title: The role of Power Doppler ultrasonography in comparison with biological markers in the evaluation of disease activity in Juvenile Idiopathic Arthritis.
abstract: OBJECTIVE
  To evaluate the performance of Power Doppler Ultrasonography (PDUS) compared with biological markers, in the assessment of disease activity in children with Juvenile Idiopathic Arthritis (JIA).
  
  
  METHODS
  Forty hospital visits were studied comprising 32 patients with JIA, during one year of follow-up. Each patient underwent clinical, laboratory and ultrasound (PDUS) evaluation. The physician global assessment score on the visual analog scale (PhGA) was used as a standard for assessing disease activity, based on previous studies. The PDUS signal was scored according to a semiquantitative four grade scale (0-3).
  
  
  RESULTS
  PDUS assessment of synovial vascularisation was more sensitive than erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP) in identification of the active disease: 90.4% vs. 57% and 28.5% respectively. CRP had a higher specificity (94%) in comparison with PDUS (89.5%). A significant association between clinical examination (PhGA) and PDUS score or ESR was found. Kappa statistics revealed a high level of agreement between PhGA and PDUS score (k=0.799) and a low level of agreement between PhGA and biological markers (k=0.356 and k=0.225 respectively). Patients with higher PDUS score (>or=2), ESR>or=30 mm/h or CRP>or=2 mg/dl were more likely to have active disease.
  
  
  CONCLUSIONS
  Laboratory tests used today are not sufficiently sensitive for the prediction of active disease. PDUS assessment of synovial vascularisation is a technique with good sensitivity and specificity, thus it may be a beneficial criteria for evaluating disease activity in JIA, completing conventional clinical examination.
authors.affiliation: Department of Pediatrics, 2nd Pediatric Clinic, Iuliu Haţieganu University of Medicine and Pharmacy, 5 Crisan str., Cluj-Napoca, Romania. spirchez.mihaela@umfcluj.ro
authors.forename: Mihaela
authors.initials: M
authors.lastname: Spârchez
authors.forename: Daniela
authors.initials: D
authors.lastname: Fodor
authors.forename: Nicolae
authors.initials: N
authors.lastname: Miu
mesh_terms: D000293:Adolescent; D001171:Arthritis, Juvenile / Q000097:blood / Q000000981:diagnostic imaging*; D015415:Biomarkers / Q000032:analysis; D001799:Blood Sedimentation; D002097:C-Reactive Protein / Q000032:analysis; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D018608:Ultrasonography, Doppler / Q000379:methods*; D055815:Young Adult
chemical_list: D015415:Biomarkers; D002097:C-Reactive Protein