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

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.

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Long-term follow-up on effectiveness and safety of etanercept in juvenile idiopathic arthritis: the Dutch national register

Annals of the Rheumatic Diseases ◽

10.1136/ard.2007.087411 ◽

2008 ◽

Vol 68 (5) ◽

pp. 635-641 ◽

Cited By ~ 139

Author(s):

F H M Prince ◽

M Twilt ◽

R ten Cate ◽

M A J van Rossum ◽

W Armbrust ◽

...

Keyword(s):

Juvenile Idiopathic Arthritis ◽

Adverse Events ◽

Rheumatoid Factor ◽

Serious Adverse Events ◽

American College Of Rheumatology ◽

Systemic Jia ◽

Long Term Follow Up ◽

Remission Criteria

Objective:We undertook an observational study to obtain a complete overview of the long-term effectiveness and safety of etanercept in patients with different juvenile idiopathic arthritis (JIA) subtypes.Methods:At baseline we collected patient and disease characteristics of all Dutch patients with JIA who started treatment with etanercept. Disease activity was evaluated (at start of the study, after 3 months and then yearly) according to the JIA core set of the American College of Rheumatology paediatric definition for 30, 50 and 70% improvement (ACR Pedi 30, 50 and 70). Use of etanercept and concomitant drugs was monitored. Adverse events were recorded.Results:We included 146 patients with JIA with a median follow-up of 2.5 years per patient (range 0.3–7.3). JIA subtypes represented: 27% systemic, 8% polyarticular rheumatoid factor positive, 38% polyarticular rheumatoid factor negative, 19% oligoarticular extended, 3% enthesitis-related and 5% psoriatica. Most patients (77%) met the criteria of the ACR Pedi 30 in the first 3 months of treatment. For the majority of patients this improvement was sustained; 53 (36%) of all patients met the remission criteria. No other second-line agents were needed in 43 patients. Although patients with systemic JIA responded initially less to etanercept therapy than patients from other subtypes, those who did respond showed equal effectiveness in the long term. Serious adverse events rate was low (0.029 per patient year).Conclusions:Etanercept is effective and safe in JIA, even for a large proportion of the patients with systemic JIA. The greatest improvement occurred in the first 3 months of treatment, and was sustained for a long time in most patients (up to 75 months).

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P035 Hip involvement in Tunisian Juvenile Idiopathic Arthritis patients

Rheumatology ◽

10.1093/rheumatology/keab722.027 ◽

2021 ◽

Vol 60 (Supplement_5) ◽

Author(s):

Makhlouf Yasmine ◽

Wafa Triki ◽

Kaouther Maatallah ◽

Hanene Ferjani ◽

Dorra Ben Nessib ◽

...

Keyword(s):

Juvenile Idiopathic Arthritis ◽

Rheumatoid Factor ◽

Age At Onset ◽

Joint Damage ◽

Joint Effusion ◽

Male Predominance ◽

Disease Characteristics ◽

Tunisian Patients ◽

The Mean ◽

Magnetic Resonance Imaging Mri

Abstract Background Juvenile idiopathic arthritis (JIA) is characterized by a widely variable clinical course and outcome. If uncontrolled, joint damage may occur. In this context, coxitis is a feared complication. The aim of our study was to determine the prevalence and patterns of hip involvement in Tunisian JIA patients. Methods A retrospective study including children with JIA according to the International League of Associations for Rheumatology (ILAR)) was conducted between 2012and 2021. Sociodemographic data as well as disease characteristics were collected. Laboratory markers including erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were recorded. Hip involvement was assessed clinical exam and imaging (standard radiograph, ultrasound or magnetic resonance imaging (MRI)). We compared these parameters between the two groups: G1: presence of coxitis and G2: absence of coxitis. Results The study included 40 patients with a male predominance: sex ratio was 1.6. The mean age was 11.1 years-old [3–16]. The mean age at onset of the disease was 18.1 years old [8–30]. The distribution of the different subsets was as follows: polyarticular with rheumatoid factor (n = 1), polyarticular without rheumatoid factor (n = 2), enthesitis-related arthritis (n = 29), oligoarthritis (n = 7), psoriatic arthritis (n = 1). Extra-articular manifestations were found in 21.2% of cases: ocular (n = 4), pulmonary (n = 2) and cardiovascular (n = 1). The mean ESR and CRP was 30.9 mm/h [2–90] and 15.8 mg/l [1–70] respectively. A high ESR or CRP were found in 67% of cases. Hip involvement concerned 70% of the patients and was bilateral in 67.9% of them. Hip radiographs were normal in 50% of cases. Ultrasound was performed in 9 patients and revealed a positive Doppler synovitis (n = 2), a negative Doppler synovitis (n = 7) and joint effusion (n = 2). MRI was performed in 20% of cases and revealed synovitis (67%) and joint effusion (33%). Overall, 79.3% of patients had medical treatment combining NSAIDs and rehabilitation, 39% of the patients had had local infiltration with Hexatrione and only two patients had hip replacement. Hip involvement was not correlated with age at onset (P = 0.2), subtype (P = 0.8), sex (P = 0.7), extraarticular manifestations (P = 0.4). Similarly, there was no correlation between the presence of coxitis and ESR (P = 0.07) as well as CRP (P = 0.5). Conclusion Our study showed that hip involvement is frequent among Tunisian patients with JIA. Although not correlated with disease characteristics, hip involvement should be assessed frequently and carefully.

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

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20184214 ◽

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.

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

Zeitschrift für Rheumatologie ◽

10.1007/s003930170063 ◽

2001 ◽

Vol 60 (3) ◽

pp. 148-155 ◽

Cited By ~ 21

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

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Ultrasound-Verified Peripheral Arthritis in Patients with HLA-B*35 Positive Spondyloarthritis

Life ◽

10.3390/life11060524 ◽

2021 ◽

Vol 11 (6) ◽

pp. 524

Author(s):

Daniela Šošo ◽

Jure Aljinović ◽

Sanja Lovrić Kojundžić ◽

Ivanka Marinović ◽

Esma Čečuk Jeličić ◽

...

Keyword(s):

Power Doppler ◽

Joint Effusion ◽

Ultrasound Finding ◽

Peripheral Arthritis ◽

Ultrasound Findings ◽

Axial Form ◽

Peripheral Spondyloarthritis ◽

Pain Patients ◽

Power Doppler Signal

Background: We aimed to investigate possible association between the HLA-B*35 allele and peripheral arthritis, tenosynovitis and enthesitis. Methods: Ultrasound of peripheral joints and tendons was performed in 72 HLA-B*35 positive patients with preliminary diagnosis of undifferentiated axial form of spondyloarthitis and joint and tendon pain. Patients with other known types of axial and peripheral spondyloarthritis were excluded as well as patients with other known types of arthritis. Results: Pathological changes were found in the joints of 33 (46%) patients and on the tendons in 13 (18%) patients. The most common ultrasound findings were joint effusion and synovial proliferation with positive power Doppler signal grade 1. The most common ultrasound finding in patients with painful tendons was tenosynovitis. A higher disease activity and an increased incidence of elevated CRP (≥5 mg/L) were more often observed in the group with positive ultrasound findings. Conclusion: In this study, we showed that the HLA-B*35 allele could be a potential risk factor for developing peripheral arthritis, but not for tenosynovits and enthesitis in patients with the undifferentiated axial form of spondyloarthritis. This result may influence the follow up of these patients, especially since it gives us an opportunity to consider the use of different types of DMARDs in the treatment of these patients.

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

Medical Ultrasonography ◽

10.11152/mu-3303 ◽

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.

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Ultrasound and power doppler evaluation of the hand and wrist in patients with psoriatic arthritis

Acta Radiologica ◽

10.1080/02841850510021256 ◽

2005 ◽

Vol 46 (4) ◽

pp. 374-385 ◽

Cited By ~ 45

Author(s):

J. Milosavljevic ◽

U. Lindqvist ◽

A. Elvin

Keyword(s):

Psoriatic Arthritis ◽

Traditional Approach ◽

Power Doppler ◽

Joint Effusion ◽

Synovial Proliferation ◽

Long Term Follow Up ◽

Us Findings ◽

Doppler Evaluation

Purpose: To evaluate the ability of high‐resolution and power Doppler sonography in detecting joint and tendon abnormalities in patients with psoriatic arthritis (PsA) of the hands and wrists compared with clinical and radiological findings. Material and Methods: Thirty‐six patients with psoriatic arthritis of the hands and wrists and 10 healthy controls were examined with ultrasound (US). The degree of synovial proliferation, tenosynovitis, presence of joint effusion as well as the vascularity of synovial tissue was estimated. US findings were scored using a newly devised scoring system. Results: Thirty‐two patients had articular synovial proliferation and/or tenosynovitis/tendinitis or joint effusion in one or more joints according to US. Twenty‐two patients had tendon changes; only five had joint effusion. The synovial, Doppler, and total articular‐teno scores were all significantly correlated to the number of swollen joints. The scores, however, did not correlate to other clinical or laboratory measurements of disease activity. Conclusion: US proved effective in demonstrating PsA involvement of the hands and wrists and was more sensitive than clinical examination in detecting pathology. Long‐term follow‐up studies are needed to evaluate whether this can change the traditional approach for assessing involvement of joints and tendons in PsA.

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