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.

scholarly journals Ultrasound of Subtalar Joint Synovitis in Patients with Rheumatoid Arthritis: Results of an OMERACT Reliability Exercise Using Consensual Definitions

2018 ◽  
Vol 46 (4) ◽  
pp. 351-359 ◽  
Author(s):  
George A.W. Bruyn ◽  
Heidi J. Siddle ◽  
Petra Hanova ◽  
Félicie Costantino ◽  
Annamaria Iagnocco ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Subtalar Joint ◽  
Interobserver Reliability ◽  
Power Doppler ◽  
Delphi Process ◽  
Joint Effusion ◽  
Synovial Hypertrophy ◽  
Reliable Tool

Objective.To evaluate the intraobserver and interobserver reliability of the ultrasonographic (US) assessment of subtalar joint (STJ) synovitis in patients with rheumatoid arthritis (RA).Methods.Following a Delphi process, 12 sonographers conducted an US reliability exercise on 10 RA patients with hindfoot pain. The anteromedial, posteromedial, and posterolateral STJ was assessed using B-mode and power Doppler (PD) techniques according to an agreed US protocol and using a 4-grade semiquantitative grading score for synovitis [synovial hypertrophy (SH) and signal] and a dichotomous score for the presence of joint effusion (JE). Intraobserver and interobserver reliability were computed by Cohen’s and Light’s κ. Weighted κ coefficients with absolute weighting were computed for B-mode and PD signal.Results.Mean weighted Cohen’s κ for SH, PD, and JE were 0.80 (95% CI 0.62–0.98), 0.61 (95% CI 0.48–0.73), and 0.52 (95% CI 0.36–0.67), respectively. Weighted Cohen’s κ for SH, PD, and JE in the anteromedial, posteromedial, and posterolateral STJ were −0.04 to 0.79, 0.42–0.95, and 0.28–0.77; 0.31–1, −0.05 to 0.65, and −0.2 to 0.69; 0.66–1, 0.52–1, and 0.42–0.88, respectively. Weighted Light’s κ for SH was 0.67 (95% CI 0.58–0.74), 0.46 (95% CI 0.35–0.59) for PD, and 0.16 (95% CI 0.08–0.27) for JE. Weighted Light’s κ for SH, PD, and JE were 0.63 (95% CI 0.45–0.82), 0.33 (95% CI 0.19–0.42), and 0.09 (95% CI −0.01 to 0.19), for the anteromedial; 0.49 (95% CI 0.27–0.64), 0.35 (95% CI 0.27–0.4), and 0.04 (95% CI −0.06 to 0.1) for posteromedial; and 0.82 (95% CI 0.75–0.89), 0.66 (95% CI 0.56–0.8), and 0.18 (95% CI 0.04–0.34) for posterolateral STJ, respectively.Conclusion.Using a multisite assessment, US appears to be a reliable tool for assessing synovitis of STJ in RA.

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.

scholarly journals Responsiveness in Rheumatoid Arthritis. A Report from the OMERACT 11 Ultrasound Workshop

2013 ◽  
Vol 41 (2) ◽  
pp. 379-382 ◽  
Author(s):  
Annamaria Iagnocco ◽  
Esperanza Naredo ◽  
Richard Wakefield ◽  
George A.W. Bruyn ◽  
Paz Collado ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Task Force ◽  
Power Doppler ◽  
Consensus Definition ◽  
Synovitis Score ◽  
The Us ◽  
Definition Of ◽  
Acceptable Reliability ◽  
Power Doppler Signal

Objective.To summarize the work performed by the Outcome Measures in Rheumatology (OMERACT) Ultrasound (US) Task Force on the validity of different US measures in rheumatoid arthritis (RA) and juvenile idiopathic arthritis (JIA) presented during the OMERACT 11 Workshop.Methods.The Task Force is an international group aiming to iteratively improve the role of US in arthritis clinical trials. Recently a major focus of the group has been the assessment of responsiveness of a person-level US synovitis score in RA: the US Global Synovitis Score (US-GLOSS) combines synovial hypertrophy and power Doppler signal in a composite score detected at joint level. Work has also commenced examining assessment of tenosynovitis in RA and the role of US in JIA.Results.The US-GLOSS was tested in a large RA cohort treated with biologic therapy. It showed early signs of improvement in synovitis starting at Day 7 and increasing to Month 6, and demonstrated sensitivity to change of the proposed grading. Subsequent voting questions concerning the application of the US-GLOSS were endorsed by > 80% of OMERACT delegates. A standardized US scoring system for detecting and grading severity of RA tenosynovitis and tendon damage has been developed, and acceptable reliability data were presented from a series of exercises. A preliminary consensus definition of US synovitis in pediatric arthritis has been developed and requires further testing.Conclusion.At OMERACT 11, consensus was achieved on the application of the US-GLOSS for evaluating synovitis in RA; and work continues on development of RA tenosynovitis scales as well as in JIA synovitis.

scholarly journals Use of Power Doppler Ultrasound in Haemophilia Could Predict Early Relapse of Intra Articular Bleeding after Haemarthrosis: A Prospective Cohort of 27 Haemarthrosis Monitored By Articular Ultrasound

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 1086-1086
Author(s):  
Laurent Frenzel ◽  
Stephanie Luzy ◽  
Cecile Lozach ◽  
Richard Delarue ◽  
Olivier Hermine ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Physical Examination ◽  
Synovial Membrane ◽  
Power Doppler ◽  
Doppler Signal ◽  
Joint Effusion ◽  
Clotting Factor ◽  
Joint Mobility ◽  
Early Relapse ◽  
Power Doppler Signal

Abstract Introduction: Whereas prophylactic treatment with clotting factor has demonstrated superiority to prevent joint disease versus on-demand therapy in haemophilia, haemophilic arthropathy remains an important complication of the disease. Repetitive intra articular bleeding are directly correlated to this progressive joint destruction. In rheumatoid arthritis, the use of articular Ultrasound with Power Doppler (USPD) has demonstrated superiority to predict joint inflammation and destruction over clinical examination and biological tests. Intensity of PD ultrasound is correlate to tissue vascularisation. As hypervascularization of synovial membrane would be probably associated to occurrence of intra articular bleeding, we proposed to evaluate PD ultrasound of synovial membrane in haemophilia. after a joint haemorrhage to predict haemarthrosis relapse. Method: Patients with severe haemophilia A(HA), B (HB) or type 3 von Willebrand (vWD) disease with acute haemarthrosis were prospectively included in a monocentric study, from April 2013 and November 2014. All included patients were treated using complementary daily clotting factor substitution according to clinical context. Clinical and USPD examination of the bleeding joint were performed at diagnosis (week 0: W0), week 1 (W1), week 2 (W2), month 1 (M1), month 2 (M2) and month 6 (M6). Physical examination considered pain, swelling and joint mobility. USPD was performed by the same radiologist, experienced in musculoskeletal ultrasound, using General Electric LogiqE9 device, with a high frequency (6-15 MHz) linear probe (PRF = 0,8 MHz), considering joint effusion, synovial thickening, presence of Power Doppler signal and bone erosion. Results : 21 patients were included: 16 children and 5 adults (median of age: 11,4 years-old). 14 patients presented HA, 3 HB and 4 vWD. 6 of them had inhibitors against clotting factor (4 with HA and 2 with vWD). All patients were on prophylactic regimen. 27 haemarthrosis were evaluated: 17 elbows, 7 knees and 3 ankles. 5 relapses were observed (median of time: 53 days). 3 of them had inhibitors (3/5). Clinically, all patients had no more pain at W2, even in case of relapse. At W2, swelling joint and joint mobility were identical to those before hemarthrosis. USPD showed: - 20/22 joints without Power Doppler signal did not rebleed, - all rebleeding joints presented Power Doppler signal (5/5), - in patients with no relapse, Power Doppler signal mainly disappeared between W2 (8/16) and M1 (11/16), - at M6, 8/12 patients presented abnormal USPD finding (6/12 joint effusion, 8/12 synovial thickening) without clinical evidence of relapse. Conclusion: As yet demonstrated in rheumatoid arthritis, USPD seems more sensitive than physical examination and very useful to manage haemarthrosis. Without PD signal, the risk of early relapse seems to be very low. Moreover the presence of PD signal seems to be correlated with higher risk of relapse. These findings would lead to better support patients with PD signal in order to avoid relapse, especially from W2 until PD signal disappeared. Persistent PD signal could justify an intensification of the treatment. Further studies should be conducted to confirm these data. Disclosures No relevant conflicts of interest to declare.

scholarly journals Role of ultrasound in assessment of abnormalities in knee trauma in comparison to MRI

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
M I Fahmy ◽  
A F Abdelghany ◽  
A H Aly ◽  
D S Farid
Keyword(s):  
Lateral Collateral Ligament ◽  
Joint Effusion ◽  
Initial Assessment ◽  
Radiology Department ◽  
Resonance Imaging ◽  
Collateral Ligament ◽  
Knee Trauma ◽  
Magnetic Resonance Imaging Mri ◽  
High Resolution Ultrasonography

Abstract Aim of the Work to assess the role of high resolution ultrasonography (US) in the evaluation and assessment of different abnormalities resulting from knee trauma compared to Magnetic resonance imaging MRI Aim and Patients and Methods 51 patients presenting with knee pain after variable degrees of knee trauma and referred to radiology department will be examined by US and MRI. Results are compared and data analysed. Results US had significant results in medial collateral ligament (MCL), menisci, quadriceps and patellar tendons, joint effusion and parameniscal cysts. Poor US results were obtained in cruciate, lateral collateral ligament (LCL) and bone injuries. Conclusion Ultrasound can be used in the initial assessment of patients after knee trauma. It has comparable results to MRI in tendons, periarticular ligaments, joint effusion and menisci assessment with still some limitations noted in the cruciate ligaments and bone injuries assessment.

scholarly journals Structural and inflammatory sonographic findings in erosive and non-erosive osteoarthritis of the interphalangeal finger joints

2010 ◽  
Vol 69 (12) ◽  
pp. 2173-2176 ◽  
Author(s):  
Ruth Wittoek ◽  
Philippe Carron ◽  
Gust Verbruggen
Keyword(s):  
Structural Changes ◽  
Power Doppler ◽  
Conventional Radiography ◽  
Doppler Signal ◽  
Joint Effusion ◽  
Erosive Osteoarthritis ◽  
Finger Joints ◽  
Inflammatory Changes ◽  
Power Doppler Signal

ObjectiveThe objectives were: (1) to determine if ultrasound (US) can detect more erosions in erosive osteoarthritis (EOA) of the interphalangeal (IP) joints than conventional radiography (CR); and (2) to explore the frequency of structural and inflammatory findings in EOA and non-EOA.MethodsStructural changes and the anatomical phase were scored on CR in IP joints of 31 patients with EOA and 7 patients with non-EOA. Structural and inflammatory changes were scored by US. The frequency of sonographic findings was compared between the anatomical phases and between EOA and non-EOA by generalised estimation equation (GEE) modelling.ResultsUS detected 68 of 72 (94.4%) erosions seen on CR. US detected 45 additional erosive joints in EOA. The frequency of joint effusion and power Doppler signal was similar in EOA compared to non-EOA (p=0.91 and p=0.68, respectively). Statistically significantly more synovitis was present in full erosive phase compared to non-erosive phases in EOA (p=0.04). No differences in inflammatory findings were found between non-erosive phases in EOA and non-EOA.ConclusionUS is capable of detecting erosions in radiographic non-erosive phases. The highest frequency of synovitis is present in erosive joints but inflammatory findings are common in all anatomical phases of EOA and non-EOA.

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

Life ◽  
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.

scholarly journals A Cross Sectional Study on Imaging of Paediatric Intra-Abdominal Cystic Lesions

2021 ◽  
Vol 8 (03) ◽  
pp. 157-161
Author(s):  
Sreelaxmi Aitipamula ◽  
Veena Madireddy ◽  
Vijaya Kumari Mudunoor ◽  
Baranitharan S
Keyword(s):  
Cross Sectional Study ◽  
Duplication Cyst ◽  
Radiology Department ◽  
Imaging Features ◽  
Cystic Lesions ◽  
Age Group ◽  
Cross Sectional ◽  
Paediatric Age ◽  
Abdominal Lesions

BACKGROUND Abdominal cystic lesions are not so uncommon in the paediatric age group. Ultrasonography (USG) is the initial investigation of choice for detection of lesions. Computed tomography (CT) and magnetic resonance imaging (MRI) further compliment the findings of USG and help in the final diagnosis of various abdominal lesions in this age group. Because of the overlap in imaging features, histologic analysis is usually necessary to establish a diagnosis. The major role of the radiologist is to document the cystic nature of these abdominal masses and to determine the origin. Our aim was to study the incidence of cystic abdominal lesions in the paediatric age group and role of imaging in the diagnosis of various types of cystic lesions. METHODS This is a cross sectional study of 60 children who have been referred to radiology department with abdominal symptoms, over a period of 18 months (from April 2018 to September 2019) in Niloufer hospital, Hyderabad. Children suspected to have abdominal lesions have been referred to radiology department. USG is the initial investigation done and further CT / MRI has been done according to the findings on USG. Paediatric patients of age day 1 to 12 years, both male and female suspected to have abdominal cystic lesions either clinically or sonologically have been included in the study. Retroperitoneal lesions are excluded from study. RESULTS Out of the 60 patients studied, 44 patients were females and the rest were males. The most affected age group was between 0 - 1 year which constituted to 50 percent of the total cases studied. The most common pathologies are ovarian cyst and duplication cyst which constituted about 49 % of the cases. Statistical significance has been observed between the gender and incidence of cystic lesions. CONCLUSIONS Imaging plays a key role in the evaluation of various types of cystic lesions in the paediatric age group and arrive at a particular diagnosis based on specific imaging features. The radiologist must consider patient age, clinical parameters and imaging findings to formulate the likely diagnosis of cystic lesions. USG being cost effective, widely available and with no risk of radiation has been chosen as the first modality for investigation. KEYWORDS Cystic Lesions, USG, CT / MRI, Ovarian Cyst, Enteric Duplication Cyst

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.

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