scholarly journals Ultrasound versus physical examination in predicting disease flare in children with juvenile idiopathic arthritis: a systematic literature review and qualitative synthesis

2022 ◽  
Author(s):  
Orazio De Lucia ◽  
Teresa Giani ◽  
Roberto Caporali ◽  
Rolando Cimaz
Keyword(s):  
Systematic Review ◽  
Juvenile Idiopathic Arthritis ◽  
Pediatric Rheumatology ◽  
Power Doppler ◽  
The Other ◽  
Qualitative Synthesis ◽  
Disease Flare ◽  
Power Doppler Signal ◽  
Subclinical Synovitis

In this systematic review we analyzed the published articles related to the predictive value for flare of subclinical synovitis assessed by ultrasound (US) in juvenile idiopathic arthritis (JIA). Medline, Embase and Cochrane databases were searched from 1990 to 2020 by two authors, using PICO methodology. The study is built and reported according to PRISMA guidelines. Searches identified four articles comprising a total of 187 JIA patients in clinical remission from at least 3 months. Two of the articles found US subclinical signs of synovitis to be predictive for flare, with a five times higher risk (with Power Doppler signal as an important feature), while in the other two baseline US abnormalities did not predict a clinical flare. The articles differed for protocols, definitions, and length of follow-up. US has an expanding role in pediatric rheumatology, with interest-ing applications especially during the follow-up, potentially identifying subclinical inflammatory signs predictive of flare. However, the few studies available do not allow definite conclusions at this time.

scholarly journals OP0161 PREDICTIVE VALUE OF MUSCULOSKELETAL ULTRASOUND IN PATIENTS WITH JUVENILE IDIOPATHIC ARTHRITIS IN CLINICAL REMISSION

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 97.2-97
Author(s):  
M. Mazzoni ◽  
S. Merlo ◽  
C. Morreale ◽  
A. Pistorio ◽  
S. Viola ◽  
...  
Keyword(s):  
Juvenile Idiopathic Arthritis ◽  
Clinical Remission ◽  
Structural Damage ◽  
Power Doppler ◽  
Musculoskeletal Ultrasound ◽  
Inactive Disease ◽  
Disease Flare ◽  
Subclinical Synovitis

Background:The accurate assessment of remission status in JIA patients is of utmost relevance to taper medications and prevent side effects from their long-term administration. In RA patients in clinical remission (CR), musculoskeletal ultrasound (MSUS) allows to detect persistent joint inflammation (subclinical synovitis), which predicts disease flare and structural damage progression. Although subclinical synovitis has been reported in a substantial proportion of JIA patients with inactive disease, its prognostic value is still being defined.Objectives:1) to investigate the prevalence of MSUS-detected subclinical synovitis in JIA patients in CR; 2) to establish which and how many joints should be scanned to reliably assess remission; 3) to evaluate the persistence of subclinical synovitis over the time; 4) to investigate whether subclinical synovitis entails a risk of disease flare and whether it should affect the therapeutic strategy.Methods:135 consecutive JIA patients who met the Wallace criteria for CR were included in this 3-years prospective study. All patients underwent MSUS assessment of 56 joints at study entry and at 6 months follow-up visit. Joints were scanned for synovial hyperplasia, joint effusion and Power Doppler (PD) signal by two independent ultrasonographers. Patients were followed clinically for 3 years. A flare of synovitis was defined as a recurrence of clinically active arthritis. The association between clinical and MSUS variables with flare, was evaluated by adjusted logistic regression models.Results:135 patients (78.5% F; median age 11.3 y; median disease duration 5.7 y; median CR duration 1.4 y) were included. Fifty-seven/135 (42.2%) patients had persistent oligoarthiritis; 41/135 (30.4%) extended oligoarthiritis; 32/135 (23.7%) polyarthiritis; 5/135 (3.7%) systemic arthritis. Seventy-eight/135 (57.7%) patients were in CR on medication. Subclinical synovitis was detected in 32/135 (23.7%) patients and in 53/7560 (0.7%) joints. Subclinical tenosynovitis was present in 20/135 (14.8%) patients. Subclinical synovitis was found more frequently in the ankle and wrist joints. 58.6% of patients showed persistent subclinical synovitis at 6 month follow up MSUS examination. During the 3-year follow up 45/135 (33.3%) patients experienced a disease flare (median survival time 2.2 y). PD positivity in tendons was the stronger independent risk factor of flare on multivariable regression analysis (HR: 4.8; P=0.04). Other predictors of flare were the JIA subtype (oligo-extended form: HR: 2.3; P=0.031) and the status of CR on medication (HR: 3.7; P=0.002).Conclusion:our results confirm that MSUS is more sensitive than clinical evaluation in the assessment of persistent synovial inflammation in JIA patients. Subclinical tenosynovitis was the best predictor of disease flare. To date, the role of tenosynovitis in the diagnosis and prognosis of JIA has been poorly investigated. Our results further support the role of MSUS, especially of the wrist and the ankle, in monitoring JIA patients in clinical remission and to predict disease flare.References:[1]De Lucia O, et al. Baseline ultrasound examination as possible predictor of relapse in patients affected by juvenile idiopathic arthritis (JIA). Ann Rheum Dis. 2018 Oct;77(10):1426-1431.[2]Filippou G, et al. The predictive role of ultrasound-detected tenosynovitis and joint synovitis for flare in patients with rheumatoid arthritis in stable remission. Results of an Italian multicentre study of the Italian Society for Rheumatology Group for Ultrasound: the STARTER study. Ann Rheum Dis 2018;77:1283-9.Disclosure of Interests:None declared

scholarly journals Ultrasound erosions in the feet best predict progression to inflammatory arthritis in anti-CCP positive at-risk individuals without clinical synovitis

2020 ◽  
Vol 79 (7) ◽  
pp. 901-907 ◽  
Author(s):  
Andrea Di Matteo ◽  
Kulveer Mankia ◽  
Laurence Duquenne ◽  
Edoardo Cipolletta ◽  
Richard J Wakefield ◽  
...  
Keyword(s):  
At Risk ◽  
Inflammatory Arthritis ◽  
Power Doppler ◽  
High Titre ◽  
Peptide Antibody ◽  
Clinical Arthritis ◽  
Citrullinated Peptide ◽  
Power Doppler Signal ◽  
Subclinical Synovitis

ObjectivesTo investigate, in anti-cyclic citrullinated peptide antibody positive (CCP+) at-risk individuals without clinical synovitis, the prevalence and distribution of ultrasound (US) bone erosions (BE), their correlation with subclinical synovitis and their association with the development of inflammatory arthritis (IA).MethodsBaseline US scans of 419 CCP+ at-risk individuals were analysed. BE were evaluated in the classical sites for rheumatoid arthritis damage: the second and fifth metacarpophalangeal (MCP2 and MCP5) joints, and the fifth metatarsophalangeal (MTP5) joints. US synovitis was defined as synovial hypertrophy (SH) ≥2 or SH ≥1+power Doppler signal ≥1. Subjects with ≥1 follow-up visit were included in the progression analysis (n=400).ResultsBE were found in ≥1 joint in 41/419 subjects (9.8%), and in 55/2514 joints (2.2%). The prevalence of BE was significantly higher in the MTP5 joints than in the MCP joints (p<0.01). A significant correlation between BE and US synovitis in the MTP5 joints was detected (Cramer’s V=0.37, p<0.01). The OR for the development of IA (ever) was highest for the following: BE in >1 joint 10.6 (95% CI 1.9 to 60.4, p<0.01) and BE and synovitis in ≥1 MTP5 joint 5.1 (95% CI 1.4 to 18.9, p=0.02). In high titre CCP+ at-risk individuals, with positive rheumatoid factor and BE in ≥1 joint, the OR increased to 16.9 (95% CI 2.1–132.8, p<0.01).ConclusionsIn CCP+ at-risk individuals, BE in the feet appear to precede the onset of clinical synovitis. BE in >1 joint, and BE in combination with US synovitis in the MTP5 joints, are the most predictive for the development of clinical arthritis.

scholarly journals AB0189 ASSESSMENT OF POWER DOPPLER SYNOVITIS IN RHEUMATOID ARTHRITIS PATIENTS WITH CLINICAL REMISSION

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1394.2-1394
Author(s):  
R. Fakhfakh ◽  
N. El Amri ◽  
K. Baccouche ◽  
H. Zeglaoui ◽  
E. Bouajina
Keyword(s):  
Rheumatoid Arthritis ◽  
Functional Capacity ◽  
Clinical Remission ◽  
Power Doppler ◽  
Health Assessment ◽  
Disease Flare ◽  
Synovial Hypertrophy ◽  
The Mean ◽  
Grade 3 ◽  
Subclinical Synovitis

Background:Ultrasound-detected synovitis, mainly synovial Doppler signal, has shown predictive value in relation to radiographic damage progression and disease flare or relapse in rheumatoid arthritis (RA) patients with clinical remission.Objectives:The aim of the study was to analyze the correlation between power Doppler scores and clinical/laboratory and radiographic data in clinical remission RA patients.Methods:Cross-sectional study including patients with RA in clinical remission defined by: DAS28ESR ≤ 2.6, without disease flare or changes in therapy in the previous 6 months. Each patient underwent ultrasound: B-mode and PD assessments of 36 joints and 20 tendons in the Rheumatology Department over a period of 6 month. Synovitis and tenosynovitis were defined and scored according to the Outcome Measures in Rheumatology Clinical Trials (OMERACT). Radiological measurements included the modified Sharp/van der Heijde method (SHS). Functional capacity was assessed by the Health Assessment Questionnaire (HAQ).Results:Thirty two patients were enrolled, the mean age was 53.7±13.4 and 75% were female. The mean disease duration was 15 years ± 8.8. Subclinical synovitis were the most frequent in wrist (56.3%), 2ndmetacarpophalangeal joints (28.1%) and 2ndmetatarsophalangeal joints (29%). The mean subclinical synovitis/ tenosynovitis numbers was 4±3.1 per patient. Synovial hypertrophy and B mode tenosynovitis were detected in 93.8%: 71.3% had a grade = 2 and 9.8% had a grade= 3. Total B mode score was correlated only with the SHS score in the feet (r: 0.4, p: 0.03). PD signal was detected in 62.5% of patients: 37.5% had a grade =2 and 9.4% had a grade= 3. Total PD score was correlated with DAS28 (r:0.42, p:0.02), the SHS score in the hands (r:0.39, p:0.03) and in the feet (r:0.5, p:0.007), synovial hypertrophy (r:0.6, p:0.0001) and HAQ (r:0.32, p:0.06). No correlation was found with CDAI, SDAI, swollen joint counts, tender joint counts, patient global health assessment, erythrocyte sedimentation rate, C-reactive protein, rheumatoid factor and anti-cyclic citrullinated peptide, biologic treatment.Conclusion:Synovial hypertrophy and PD signal were frequent in RA remission. PD signal was associated with RA activity, radiologic damage and functional capacity.References:[1]Yan Geng & Jingjing Han & Xuerong Deng and al. Presence of power Doppler synovitis in rheumatoid arthritis patients with synthetic and/or biological disease-modifying anti-rheumatic drug-induced clinical remission: experience from a Chinese cohort. Clinical Rheumatology 2014. DOI 10.1007/s10067-014-2634-yDisclosure of Interests:None declared

scholarly journals A Systematic Review of the Inclusion of Non-Inflammatory Ultrasonographic Enthesopathy Findings in Enthesitis Scoring Indices

Diagnostics ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. 669
Author(s):  
Sheryl Mascarenhas ◽  
Nina Couette
Keyword(s):  
Systematic Review ◽  
Inflammatory Disease ◽  
Power Doppler ◽  
Scoring Systems ◽  
Doppler Signal ◽  
Diagnosis And Management ◽  
Inflammatory Conditions ◽  
Rheumatic Conditions ◽  
Cardinal Feature ◽  
Power Doppler Signal

Ultrasound has advanced the diagnosis and management of patients with inflammatory rheumatic conditions. It can be used to identify and monitor enthesitis, a cardinal feature of spondyloarthropthies. Several enthesitis scoring systems utilizing ultrasound to determine entheseal involvement have been developed. These scoring systems generally rely on determining the presence or absence of erosions, tendon enlargement, power Doppler signal, or enthesophytes. This systematic review identified ultrasound scoring systems that have been utilized for evaluating enthesitis and what key components derive the score. Review of these scoring systems, however, demonstrated confounding as some of the score components including enthesophytes may be seen in non-inflammatory conditions and some components including erosions can be seen from chronic damage, but not necessarily indicate active inflammatory disease. What is furthermore limiting is that currently there is not an agreed upon term to describe non-inflammatory enthesopathies, further complicating these scoring systems. This review highlights the need for a more comprehensive ultrasound enthesopathy scoring index.

Baseline ultrasound examination as possible predictor of relapse in patients affected by juvenile idiopathic arthritis (JIA)

2018 ◽  
Vol 77 (10) ◽  
pp. 1426-1431 ◽  
Author(s):  
Orazio De Lucia ◽  
Viviana Ravagnani ◽  
Francesca Pregnolato ◽  
Arvena Hila ◽  
Irene Pontikaki ◽  
...  
Keyword(s):  
Juvenile Idiopathic Arthritis ◽  
Rheumatoid Factor ◽  
Strong Predictor ◽  
Power Doppler ◽  
Joint Effusion ◽  
Synovial Hyperplasia ◽  
Individual Patient Level ◽  
Grey Scale ◽  
Therapy Modification

ObjectivesTo define the correlation between joint ultrasonography and clinical examination in patients with juvenile idiopathic arthritis (JIA) and to assess whether synovitis detected by ultrasonography in clinically inactive patients predicts arthritis flares.Methods88 consecutive patients with JIA—46 (52%) with persistent oligoarthritis, 15 (17%) with extended oligoarthritis, 15 (17%) with rheumatoid factor-negative polyarthritis and 12 (14%) with other forms of JIA, all clinically inactive for a minimum of 3 months—underwent ultrasound (US) assessment of 44 joints. Joints were scanned at study entry for synovial hyperplasia, joint effusion and power Doppler (PD) signal. Patients were followed clinically for 4 years.ResultsUS was abnormal in 20/88 (22.7%) patients and in 38/3872 (0.98%) joints. Extended oligoarthritis and rheumatoid factor-negative polyarthritis were more frequent in US-positive than in US-negative patients (35.0% vs 11.8% and 30.0% vs 13.2%, respectively; P=0.005). During 4 years of follow-up, 41/88 (46.6%) patients displayed a flare; 26/68 (38.2%) were US-negative and 15/20 (75%) were US-positive at baseline. Abnormality on US examination, after correction for therapy modification, significantly increased the risk of flare (OR=3.8, 95% CI 1.2 to 11.5). The combination of grey scale and PD abnormalities displayed a much higher predictive value of relapse (65%, 13/20) than grey scale alone (33%, 6/18).ConclusionsUS abnormalities are a strong predictor of relapse at individual patient level. Irrespective of treatment, the risk of flare in US-positive versus US-negative patients was almost four times higher. In case of US abnormalities, patients should be carefully followed regardless of both the International League of Associations for Rheumatology and Wallace categories.

Prevalence and real-world management of vedolizumab-associated enthesitis in successfully treated IBD patients

Rheumatology ◽  
2021 ◽  
Author(s):  
Mirko Di Ruscio ◽  
Ilaria Tinazzi ◽  
Angela Variola ◽  
Andrea Geccherle ◽  
Antonio Marchetta ◽  
...  
Keyword(s):  
De Novo ◽  
Severe Disease ◽  
Power Doppler ◽  
Case Series ◽  
Imaging Features ◽  
Duration Of Symptoms ◽  
The Mean ◽  
Power Doppler Signal ◽  
Sonographic Imaging

Abstract Background Some studies have reported the development of moderate and severe de novo SpA-associated disease under vedolizumab (VDZ) treatment for IBD. Herein, we report a case series who developed severe enthesitis under VDZ therapy from a cohort of 90 treated cases. Methods In a single Italian IBD Unit in which 90 cases were on VDZ therapy, we identified 11 cases who developed severe enthesitis. The onset of disease in relationship to VDZ initiation, clinical and sonographic imaging features, and outcomes (including therapy switches) was described. Results A total of 11 cases, including 8 prior anti-TNF failures, with new-onset entheseal pathology were identified: multifocal (n = 4), unifocal (n = 6), and enthesitis/synovitis/dactylitis (n = 1). The mean duration of symptoms was 46 weeks (range 6–119), the mean CRP was 5.1 mg/dl, and the majority were HLA-B27 negative and showed good clinical response for gut disease. Clinical features and US showed severe enthesitis, including power Doppler change in 7 patients. All patients were initially treated with NSAIDs, and 5 patients underwent local steroid injections. At 12 months, 5/7 cases continued VDZ and 2 were switched to ustekinumab. At 12 months follow-up of 7 cases, 5 patients were in clinical remission and 2 patients had mild enthesitis with minimal increase of power Doppler signal. In addition, 4/7 severe patients developed marked post-inflammatory entheseal calcifications Conclusions A predominant isolated severe enthesitis pattern of SpA may develop under VDZ therapy with severe disease in 8% of cases. Most cases continued VDZ therapy.

scholarly journals Role of imaging in evaluation and management of juvenile idiopathic arthritis: a prospective cohort study

2018 ◽  
Vol 6 (11) ◽  
pp. 3516
Author(s):  
Devi K. Bhanu ◽  
Joseph Varghese
Keyword(s):  
Juvenile Idiopathic Arthritis ◽  
Elbow Joint ◽  
Subtalar Joint ◽  
Wrist Joint ◽  
Power Doppler ◽  
Joint Effusion ◽  
Radiology Department ◽  
Age Group ◽  
Power Doppler Signal

Background: This study was aimed to evaluate the role of imaging in diagnosis and management of juvenile idiopathic arthritis by comparing the evaluation findings of clinical and ultrasound of all 14 joints in arthritis affected patients under 16 years of age.Methods: Prospectively study was done on patients in age group of 0-16years, who referred to radiology department based on clinical assessment. USG is done in both shoulder, elbow, wrist, hip, knee, ankle and subtalar joints of each patient to assess the following parameters Synovial hypertrophy, joint effusion, power doppler signal, tenosynovitis, enthesitis, cartilage thinning, bone erosions and bursitis.Results: Out of 980 joints assessed 344 joints (35.1% of all joints) had clinical synovitis, while USG evidence was in 382 joints (38.9% of all joints). Among the 344 clinically positive joints (35.1% of all joints), 223 joints (64.8%) had features of synovitis in USG and the rest 121 (35.2%) joints were clinically positive turned out to be ultrasound negative. Out of 980 joints 636 joints (64.8%) were clinically negative, of these 159 joints (25%) was found to have synovitis in ultrasound and 477 joints (75%) turned out to be negative on ultrasound examination.Conclusions: The sensitivity and specificity of ultrasound over clinical examination in shoulder joint was 47.6% and 89.1% respectively, in elbow joint 53.8% and 92.1%, in wrist joint 64.3% and 72.6%, in hip joint 65.1% and 64.9%, in knee joint 74.7% and 61.2%, in ankle joint 67.2% and 59.2% and in subtalar joint 56.7% and 71.8%, respectively.

Power Doppler sonography in the evaluation and follow-up of knee involvement in patients with juvenile idiopathic arthritis

2001 ◽  
Vol 60 (3) ◽  
pp. 148-155 ◽  
Author(s):  
A. A. Shahin ◽  
S. A. El-Mofty ◽  
E. A. El-Sheikh ◽  
H. A. Hafez ◽  
O. M. Ragab
Keyword(s):  
Juvenile Idiopathic Arthritis ◽  
Doppler Sonography ◽  
Power Doppler ◽  
Power Doppler Sonography

scholarly journals AB0729 CLINICO-EPIDEMIOLOGICAL PROFILE OF JUVENILE IDIOPATHIC ARTHRITIS (JIA) PATIENTS IN KENYA; DATA FROM THE KENYA PEDIATRIC RHEUMATOLOGY (KAPRI) REGISTRY

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1395.2-1395
Author(s):  
A. Migowa ◽  
R. Odhiambo ◽  
J. Orwa ◽  
J. Shah
Keyword(s):  
Juvenile Idiopathic Arthritis ◽  
Rheumatoid Factor ◽  
Clinical Features ◽  
Rheumatic Diseases ◽  
Pediatric Rheumatology ◽  
Antinuclear Antibody ◽  
Clinical Characteristics ◽  
The Other ◽  
Biological Therapies ◽  
Systemic Jia

Background:Pediatric rheumatic diseases are chronic illnesses that impart a significant disease burden upon societies (1-3). Determination of the burden and clinical characteristics of these diseases is a critical first step to improving access to care and optimizing use of existing health systems for the well-being of these patients (4-6). A pediatric rheumatology registry is critical in defining the spectrum, clinical characteristics, outcomes and responses of various interventions for pediatric rheumatic diseases. Given that none exists in Kenya, the Kenya Pediatric Rheumatology Registry (KAPRI) registry offers a platform to generate this much needed data in sub-Sahara Africa.Objectives:Our objective was to determine the baseline patient characteristics, clinical features and outcomes of the Juvenile Idiopathic Arthritis (JIA) patients assessed at the Aga Khan University Medical College East Africa who were enrolled into the KAPRI registry from inception in March 2019 to December 2020.Methods:All patients with an ICD 10 M code diagnosis of Juvenile Arthritis were selected from the KAPRI registry database. Age, gender, laboratory and clinical features at diagnosis and treatment options offered were extracted from the database. A further detailed chart review was undertaken to determine the proportion of patients who achieved remission or minimally active diseases.Results:Among the 207 patients enrolled thus far, 16 (7.7%) were diagnosed to have JIA. Majority of the patients were females (75%; n=12) with a mean age of 7 years and 3 months (Range:1 year – 13 years 7 months).All patients had joint pain and swelling as the initial presenting complaints. Majority of the patients had polyarticular JIA (75%, n=12). The other 4 patients were oligoarticular (n=2) and systemic JIA (n=2). Among the polyarticular JIA patients (n=12), only 3 (25%) were rheumatoid factor (RF) positive and 1 was antinuclear antibody (ANA) positive. The oligoarticular and systemic JIA patients were all negative for antinuclear antibody, rheumatoid factor and cyclic citrullinated peptide antibodies (anti-ccp). Seven patients (43.8%) required biological therapies; tocilizumab (n=2: systemic JIA), adalimumab (n=2: polyarticular JIA), etanercept (n=2: polyarticular JIA) and tofacitnib (n=1: polyarticular JIA). One patient with systemic JIA on tocilizumab developed herpes simplex which was successfully managed with oral acyclovir. All the other patients did not develop any infections, allergic reactions or any other untoward events as adverse outcomes following the use of biological therapies. Five patients have attained remission as illustrated in the Table 1 below. Two patients have been lost to follow up.Conclusion:Seronegative polyarticular JIA was the predominant form of JIA observed with a predilection to affect more girls and boys. Over a period of 2 years, remission has been attained among 31.25% of the patients (5 of 16) with use of synthetic disease modifying anti-rheumatic drugs and biological therapies.References:[1]Moorthy LN, Peterson MG, Hassett AL, Lehman TJ. Burden of childhood onset arthritis. Pediatr Rheumatol Online J. 2010;8:20.[2]Minden K, Niewerth M, Listing J, et al. The economic burden of juvenile idiopathic arthritis-results from the German paediatric rheumatologic database. Clin Exp Rheumatol. 2009;27(5):863–9.[3]Bernatsky S, Duffy C, Malleson P, Feldman DE, St Pierre Y, Clarke AE. Economic impact of juvenile idiopathic arthritis. Arthritis Rheum. 2007;57(1):44–8.[4]Migowa A, Colmegna I, Hitchon C, Were E, Ng’ang’a E, Ngwiri T, et al. The spectrum of rheumatic in-patient diagnoses at a pediatric hospital in Kenya. Pediatric Rheumatology (2017)[5]Woolf AD. The bone and joint decade 2000–2010. Ann Rheum Dis. 2000; 59(2):81–2.[6]Scott C, Webb K. Pediatric rheumatology in sub-Saharan Africa. Rheumatology (Oxford). 2014;53(8):1357–8.Disclosure of Interests:None declared

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