultrasound in children: Current state and future directions. Eur J Rheumatol 2020; 7:S28-S37. [PMID: 35929859 PMCID: PMC7004269 DOI: 10.5152/eurjrheum.2019.19170] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 10/20/2019] [Indexed: 08/07/2023] Open
Abstract
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.
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Affiliation(s)
| | - Tracy Ting
- Department of Rheumatology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Patricia Vega-Fernandez
- Department of Rheumatology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
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Zhou L, Gu X. Correlation of ultrasonography synovitis with disease activity and clinical response to etanercept treatment in juvenile idiopathic arthritis patients. ACTA ACUST UNITED AC 2019; 52:e8565. [PMID: 31778437 PMCID: PMC6886362 DOI: 10.1590/1414-431x20198565] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 09/12/2019] [Indexed: 12/13/2022]
Abstract
This study aimed to investigate the correlation of ultrasonography (US) of synovitis with disease activity and clinical response to etanercept (ETN) in juvenile idiopathic arthritis (JIA) patients. Eighty-two JIA patients who underwent ETN treatment for 24 weeks were consecutively enrolled. US evaluations of 28 joints (shoulder, elbow, wrist, metacarpophalangeal, and proximal interphalangeal of hands and knee) at baseline were performed using grey-scale US and power doppler (PD) US, and US synovitis was defined as grey-scale abnormalities or PD abnormalities. Clinical response was assessed according to the ACRpedi 50 response criteria. In total, 2296 joints were scanned and 608 (26.5%) joints presented US synovitis, which was numerically higher than clinical synovitis (513 (22.3%)). The mean number of joints showing synovitis on US was 7.42±3.35, which was also numerically higher than that of clinical synovitis (6.26±2.70). The number of joints showing synovitis on US was positively correlated with C-reactive protein, erythrocyte sedimentation rate, number of joints with active disease, number of joints with limited range of motion, physician's global assessment of disease activity, parent/patient global assessment of overall well-being, and childhood health assessment questionnaire score. Most interestingly, the baseline number of joints showing synovitis on US was increased in ACRpedi 50 response JIA patients compared to non-response JIA patients, and it serves as an independent predictive factor for higher clinical response to ETN treatment. In conclusion, US is a more sensitive test to evaluate subclinical synovitis and disease activity in JIA patients, and US synovitis might serve as a marker for predicting increased clinical response rate to ETN treatment.
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Affiliation(s)
- Li Zhou
- Wuhan Children's Hospital, Wuhan Maternal and Child Healthcare Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaojie Gu
- Department of Ultrasound, Children's Hospital of Nanjing Medical University, Nanjing, China
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Alis D, Erol BC, Akbas S, Barut K, Kasapcopur O, Adaletli I. Superb Microvascular Imaging Compared With Power Doppler Ultrasound in Assessing Synovitis of the Knee in Juvenile Idiopathic Arthritis: A Preliminary Study. JOURNAL OF ULTRASOUND IN MEDICINE 2019; 39:99-106. [PMID: 31222785 DOI: 10.1002/jum.15079] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 05/07/2019] [Accepted: 05/22/2019] [Indexed: 02/06/2023]
Affiliation(s)
- Deniz Alis
- Department of RadiologyIstanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital Halkali, Istanbul Turkey
| | - Burak Caglar Erol
- Department of RadiologyIstanbul University–Cerrahpasa, Cerrahpasa Faculty of Medicine KMPasa, Istanbul Turkey
| | - Serkan Akbas
- Department of RadiologyIstanbul University–Cerrahpasa, Cerrahpasa Faculty of Medicine KMPasa, Istanbul Turkey
| | - Kenan Barut
- Department of PediatricsIstanbul University–Cerrahpasa, Cerrahpasa Faculty of Medicine KMPasa, Istanbul Turkey
| | - Ozgur Kasapcopur
- Department of PediatricsIstanbul University–Cerrahpasa, Cerrahpasa Faculty of Medicine KMPasa, Istanbul Turkey
| | - Ibrahim Adaletli
- Department of PediatricsIstanbul University–Cerrahpasa, Cerrahpasa Faculty of Medicine KMPasa, Istanbul Turkey
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Ventura-Ríos L, Faugier E, Barzola L, De la Cruz-Becerra LB, Sánchez-Bringas G, García AR, Maldonado R, Roth J, Hernández-Díaz C. Reliability of ultrasonography to detect inflammatory lesions and structural damage in juvenile idiopathic arthritis. Pediatr Rheumatol Online J 2018; 16:58. [PMID: 30223838 PMCID: PMC6142317 DOI: 10.1186/s12969-018-0275-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 09/07/2018] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Musculoskeletal Ultrasonography (MSUS) is an important tool for the clinical assessment in Juvenile Idiopathic Arthritis (JIA). The objective of this study was to evaluate the reliability of MSUS to detect elementary lesions: synovitis, tenosynovitis, cartilage damage and bone erosions in the wrist and metacarpal (MCP) joints of patients with JIA. METHODS Thirty children in various subgroups of JIA according to ILAR criteria, were included in this cross-sectional study. Clinical data including painful, swollen and limited joints were recorded. Five rheumatologist ultrasonographers, blinded to the clinical evaluation, evaluated the presence of elementary lesions in the wrist and MCP 2 and 3 joints bilaterally. The synovitis was graded in B-Mode and Power Doppler (PD). In addition to descriptive statistics intra- and inter-observer reliability was calculated using Cohen's kappa according to Landis and Koch. RESULTS US detected more synovitis than the clinical examination (62% vs 28%, 30% vs 23% and 22% vs 17% in the wrist, second and third MCP joints respectively). The intra-observer concordance for synovitis in all joints was excellent in B-Mode (k 0.84 .63-1.0 p = 0.001), except for MCP 2, where it was good (0.61, IC 95% .34-89, p = 0.001). For both modalities (PD, B-Mode) tenosynovitis, cartilage damage and bone erosions it was also excellent. Regarding synovitis grading the concordance was excellent for all grades (0.83-1.0, IC 95% 0.51.1.0, p = 0.001), except for grade 1 where it was good (0.61, IC 95% 0.43-.83, p = 0.001). Reliability inter-observer for grayscale synovitis (0.67-0.95, IC 95% 0.67-1.0, p = 0.001), tenosynovitis grayscale (0.89, IC 95% 0.78-0.99, p.001), damage cartilage (0.89, IC 95% 0.78-0.99, p = 0.001), PD (0.66, IC 95% 0.39-1.0, p = 0.001). The concordance for grading synovitis was excellent, but for grayscale grade 1 and 2 (.66, IC 95% .53-.74, p = 0.007) and PD grade 1 and 2 (0.63, IC 95% .58-.91, p = 004) was good. CONCLUSIONS The intra- and inter-observer reliability of MSUS for inflammatory and structural lesions is good to excellent for the wrist and MCP in patients with JIA.
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Affiliation(s)
- Lucio Ventura-Ríos
- Laboratorio de ultrasonido musculoesquelético y articular, Instituto Nacional de Rehabilitación, Luis Guillermo Ibarra Ibarra, Calzada México-Xochimilco 289, Arenal de Guadalupe, Tlalpan, 14389, Mexico city, Mexico.
| | - Enrique Faugier
- 0000 0004 0633 3412grid.414757.4Reumatología Pediátrica, Hospital Infantil de México, Mexico city, Mexico
| | - Laura Barzola
- grid.414547.7Reumatología, Hospital de Niños Dr. Ricardo Gutiérrez, Buenos Aires, Argentina
| | - L. B. De la Cruz-Becerra
- 0000 0004 1760 058Xgrid.464574.0Hospital Universitario “Dr. José E. González”, UANL, Monterrey, Nuevo León Mexico
| | - Guadalupe Sánchez-Bringas
- 0000 0001 2159 0001grid.9486.3Embriology Department, Medicine School, Universidad Nacional Autónoma de Mexico, Mexico City, Mexico
| | - Andrés Rodríguez García
- 0000 0004 0633 3412grid.414757.4Reumatología Pediátrica, Hospital Infantil de México, Mexico city, Mexico
| | - Rocío Maldonado
- 0000 0004 0633 3412grid.414757.4Reumatología Pediátrica, Hospital Infantil de México, Mexico city, Mexico
| | - Johannes Roth
- 0000 0000 9402 6172grid.414148.cDivision of Pediatric Dermatology & Rheumatology, Children’s Hospital of Eastern Ontario, Ottawa, Canada
| | - Cristina Hernández-Díaz
- 0000 0004 0633 2911grid.419223.fLaboratorio de ultrasonido musculoesquelético y articular, Instituto Nacional de Rehabilitación, Luis Guillermo Ibarra Ibarra, Calzada México-Xochimilco 289, Arenal de Guadalupe, Tlalpan, 14389 Mexico city, Mexico
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