Ultrasonography in the early diagnosis of hip joint involvement in juvenile rheumatoid arthritis.
OBJECTIVE
To determine the value of ultrasonography in detection of early alterations and subsequent evolution of hip joint disease in patients with juvenile rheumatoid arthritis (JRA).


METHODS
Hip joints of 53 patients were evaluated clinically, by conventional radiography and ultrasound. Ten children free of signs/symptoms related to rheumatic diseases were chosen as a control group. Nine patients were followed up 28 months after baseline examinations. The clinical, radiological, and ultrasound evaluations were repeated.


RESULTS
Conventional radiography showed alterations in 10 patients (18.9%) who had shown clinical manifestations of advanced disease of the hip joint while ultrasound detected abnormalities in asymptomatic patients who had had normal radiographs. Ultrasound revealed the occurrence of 47.2% involvement in the hips of patients with JRA. Thus, ultrasound was apparently more sensitive than conventional radiographs in diagnosing changes in the hip joints of patients with JRA. Further, such involvement was found with greater frequency in the systemic and polyarticular types of JRA, in children less than 5 years of age, in those with longer duration of disease, and in those who belonged to a poorer functional class. In 3 of 9 patients who initially had normal radiographs and altered ultrasound, we found severe hip alterations upon reevaluation by radiography, after a period ranging from 21 to 39 months.


CONCLUSIONS
Ultrasonography is a method of diagnosis that must be considered in hip joint evaluation of patients with JRA.
Fedrizzi
M S
MS
Department of Pediatrics, Escola Paulista de Medicina, Universidade Federal de São Paulo, Brazil.
Ronchezel
M V
MV
Hilario
M O
MO
Lederman
H M
HM
Sawaya
S
S
Goldenberg
J
J
Sole
D
D
D000293:Adolescent; D001171:Arthritis, Juvenile / Q000000981:diagnostic imaging*; D002648:Child; D002675:Child, Preschool; D005122:Exudates and Transudates / Q000000981:diagnostic imaging; D005260:Female; D006621:Hip Joint / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D011859:Radiography; D016059:Range of Motion, Articular; D014463:Ultrasonography