Comparison of clinical versus ultrasound-determined synovitis in juvenile idiopathic arthritis.
OBJECTIVE
To compare clinical evaluation and ultrasonography (US) in the assessment of joint synovitis in children with juvenile idiopathic arthritis (JIA).


METHODS
Thirty-two patients underwent clinical evaluation of 52 joints by 2 pediatric rheumatologists. Joints were assessed for swelling, tenderness/pain on motion, and restricted motion. The same joints were scanned independently by an experienced sonographer for synovial hyperplasia, joint effusion, and power Doppler (PD) signal.


RESULTS
In total, 1,664 joints were assessed both clinically and with US. On clinical examination, 98 joints (5.9%) were swollen, 59 joints (3.5%) were tender, and 40 joints (2.4%) had restricted motion. On US evaluation, 125 joints (7.5%) had synovial hyperplasia, 153 joints (9.2%) had joint effusion, and 53 joints (3.2%) had PD signal. A total of 104 (6.3%) and 167 (10%) joints had clinical and US synovitis, respectively. Of the 1,560 clinically normal joints, 86 (5.5%) had subclinical synovitis (i.e., had synovitis on US). US led to classifying 5 patients as having polyarthritis who were classified as having oligoarthritis or were found to have no synovitis on clinical evaluation. US variables were moderately correlated with clinical measures of joint swelling, but poorly correlated with those of joint tenderness/pain on motion and restricted motion. Overall, correlations were lower for PD signal than for synovial hyperplasia and joint effusion.


CONCLUSIONS
We found that subclinical synovitis as detected by US is common in children with JIA. This finding may have important implications for patient classification and may affect the choice of the optimal therapeutic strategy in individual patients.
Magni-Manzoni
Silvia
S
Fondazione IRCCS Policlinico San Matteo, Pavia, Italy. s.magnimanzoni@smatteo.pv.it
Epis
Oscar
O
Ravelli
Angelo
A
Klersy
Catherine
C
Veisconti
Chiara
C
Lanni
Stefano
S
Muratore
Valentina
V
Sciré
Carlo Alberto
CA
Rossi
Silvia
S
Montecucco
Carlomaurizio
C
D001171:Arthritis, Juvenile / Q000145:classification / Q000000981:diagnostic imaging* / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007596:Joints / Q000000981:diagnostic imaging; D008297:Male; D015588:Observer Variation; D010808:Physical Examination / Q000592:standards* / Q000706:statistics & numerical data; D015995:Prevalence; D015203:Reproducibility of Results; D013585:Synovitis / Q000145:classification / Q000000981:diagnostic imaging* / Q000453:epidemiology; D018608:Ultrasonography, Doppler / Q000592:standards* / Q000706:statistics & numerical data