The detection of subclinical synovitis by ultrasound in oligoarticular juvenile idiopathic arthritis: a pilot study
| Autor: | Kirsty E. Haslam, Richard J. Wakefield, Susan Wyatt, Liza J. McCann |
|---|---|
| Rok vydání: | 2009 |
| Předmět: |
musculoskeletal diseases
Male medicine.medical_specialty Adolescent Hand Joints Arthritis Physical examination Rheumatology Internal medicine Synovitis Foot Joints medicine Humans Pharmacology (medical) Child Physical Examination Subclinical infection Ultrasonography medicine.diagnostic_test business.industry medicine.disease Arthritis Juvenile Surgery El Niño Child Preschool Female Oligoarticular Juvenile Idiopathic Arthritis business Epidemiologic Methods Juvenile rheumatoid arthritis |
| Zdroj: | Rheumatology (Oxford, England). 49(1) |
| ISSN: | 1462-0332 |
| Popis: | Adult studies have demonstrated that ultrasonography (US) is more sensitive at detecting synovitis than clinical examination. The detection of subclinical disease has implications for deciding which patients receive more aggressive therapy from the outset. This study aimed to determine whether children with clinically diagnosed oligoarticular juvenile idiopathic arthritis (JIA) had US-detectable subclinical synovitis.This was a cross-sectional pilot study conducted in a tertiary paediatric rheumatology clinic. Seventeen children with a median age of 10 years (range 3-13 years) and with oligoarticular disease of duration12 months (median 5 months) were recruited. All subjects were DMARD and oral/i.v. corticosteroid naïve. A core set of 40 joints was clinically examined for synovitis and then scanned by a rheumatologist trained in joint US and blinded to all clinical data, at the same appointment.In total, 680 joints were examined both clinically and by US. Twenty-three joints were found to have clinical synovitis, and of these only 17 had synovitis confirmed by US. A further 15 joints were found to have synovitis on US examination alone. Overall, subclinical synovitis was detected in 6/17 children, mostly in the hands and feet. One child was reclassified as having polyarticular disease.This pilot study has highlighted a discrepancy between clinical examination and ultrasound when assessing the joints of children with JIA. US is a feasible tool for examining multiple joints and identifying subclinical synovitis, particularly when considering the small joints of the hands and feet. |
| Databáze: | OpenAIRE |
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