Ultrasonography and color Doppler in juvenile idiopathic arthritis: diagnosis and follow-up of ultrasound-guided steroid injection in the ankle region. A descriptive interventional study
| Autor: | Louise Laurell, Susan Nielsen, Michel Court-Payen, Anders Fasth, Mikael Boesen, Marek Zak |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2011 |
| Předmět: |
musculoskeletal diseases
medicine.medical_specialty lcsh:Diseases of the musculoskeletal system Arthritis Wrist Pediatrics Atrophy Rheumatology Internal medicine Synovitis medicine Deformity Immunology and Allergy Pediatrics Perinatology and Child Health business.industry Research lcsh:RJ1-570 lcsh:Pediatrics medicine.disease Tendon Surgery medicine.anatomical_structure Pediatrics Perinatology and Child Health Radiology medicine.symptom Ultrasonography lcsh:RC925-935 business |
| Zdroj: | Pediatric Rheumatology Online Journal, Vol 9, Iss 1, p 4 (2011) Pediatric Rheumatology Online Journal Pediatric Rheumatology; 9(1), no 4 (2011) |
| ISSN: | 1546-0096 |
| Popis: | Background The ankle region is frequently involved in juvenile idiopathic arthritis (JIA) but difficult to examine clinically due to its anatomical complexity. The aim of the study was to evaluate the role of ultrasonography (US) of the ankle and midfoot (ankle region) in JIA. Doppler-US detected synovial hypertrophy, effusion and hyperemia and US was used for guidance of steroid injection and to assess treatment efficacy. Methods Forty swollen ankles regions were studied in 30 patients (median age 6.5 years, range 1-16 years) with JIA. All patients were assessed clinically, by US (synovial hypertrophy, effusion) and by color Doppler (synovial hyperemia) before and 4 weeks after US-guided steroid injection. Results US detected 121 compartments with active disease (joints, tendon sheaths and 1 ganglion cyst). Multiple compartments were involved in 80% of the ankle regions. The talo-crural joint, posterior subtalar joint, midfoot joints and tendon sheaths were affected in 78%, 65%, 30% and 55% respectively. Fifty active tendon sheaths were detected, and multiple tendons were involved in 12 of the ankles. US-guidance allowed accurate placement of the corticosteroid in all 85 injected compartments, with a low rate of subcutaneous atrophy (4,7%). Normalization or regression of synovial hypertrophy was obtained in 89%, and normalization of synovial hyperemia in 89%. Clinical resolution of active arthritis was noted in 72% of the ankles. Conclusions US enabled exact anatomical location of synovial inflammation in the ankle region of JIA patients. The talo-crural joint was not always involved. Disease was frequently found in compartments difficult to evaluate clinically. US enabled exact guidance of steroid injections, gave a low rate of subcutaneous atrophy and was proved valuable for follow-up examinations. Normalization or regression of synovial hypertrophy and hyperemia was achieved in most cases, which supports the notion that US is an important tool in the management of ankle involvement in JIA. |
| Databáze: | OpenAIRE |
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