Utilizing ultrasound findings of a single indicator joint to assess non-systemic juvenile idiopathic arthritis

Yung-Hsien Huang, Ya-Chiao Hu, Chun-Hua Liao, Bor-Luen Chiang, Cheng-Hsun Lu, Ko-Jen Li, Yao-Hsu Yang, Yung-Hsien Huang, Ya-Chiao Hu, Chun-Hua Liao, Bor-Luen Chiang, Cheng-Hsun Lu, Ko-Jen Li, Yao-Hsu Yang

Abstract

Background: Musculoskeletal ultrasound (MSUS) has been used worldwide in adult patients with rheumatoid arthritis (RA) but is beginning to play an increasing role in patients with juvenile idiopathic arthritis (JIA). The aim of this study was to investigate the application of MSUS findings of a single indicator joint in JIA to assess the disease activity and classify disease subtype.

Methods: Thirty-five non-systemic JIA patients with a total of 62 visits were retrospectively recruited in this study. Among the involved joints, the joint with highest value of grey-scale (GS) plus power Doppler (PD) (=GSPD) was selected as the indicator joint at each visit. The correlations between each MSUS parameter (GS, PD, GSPD) of indicator joints and the Physician Global Assessment (PGA) score, the Childhood Health Assessment Questionnaire-disability index (CHAQ-DI), and laboratory data were analyzed. The ultrasound features in different subtypes of JIA were also compared.

Results: PD was weakly correlated with the PGA score (rho = 0.323, p = 0.010), while both GS and GSPD were moderately correlated with the PGA score (rho = 0.405, p = 0.001; rho = 0.434, p = 0.000). On the other hand, GS, PD, and GSPD were weakly correlated with CHAQ-DI. Although erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) had a weak correlation with PGA, they were not statistically correlated with GS, PD, or GSPD. The proportions of effusion, synovial hypertrophy, and enthesopathy in three different subtypes, showed significant differences (Fisher's exact test, p = 0.037; p = 0.004; p = 0.019). Enthesopathy was only seen in joints of enthesitis-related arthritis (ERA), but not in joints of polyarthritis and oligoarthritis.

Conclusions: MSUS is an acceptable non-invasive tool for the patients with JIA, particularly for those with non-systemic JIA, that might assist disease classification, and whose parameters of the indicator joints may potentially contribute to the evaluation of disease activity.

Keywords: Disease activity; Indicator joint; Juvenile idiopathic arthritis; Musculoskeletal ultrasound.

Conflict of interest statement

None to declare.

Figures

Fig. 1
Fig. 1
MSUS features in JIA. a Effusion (double-headed arrow) in the suprapatellar pouch of the knee. b Synovial hypertrophy with PD signals (arrowheads) in the radiocarpal and intercarpal joint. c Longitudinal ultrasound image of the patellar tendon that shows hypoechogenicity and PD signals (arrow) inside the enthesis
Fig. 2
Fig. 2
The scatterplot diagram of the correlation between PGA score and CHAQ-DI
Fig. 3
Fig. 3
The percentage of (a) effusion, (b) synovial hypertrophy, and (c) enthesopathy in different JIA subtypes. *p < 0.05. Oligo: oligoarthritis, Poly: polyarthritis, ERA: enthesitis-related arthritis

References

    1. Ravelli A, Martini A. Juvenile idiopathic arthritis. Lancet. 2007;369(9563):767–778. doi: 10.1016/S0140-6736(07)60363-8.
    1. Hahn YS, Kim JG. Pathogenesis and clinical manifestations of juvenile rheumatoid arthritis. Korean J Pediatr. 2010;53(11):921–930. doi: 10.3345/kjp.2010.53.11.921.
    1. Boros C, Whitehead B. Juvenile idiopathic arthritis. Aust Fam Physician. 2010;39(9):630–636.
    1. Ilowite NT, Walco GA, Pochaczevsky R. Assessment of pain in patients with juvenile rheumatoid arthritis: relation between pain intensity and degree of joint inflammation. Ann Rheum Dis. 1992;51(3):343–346. doi: 10.1136/ard.51.3.343.
    1. Sztajnbok F, Coronel-Martinez DL, Diaz-Maldonado A, Novarini C, Pistorio A, Viola S, Ruperto N, Buoncompagni A, Martini A, Ravelli A. Discordance between physician's and parent's global assessments in juvenile idiopathic arthritis. Rheumatology (Oxford) 2007;46(1):141–145. doi: 10.1093/rheumatology/kel201.
    1. Berntson L, Wernroth L, Fasth A, Aalto K, Herlin T, Nielsen S, Nordal E, Rygg M, Zak M. Assessment of disease activity in juvenile idiopathic arthritis. The number and the size of joints matter. J Rheumatol. 2007;34(10):2106–2111.
    1. Vandvik IH, Høyeraal HM, Larsen S. Agreement between parents and physicians regarding clinical evaluation of patients with juvenile rheumatoid arthritis. Scand J Rheumatol. 1988;17(6):459–463. doi: 10.3109/03009748809098807.
    1. Hameed B, Pilcher J, Heron C, Kiely PD. The relation between composite ultrasound measures and the DAS28 score, its components and acute phase markers in adult RA. Rheumatology (Oxford) 2008;47(4):476–480. doi: 10.1093/rheumatology/kem383.
    1. Breton S, Jousse-Joulin S, Cangemi C, de Parscau L, Colin D, Bressolette L, Saraux A, Devauchelle-Pensec V. Comparison of clinical and ultrasonographic evaluations for peripheral synovitis in juvenile idiopathic arthritis. Semin Arthritis Rheum. 2011;41(2):272–278. doi: 10.1016/j.semarthrit.2010.12.005.
    1. Haslam KE, McCann LJ, Wyatt S, Wakefield RJ. The detection of subclinical synovitis by ultrasound in oligoarticular juvenile idiopathic arthritis: a pilot study. Rheumatology (Oxford) 2010;49(1):123–127. doi: 10.1093/rheumatology/kep339.
    1. Karmazyn B, Bowyer SL, Schmidt KM, Ballinger SH, Buckwalter K, Beam TT, Ying J. US findings of metacarpophalangeal joints in children with idiopathic juvenile arthritis. Pediatr Radiol. 2007;37(5):475–482. doi: 10.1007/s00247-007-0438-9.
    1. Weiss PF, Chauvin NA, Klink AJ, Localio R, Feudtner C, Jaramillo D, Colbert RA, Sherry DD, Keren R. Detection of enthesitis in children with enthesitis-related arthritis: dolorimetry compared to ultrasonography. Arthritis Rheumatol. 2014;66(1):218–227. doi: 10.1002/art.38197.
    1. Shenoy S, Aggarwal A. Sonologic enthesitis in children with enthesitis-related arthritis. Clin Exp Rheumatol. 2016;34(1):143–147.
    1. Magni-Manzoni S. Ultrasound in juvenile idiopathic arthritis. Pediatr Rheumatol Online J. 2016;14(1):33. doi: 10.1186/s12969-016-0096-2.
    1. Magni-Manzoni S, Epis O, Ravelli A, Klersy C, Veisconti C, Lanni S, Muratore V, Sciré CA, Rossi S, Montecucco C. Comparison of clinical versus ultrasound-determined synovitis in juvenile idiopathic arthritis. Arthritis Rheum. 2009;61(11):1497–1504. doi: 10.1002/art.24823.
    1. Spârchez M, Fodor D, Miu N. The role of power Doppler ultrasonography in comparison with biological markers in the evaluation of disease activity in juvenile idiopathic arthritis. Med Ultrason. 2010;12(2):97–103.
    1. Algergawy S, Haliem T, Al-Shaer O. Clinical, laboratory, and ultrasound assessment of the knee in juvenile rheumatoid arthritis. Clin Med Insights Arthritis Musculoskelet Disord. 2011;4:21–27. doi: 10.4137/CMAMD.S4371.
    1. Fries JF, Spitz PW, Young DY. The dimensions of health outcomes: the health assessment questionnaire, disability and pain scales. J Rheumatol. 1982;9(5):789–793.
    1. Wallace CA, Ruperto N, Giannini E. Preliminary criteria for clinical remission for select categories of juvenile idiopathic arthritis. J Rheumatol. 2004;31(11):2290–2294.
    1. Collado P, Vojinovic J, Nieto JC, Windschall D, Magni-Manzoni S, Bruyn GA, et al. Toward standardized musculoskeletal ultrasound in pediatric rheumatology: Normal age-related ultrasound findings. Arthritis Care Res (Hoboken). 2016;68(3):348–356. doi: 10.1002/acr.22670.
    1. Backhaus M, Burmester GR, Gerber T, Grassi W, Machold KP, Swen WA, Wakefield RJ, Manger B, Working Group for Musculoskeletal Ultrasound in the EULAR Standing Committee on International Clinical Studies including Therapeutic Trials Guidelines for musculoskeletal ultrasound in rheumatology. Ann Rheum Dis. 2001;60(7):641–649. doi: 10.1136/ard.60.7.641.
    1. D'Agostino MA, Terslev L, Aegerter P, Backhaus M, Balint P, Bruyn GA, et al. Scoring ultrasound synovitis in rheumatoid arthritis: a EULAR-OMERACT ultrasound taskforce-part 1: definition and development of a standardised, consensus-based scoring system. RMD Open. 2017;3(1):e000428. doi: 10.1136/rmdopen-2016-000428.
    1. Spârchez M, Fodor D. What's new in musculoskeletal ultrasound in pediatric rheumatology? Med Ultrason. 2018;20(3):371–378. doi: 10.11152/mu-1604.
    1. Ritchie RF, Palomaki GE, Neveux LM, Navolotskaia O, Ledue TB, Craig WY. Reference distributions for complement proteins C3 and C4: a practical, simple and clinically relevant approach in a large cohort. J Clin Lab Anal. 2004;18(1):1–8. doi: 10.1002/jcla.10100.
    1. Moretti C, Viola S, Pistorio A, Magni-Manzoni S, Ruperto N, Martini A, Ravelli A. Relative responsiveness of condition specific and generic health status measures in juvenile idiopathic arthritis. Ann Rheum Dis. 2005;64(2):257–261. doi: 10.1136/ard.2003.016519.
    1. Ruperto N, Ravelli A, Falcini F, Lepore L, Buoncompagni A, Gerloni V, Bardare M, Cortis E, Zulian F, Sardella ML, Giovanni Strano C, Alessio M, Alpigiani MG, Migliavacca D, Pistorio A, Viola S, Martini A. Responsiveness of outcome measures in juvenile chronic arthritis. Italian pediatric rheumatology study group. Rheumatology (Oxford) 1999;38(2):176–180. doi: 10.1093/rheumatology/38.2.176.
    1. Lanni S, Wood M, Ravelli A, Magni Manzoni S, Emery P, Wakefield RJ. Towards a role of ultrasound in children with juvenile idiopathic arthritis. Rheumatology (Oxford) 2013;52(3):413–420. doi: 10.1093/rheumatology/kes287.
    1. Prakken B, Albani S, Martini A. Juvenile idiopathic arthritis. Lancet. 2011;377(9783):2138–2149. doi: 10.1016/S0140-6736(11)60244-4.
    1. Hyrich KL, Lal SD, Foster HE, Thornton J, Adib N, Baildam E, Gardner-Medwin J, Wedderburn LR, Chieng A, Davidson J, Thomson W. Disease activity and disability in children with juvenile idiopathic arthritis one year following presentation to paediatric rheumatology. Results from the childhood arthritis prospective study. Rheumatology (Oxford) 2010;49(1):116–122. doi: 10.1093/rheumatology/kep352.
    1. Kawashiri SY, Suzuki T, Nakashima Y, Horai Y, Okada A, Iwamoto N, Ichinose K, Tamai M, Arima K, Nakamura H, Origuchi T, Uetani M, Aoyagi K, Eguchi K, Kawakami A. Ultrasonographic examination of rheumatoid arthritis patients who are free of physical synovitis: power Doppler subclinical synovitis is associated with bone erosion. Rheumatology (Oxford) 2014;53(3):562–569. doi: 10.1093/rheumatology/ket405.
    1. Magni-Manzoni S, Scirè CA, Ravelli A, Ravelli A, Klersy C, Rossi S, Muratore V, et al. Ultrasound-detected synovial abnormalities are frequent in clinically inactive juvenile idiopathic arthritis, but do not predict a flare of synovitis. Ann Rheum Dis. 2013;72(2):223–228. doi: 10.1136/annrheumdis-2011-201264.
    1. Miotto ESVB, Mitraud SAV, Furtado RNV, Natour J, Len CA, Terreri M. Patients with juvenile idiopathic arthritis in clinical remission with positive power Doppler signal in joint ultrasonography have an increased rate of clinical flare: a prospective study. Pediatr Rheumatol Online J. 2017;15(1):80. doi: 10.1186/s12969-017-0208-7.
    1. McGonagle D, Benjamin M. Towards a new clinico-immunopathological classification of juvenile inflammatory arthritis. J Rheumatol. 2009;36(8):1573–1574. doi: 10.3899/jrheum.090599.
    1. Consolaro A, Ruperto N, Bazso A, Pistorio A, Magni-Manzoni S, Filocamo G, Malattia C, Viola S, Martini A, Ravelli A, Paediatric Rheumatology International Trials Organisation Development and validation of a composite disease activity score for juvenile idiopathic arthritis. Arthritis Rheum. 2009;61(5):658–666. doi: 10.1002/art.24516.
    1. McErlane F, Beresford MW, Baildam EM, Chieng SE, Davidson JE, Foster HE, et al. Validity of a three-variable juvenile arthritis disease activity score in children with new-onset juvenile idiopathic arthritis. Ann Rheum Dis. 2013;72(12):1983–1988. doi: 10.1136/annrheumdis-2012-202031.
    1. Sontichai W, Vilaiyuk S. The correlation between the childhood health assessment questionnaire and disease activity in juvenile idiopathic arthritis. Musculoskeletal Care. 2018;16(3):339–344. doi: 10.1002/msc.1239.
    1. Palmisani E, Solari N, Magni-Manzoni S, Pistorio A, Labò E, Panigada S, et al. Correlation between juvenile idiopathic arthritis activity and damage measures in early, advanced, and longstanding disease. Arthritis Rheum. 2006;55(6):843–849. doi: 10.1002/art.22357.
    1. Rooney ME, McAllister C, Burns JF. Ankle disease in juvenile idiopathic arthritis: ultrasound findings in clinically swollen ankles. J Rheumatol. 2009;36(8):1725–1729. doi: 10.3899/jrheum.080508.
    1. Pascoli L, Wright S, McAllister C, Rooney M. Prospective evaluation of clinical and ultrasound findings in ankle disease in juvenile idiopathic arthritis: importance of ankle ultrasound. J Rheumatol. 2010;37(11):2409–2414. doi: 10.3899/jrheum.091262.
    1. Jousse-Joulin S, Breton S, Cangemi C, Fenoll B, Bressolette L, de Parscau L, Saraux A, Devauchelle-Pensec V. Ultrasonography for detecting enthesitis in juvenile idiopathic arthritis. Arthritis Care Res (Hoboken) 2011;63(6):849–855. doi: 10.1002/acr.20444.

Source: PubMed

Sponsorer och medarbetare

Medicinska tillstånd

Läkemedelsinterventioner

3
Prenumerera