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Ehlers L, Rolfes E, Lieber M, Müller D, Lainka E, Gohar F, Klaus G, Girschick H, Hörstermann J, Kümmerle-Deschner J, Brunner J, Palm-Beden K, Tenbrock K, von Wrangel L, Faßhauer M, Blank N, Trauzeddel R, von Stuckrad ASL, Higgins S, Welzel T, Lutz T, Hentgen V, Foell D, Wittkowski H, Kallinich T. Treat-to-target strategies for the management of familial Mediterranean Fever in children. Pediatr Rheumatol Online J 2023; 21:108. [PMID: 37752496 PMCID: PMC10521475 DOI: 10.1186/s12969-023-00875-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 08/11/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND The objective of this initiative was to develop a treat-to-target (T2T) approach for the management of patients with Familial Mediterranean Fever (FMF), including the definition of a complex treatment target, and establish strategies that improve patient care and long-term outcome. METHODS An initial set of statements as well as a flow chart visualising the proposed concept was developed. To adapt the preliminary statements to the current state of knowledge, a systematic literature search was performed and the modified statements were subject to a Delphi approach. To ensure the applicability of the statements in daily practice, an online survey was conducted among paediatric rheumatologists in Germany. In addition, data from the national AID-NET registry were analysed with respect to therapeutic response. RESULTS This T2T initiative yielded a total of 26 statements guiding FMF management with respect to diagnosis, treatment targets, treatment strategies and monitoring. The online survey identified cut-off values for inflammatory markers indicating treatment intensification and appropriate measures in case of colchicine intolerance or non-adherence. The analysis of data derived from the national AID-NET showed that colchicine therapy was successfully terminated in 61% of patients (27 out of 44) with heterozygous MEFV mutations. Multidimensional treatment targets incorporating objective and subjective reported outcome measures were developed. These provide the basis for stratifying patients into the following treatment paths: continue colchicine, persisting attacks / inflammation, colchicine intolerance, persisting arthritis, colchicine reduction and adjustment/reduction of biologics. CONCLUSIONS The proposed consensus treatment plan for the management of FMF incorporates multidimensional targets allowing transparent treatment decisions, which will promote personalised disease management and increase adherence to therapy.
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Affiliation(s)
- Lisa Ehlers
- Department of Paediatric Pulmonology, Immunology and Critical Care Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Elisabeth Rolfes
- Department of Paediatric Pulmonology, Immunology and Critical Care Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Mareike Lieber
- Department of Paediatric Pulmonology, Immunology and Critical Care Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Dominik Müller
- Department of Paediatrics, Division of Gastroenterology, Nephrology and Metabolic Diseases, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Elke Lainka
- Department of Paediatrics II, University Hospital Essen, Children's Hospital, Essen, Germany
| | - Faekah Gohar
- Clinic of Paediatric and Adolescent Rheumatology, St. Josef-Stift Sendenhorst, Northwest German Center for Rheumatology, Sendenhorst, Germany
| | - Günter Klaus
- KfH Center of Paediatric Nephrology, Department of Paediatric Nephrology, Marburg, Germany
| | - Hermann Girschick
- Vivantes Klinikum Friedrichshain, Children's Hospital, Berlin, Germany
| | - Jana Hörstermann
- Deutsches Rheuma-Forschungszentrum (DRFZ), An Institute of the Leibniz Association, Berlin, Germany
| | - Jasmin Kümmerle-Deschner
- Autoinflammation Reference Center Tübingen (arcT), Division of Paediatric Rheumatology, Department of Paediatrics, University Hospital Tübingen, Tübingen, Germany
| | - Jürgen Brunner
- Department of Paediatrics, Medical University Innsbruck, Danube Private University, Innsbruck, Krems, Austria
| | - Katharina Palm-Beden
- Clinic of Paediatric and Adolescent Rheumatology, St. Josef-Stift Sendenhorst, Northwest German Center for Rheumatology, Sendenhorst, Germany
| | - Klaus Tenbrock
- Department of Paediatric Pneumology, Allergology and Immunology, RWTH Aachen, Aachen, Germany
| | | | - Maria Faßhauer
- ImmunoDeficiencyCenter Leipzig (IDCL), Hospital St. Georg GmbH Leipzig, Academic Teaching Hospital of the University of Leipzig, Leipzig, Germany
| | - Norbert Blank
- Department of Hematology, Oncology and Rheumatology, Internal Medicine V, University Hospital of Heidelberg, Heidelberg, Germany
| | - Ralf Trauzeddel
- Department of Paediatrics, Helios Klinikum Berlin-Buch, Berlin, Germany
| | - Anne Sae Lim von Stuckrad
- Department of Paediatric Pulmonology, Immunology and Critical Care Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Sonja Higgins
- Paediatric medical practice Hürthpark, Hürth, Germany
| | - Tatjana Welzel
- Autoinflammation Reference Center Tübingen (arcT), Division of Paediatric Rheumatology, Department of Paediatrics, University Hospital Tübingen, Tübingen, Germany
- Paediatric Pharmacology and Pharmacometrics, University Children's Hospital Basel (UKBB), University Basel, Basel, Switzerland
| | - Thomas Lutz
- Center for Rheumatology, Paediatric Rheumatology, Heidelberg, Germany
| | - Véronique Hentgen
- Department of Paediatrics, National Reference Center for Auto-inflammatory Diseases and Amyloidosis, CEREMAIA, Versailles Hospital, Versailles, France
| | - Dirk Foell
- Department of Paediatric Rheumatology and Immunology, University Hospital Münster, Münster, Germany
| | - Helmut Wittkowski
- Department of Paediatric Rheumatology and Immunology, University Hospital Münster, Münster, Germany
| | - Tilmann Kallinich
- Department of Paediatric Pulmonology, Immunology and Critical Care Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
- Deutsches Rheuma-Forschungszentrum (DRFZ), An Institute of the Leibniz Association, Berlin, Germany.
- Berlin Institute of Health (BIH), Berlin, Germany.
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Theodoropoulou K, Wittkowski H, Busso N, Von Scheven-Gête A, Moix I, Vanoni F, Hengten V, Horneff G, Haas JP, Fischer N, Palm-Beden K, Berendes R, Heubner G, Jansson A, Lainka E, Leimgruber A, Morris M, Foell D, Hofer M. Increased Prevalence of NLRP3 Q703K Variant Among Patients With Autoinflammatory Diseases: An International Multicentric Study. Front Immunol 2020; 11:877. [PMID: 32477355 PMCID: PMC7241420 DOI: 10.3389/fimmu.2020.00877] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 04/16/2020] [Indexed: 12/23/2022] Open
Abstract
Background: The NLRP3 inflammasome has been recognized as one of the key components of innate immunity. Gain-of-function mutations in the exon 3 of NLRP3 gene have been implicated in inflammatory diseases suggesting the presence of functionally important sites in this region. Q703K (c.2107C>A, p.Gln703Lys, also known in the literature as Q705K) is a common variant of NLRP3, that has been considered to be both clinically unremarkable or disease-causing with a reduced penetrance. Objectives: We aimed to investigate the potential genetic impact of the NLRP3 variant Q703K in patients with recurrent fever presenting with two autoinflammatory diseases: PFAPA (periodic fever, aphthous stomatitis, pharyngitis and cervical adenitis) and CAPS (cryopyrin-associated periodic syndrome), as well as with undefined autoinflammatory disease (uAID). Methods: This is an international multicentric observational retrospective study characterizing the clinical phenotype of patients presenting with recurrent fever suspected to be of auto-inflammatory origin and where the Q703K NLRP3 variant was found. Monocytes of parents of 6 Q703K+ PFAPA patients were studied and levels of pro-inflammatory cytokines produced by monocytes of Q703K+ and Q703K- parents have been compared by ELISA. Results: We report 42 patients with the Q703K NLRP3 genetic variant: 21 were PFAPA patients, 6 had a CAPS phenotype, and 15 had an uAID. The phenotypes of PFAPA, CAPS and uAID were quite similar between Q703K positive and negative patients with the exception of increased prevalence of pharyngitis in the Q703K positive CAPS population compared to the negative one. The in vitro production of IL-1β was not significantly different between Q703K+ and Q703K- monocytes from asymptomatic parents. Conclusion: The evidence we report in our study shows an increased prevalence of NLRP3 Q703K in patients with autoinflammatory diseases, suggesting an association between the Q703K variant and the risk of PFAPA, CAPS and uAID syndromes. However, we did not show a functional effect of this mutation on the inflammasome basal activity.
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Affiliation(s)
- Katerina Theodoropoulou
- Pediatric Rheumatology Unit of Western Switzerland, Pediatric Department, Lausanne University Hospital (CHUV), Lausanne, Switzerland.,Pediatric Department, Geneva University Hospital (HUG), Geneva, Switzerland.,Department of Biochemistry, University of Lausanne (UNIL), Lausanne, Switzerland
| | - Helmut Wittkowski
- Department of Pediatric Rheumatology and Immunology, University Children's Hospital, Muenster, Germany
| | - Nathalie Busso
- Service of Rheumatology, DAL, Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
| | - Annette Von Scheven-Gête
- Pediatric Rheumatology Unit of Western Switzerland, Pediatric Department, Lausanne University Hospital (CHUV), Lausanne, Switzerland.,Pediatric Department, Geneva University Hospital (HUG), Geneva, Switzerland
| | - Isabelle Moix
- Department of Genetics, SYNLAB, Lausanne, Switzerland
| | - Federica Vanoni
- Pediatric Rheumatology Unit of Western Switzerland, Pediatric Department, Lausanne University Hospital (CHUV), Lausanne, Switzerland.,Pediatric Department, Geneva University Hospital (HUG), Geneva, Switzerland.,Istituto Pediatrico Della Svizzera Italiana, Bellinzona, Switzerland
| | - Veronique Hengten
- Department of General Pediatrics, French Reference Center for Autoinflammatory Diseases (CEREMAIA), Versailles Hospital, Versailles, France
| | - Gerd Horneff
- Asklepios Children's Hospital, St. Augustin, Germany
| | - Johannes-Peter Haas
- German Center for Pediatric and Adolescent Rheumatology, Garmisch-Partenkirchen, Germany
| | - Nadine Fischer
- German Center for Pediatric and Adolescent Rheumatology, Garmisch-Partenkirchen, Germany
| | - Katharina Palm-Beden
- Department of Pediatric Rheumatology, St. Josef-Stift Sendenhorst, Sendenhorst, Germany
| | - Rainer Berendes
- Departement of Pediatric Rheumatology, St. Marien-Childrens-Hospital Landshut, Landshut, Germany
| | - Georg Heubner
- Departement of Pediatrics, Städtisches Klinikum Dresden, Dresden, Germany
| | - Annette Jansson
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital LMU Munich, Munich, Germany
| | - Elke Lainka
- Division of Pediatric Rheumatology, University Hospital Essen, Essen, Germany
| | - Annette Leimgruber
- Service of Immunology and Allergology, Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
| | | | - Dirk Foell
- Department of Pediatric Rheumatology and Immunology, University Children's Hospital, Muenster, Germany
| | - Michaël Hofer
- Pediatric Rheumatology Unit of Western Switzerland, Pediatric Department, Lausanne University Hospital (CHUV), Lausanne, Switzerland.,Pediatric Department, Geneva University Hospital (HUG), Geneva, Switzerland
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3
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Wolf C, Brück N, Koss S, Griep C, Kirschfink M, Palm-Beden K, Fang M, Röber N, Winkler S, Berner R, Latz E, Günther C, Lee-Kirsch MA. Janus kinase inhibition in complement component 1 deficiency. J Allergy Clin Immunol 2020; 146:1439-1442.e5. [PMID: 32325142 DOI: 10.1016/j.jaci.2020.04.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 03/26/2020] [Accepted: 04/03/2020] [Indexed: 12/31/2022]
Affiliation(s)
- Christine Wolf
- Department of Pediatrics, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Normi Brück
- Department of Pediatrics, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Sarah Koss
- Department of Pediatrics, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Constanze Griep
- Department of Pediatrics, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Michael Kirschfink
- Institute for Immunology, Universitätsklinikum Heidelberg, University of Heidelberg, Heidelberg, Germany
| | - Katharina Palm-Beden
- Klinik für Kinder- und Jugendrheumatologie, St Josef-Stift, Sendenhorst, Germany
| | - Mingyan Fang
- BGI Shenzhen and China National Genebank, Shenzhen, China
| | - Nadja Röber
- Institute for Immunology, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Stefan Winkler
- Department of Pediatrics, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Reinhard Berner
- Department of Pediatrics, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Eike Latz
- Institute of Innate Immunity, University of Bonn, Bonn, Germany
| | - Claudia Günther
- Department of Dermatology, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Min Ae Lee-Kirsch
- Department of Pediatrics, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
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4
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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5
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Trauzeddel RF, Lehmann H, Windschall D, Ganser G, Berendes R, Haller M, Krumrey-Langkammerer M, Palm-Beden K, Nimtz-Talaska A, Nirschl C, Schoof P, Trauzeddel R. Age-dependent arthrosonographic reference values of the hip joint in healthy children and adolescents - a cross-sectional multicenter ultrasound study. Pediatr Radiol 2017; 47:1329-1336. [PMID: 28547137 DOI: 10.1007/s00247-017-3862-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 03/16/2017] [Accepted: 04/09/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Musculoskeletal US is a noninvasive imaging method for diagnosing and monitoring inflammatory rheumatic diseases. OBJECTIVES To develop age- and gender-related arthrosonographic reference intervals for the hip joint of healthy children and adolescents. MATERIALS AND METHODS In a cross-sectional US study, we examined both hip joints of 445 children and adolescents with an age range of 1 year to 18 years. We measured the distance between the bone surface and the outer margin of the joint capsule to define the bone-capsule distance, the joint capsule and cartilage thickness, and the capsule layer thickness. Reference values were calculated. The shape of the joint capsule and bone-capsule junction zone were analyzed qualitatively. An intraobserver analysis was performed. RESULTS Bone-capsule distance, capsule thickness and the anterior capsule layer increase with age. In contrast, joint cartilage decreases. The posterior capsule layer exhibited constant thickness across all age groups. The difference between both body sides and gender was collectively less than 0.5 mm. The intraobserver variations were within the calculated reference intervals. The insertion of the capsule to the bone was mostly a peaked one. The capsule shape had a convex or straight configuration in a neutral position and a concave position during outward rotation. The intraobserver analysis revealed good to very good concordance. CONCLUSION We propose age- and gender-related reference intervals for the bone-capsule distance, joint capsule and cartilage thickness of the hip.
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Affiliation(s)
- Ralf Felix Trauzeddel
- Department of Anesthesiology and Intensive Care Medicine, Campus Charite Mitte and Campus Virchow-Klinikum, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - Hartwig Lehmann
- Department of Pediatrics, University Medicine Gießen, Feulgenstraße 10-12, 35392, Gießen, Germany
| | - Daniel Windschall
- Department of Pediatrics, Asklepios Hospital Weissenfels, Naumburger Straße 76, 06667, Weissenfels, 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
| | - Maria Haller
- Pediatrics and Adolescents Practice, Alte Bundestraße 37, 79194, Gundelfingen, Germany
| | - Manuela Krumrey-Langkammerer
- German Center for Pediatric and Adolescent Rheumatology, Gehfeldstraße 24, 82467, Garmisch-Partenkirchen, 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
| | | | - Christine Nirschl
- Department of Pediatrics, Asklepios Hospital Weissenfels, Naumburger Straße 76, 06667, Weissenfels, Germany
| | - Phillip Schoof
- Pediatric Practice Dr. Simon & Philipp Schoof, Cosimastraße 133, 81925, Munich, Germany
| | - Ralf Trauzeddel
- Department of Pediatric and Adolescent Medicine, Helios Hospital Berlin - Buch, Schwanebecker Chaussee 50, 13125, Berlin, Germany
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6
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Trauzeddel R, Windschall D, Trauzeddel RF, Nirschl C, Ganser G, Palm-Beden K, Berendes R, Haller M, Krumrey-Langkammerer M, Nimtz-Talaska A, Schoof P, Lehmann H. Arthrosonographic Reference Values of the Shoulder Joint in Healthy Children and Adolescents: A Cross-Sectional Multicentre Ultrasound Study. Klin Padiatr 2017; 229:293-301. [PMID: 28837973 DOI: 10.1055/s-0043-111596] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Background Defining of gray scale ultrasound standard reference values of the shoulder joint in childhood and adolescence during maturation. PATIENTS We examined 445 healthy girls and boys between 1 year and 18 years of age. Method A cross-sectional multicentre grey-scale ultrasound study was performed to examine the shoulder joint on both sides. The children were divided according to their gender and were further classified into six age groups, which constituted three-year age ranges, to record anatomical development changes. We measured the capsule-bone distance (BCD) as a representation of the intracapsular cavity, as well as the thickness of the joint capsule and joint cartilage. Values were expressed in mean±standard deviation (SD) and minimum-maximum (min-max). The shape of the joint capsule and capsule-bone junction zone was qualitatively analysed. Results The joint cartilage thickness decreased with increasing age in all joints independently from sex and body side. However, the BCD and the capsule thickness increased with age. There was no intraarticular fluid visible. The joint capsule had a predominantly concave form, whereas the capsule-bone junction was mostly sharp. Discussion This study is the first describing age-related normal values of the intracapsular cavity, joint capsule and cartilage thickness as well as their respective shape in a large cohort of healthy children. Conclusion The findings could be helpful to differentiate between physiological and pathological joint conditions and thereby distinguishing age-related variations from alterations caused by inflammation.
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Affiliation(s)
- Ralf Trauzeddel
- Department of Pediatric Rheumatology, Helios Hospital Berlin-Buch, Berlin, Germany
| | - Daniel Windschall
- Department of Pediatrics, Asklepios Hospital Weißenfels, Weißenfels, Germany
| | - Ralf Felix Trauzeddel
- Department of Anesthesiology and Intensive Care Medicine, Campus Mitte and Virchow Klinkum Charite, University Medicine Berlin, Berlin, Germany
| | - Christine Nirschl
- Department of Pediatrics, Asklepios Hospital Weißenfels, Weißenfels, Germany
| | - Gerd Ganser
- Department of Pediatric and Adolescent Rheumatology, St. Josef-Stift Sendenhorst, Sendenhorst, Germany
| | - Katharina Palm-Beden
- Department of Pediatric and Adolescent Rheumatology, St. Josef-Stift Sendenhorst, Sendenhorst, Germany
| | - Rainer Berendes
- Department of Pediatric Rheumatology, St. Marien's Children's Hospital, Landshut, Germany
| | - Maria Haller
- Practice for Pediatrics and Pediatric Rheumatology Gundelfingen, Germany
| | | | | | - Philipp Schoof
- Practice for Pediatrics and Pediatric Rheumatology, Munich, Germany
| | - Hartwig Lehmann
- Department of Pediatrics, Justus Liebig University Giessen, Giessen, Germany
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7
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Windschall D, Trauzeddel R, Haller M, Krumrey-Langkammerer M, Nimtz-Talaska A, Berendes R, Ganser G, Nirschl C, Schoof P, Trauzeddel RF, Palm-Beden K, Lehmann H. Pediatric musculoskeletal ultrasound: age- and sex-related normal B-mode findings of the knee. Rheumatol Int 2016; 36:1569-1577. [PMID: 27401002 DOI: 10.1007/s00296-016-3528-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 07/05/2016] [Indexed: 10/21/2022]
Abstract
Musculoskeletal ultrasound (MSUS) is an important tool for evaluating disease activity, therapeutic progress, and remission status of rheumatic diseases in children. Knowledge of age-related normal findings is essential when interpreting pathological findings such as those seen in juvenile idiopathic arthritis. To evaluate normal findings of the knee joint, we recorded age-related stages of musculoskeletal development in the knee of 435 healthy children between 1 and 18 years of age using high-resolution B-mode MSUS. We determined approximate age- and sex-related norms for the suprapatellar recess size, ossified patella size, and distal femoral intercondylar cartilage thickness. In almost all age-groups, over 64 % of children had visible fluid accumulation in the suprapatellar recess. Significant correlations were found between chronological age and the suprapatellar recess size and ossified patella length (p < 0.05). An age-dependent decrease in intercondylar cartilage thickness of the distal femoral epiphysis was found in children between 10 and 18 years of age. High-resolution B-mode MSUS is an excellent tool for assessing joint and skeletal development in children. Our reference data can be used to discriminate better between normal physiological findings and pathological abnormalities.
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Affiliation(s)
- Daniel Windschall
- Department of Pediatrics, Asklepios Hospital Weissenfels, Naumburger-Strasse 76, 06667, Weissenfels, Germany.
| | - Ralf Trauzeddel
- Department of Pediatric Rheumatology, Helios Klinikum Berlin-Buch, Schwanebecker Chaussee 50, 13125, Berlin, Germany
| | - Maria Haller
- Practice for Pediatrics and Pediatric Rheumatology, Alte Bundesstrasse 37, 79194, Gundelfingen, Germany
| | | | - Antje Nimtz-Talaska
- Practice for Pediatrics and Pediatric Rheumatology, Am Kleistpark 1, 15230, Frankfurt (Oder), Germany
| | - Rainer Berendes
- Department of Pediatric Rheumatology, St. Marien Children's Hospital, Grillparzerstrasse 9, 84036, Landshut, Germany
| | - Gerd Ganser
- Clinic for Pediatric Rheumatology, St. Josef Stift, Westtor 7, 48324, Sendenhorst, Germany
| | - Christine Nirschl
- Department of Pediatrics, Asklepios Hospital Weissenfels, Naumburger-Strasse 76, 06667, Weissenfels, Germany
| | - Philipp Schoof
- Practice for Pediatrics and Pediatric Rheumatology, Cosimastrasse 133, 81925, Munich, Germany
| | | | - Katharina Palm-Beden
- Clinic for Pediatric Rheumatology, St. Josef Stift, Westtor 7, 48324, Sendenhorst, Germany
| | - Hartwig Lehmann
- Department for Pediatric Rheumatology, Clinic for Pediatrics and Neonatology, Justus Liebig-University Giessen, Feulgenstrasse 10-12, 35392, Giessen, Germany
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