title: Ultrasonography for detecting enthesitis in juvenile idiopathic arthritis.
abstract: OBJECTIVE
  Enthesitis is a major feature of juvenile idiopathic arthritis (JIA) but is difficult to diagnose clinically. Our objective was to compare the accuracy of ultrasonography with power Doppler (US-PD) versus clinical examination for diagnosing enthesitis in patients with JIA and healthy controls.
  
  
  METHODS
  Twenty-six consecutive patients with JIA and 41 healthy volunteers underwent standardized clinical and US-PD examinations of 5 entheseal sites (proximal and distal quadricepital tendon insertions, Achilles tendon, and plantar fascia). US-PD reproducibility was evaluated. US-PD enthesitis was defined as a PD signal at the enthesis insertion. Bursitis, erosions, and cartilage vascularization were recorded.
  
  
  RESULTS
  In the JIA group, 27 (12.5%) of the entheseal sites exhibited clinical enthesitis (distal patellar ligament in 45% of cases) and 20 (9.4%) exhibited US-PD enthesitis (distal patellar tendon in 30%), including 10 clinically normal sites (50%). US-PD enthesitis was found in several patients with oligoarthritis or polyarthritis. Clinical enthesitis (P < 0.0001) and HLA-B27-positive (P = 0.05) status were significantly associated with US-PD enthesitis. Erosion and bursitis, but not tendon thickening, were associated with US-PD enthesitis. US-PD enthesitis was not found at any of the 410 entheseal sites in controls; grade 1 cartilage vascularization was noted at 6% of the control sites.
  
  
  CONCLUSIONS
  Enthesitis is a rare phenomenon in JIA. Clinically silent enthesitis is detected by US-PD and can be found in JIA categories other than enthesitis-related arthritis. Tendon thickening and cartilage vascularization can be detected in healthy controls. These findings may have implications for patient classification of the use of US-PD.
authors.affiliation: Centre Hospitalier Universitaire Brest and Université de Bretagne Occidentale, Brest, France.
authors.forename: Sandrine
authors.initials: S
authors.lastname: Jousse-Joulin
authors.forename: Sylvain
authors.initials: S
authors.lastname: Breton
authors.forename: Claire
authors.initials: C
authors.lastname: Cangemi
authors.forename: Bertrand
authors.initials: B
authors.lastname: Fenoll
authors.forename: Luc
authors.initials: L
authors.lastname: Bressolette
authors.forename: Loic
authors.initials: L
authors.lastname: de Parscau
authors.forename: Alain
authors.initials: A
authors.lastname: Saraux
authors.forename: Valérie
authors.initials: V
authors.lastname: Devauchelle-Pensec
mesh_terms: D000293:Adolescent; D001171:Arthritis, Juvenile / Q000097:blood / Q000150:complications / Q000000981:diagnostic imaging*; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D012216:Rheumatic Diseases / Q000097:blood / Q000150:complications / Q000000981:diagnostic imaging; D052256:Tendinopathy / Q000097:blood / Q000150:complications / Q000000981:diagnostic imaging*; D018608:Ultrasonography, Doppler / Q000379:methods