title: Do patients with juvenile idiopathic arthritis in remission exhibit active synovitis on joint ultrasound?
abstract: The aim of the study was to assess the presence and characteristics of subclinical synovitis using power Doppler (PD) ultrasonography on patients with juvenile idiopathic arthritis (JIA) in clinical remission and compare the findings with those of healthy children. A cross-sectional study was carried out involving the clinical (physical exam, functional capacity and laboratory tests) and ultrasonography evaluation of 34 joints (synovial fluid/hypertrophy, PD signal and bone erosion). Subclinical synovitis was defined as the presence of synovial hypertrophy/joint effusion with or without any PD signal. Thirty-six patients (11.5 ± 3.74 years) and 36 controls (sex and age matched) were evaluated (2,448 joints). Twenty-seven patients were in remission on medication (mean duration: 1.8 ± 2.2 years). Subclinical synovitis was detected in 41.7% patients and 11.1% controls (p = 0.003). Erosion was detected in three patients (8.3%). Subclinical synovitis was found in 38/1,224 (3.1%) joints in the patients (most affected: radiocarpal wrist, anterior elbow and tibiotalar ankle) and 8/1,224 (0.6%) joints in the controls (most affected: radiocarpal wrist). Differences in subclinical synovitis between patients and controls were found in the elbows (p = 0.033) and ankles (p = 0.006). A greater frequency of subclinical synovitis was found in patients with the extended oligoarticular or polyarticular subtypes (p = 0.013), those at an older age at disease onset (p = 0.007) and using methotrexate (p = 0.049). Patients with JIA in remission exhibit subclinical synovitis more frequently than controls. Subclinical synovitis was more frequent in patients with the polyarticular involvement and those at an older age at disease onset.
authors: Pediatric Rheumatology Unit, Allergy, Immunology and Rheumatology Division, Pediatric Department, Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM), Rua Ipê, 112/111, Vila Clementino, São Paulo, SP, CEP 04022-005, Brazil, vanbugni@hotmail.com.
authors: Vanessa
authors: V
authors: Bugni Miotto e Silva
authors: Carolina
authors: C
authors: de Freitas Tavares da Silva
authors: Sônia
authors: S
authors: de Aguiar Vilela Mitraud
authors: Rita
authors: R
authors: Nely Vilar Furtado
authors: Maria Odete
authors: MO
authors: Esteves Hilário
authors: Jamil
authors: J
authors: Natour
authors: Maria Teresa
authors: MT
authors: Terreri
mesh_terms: D000293:Adolescent; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001171:Arthritis, Juvenile / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000453:epidemiology*; D002648:Child; D003430:Cross-Sectional Studies; D004551:Elbow Joint / Q000000981:diagnostic imaging; D005260:Female; D006621:Hip Joint / Q000000981:diagnostic imaging; D006801:Humans; D007596:Joints / Q000000981:diagnostic imaging*; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D015588:Observer Variation; D012074:Remission Induction; D013582:Synovial Fluid / Q000000981:diagnostic imaging; D013585:Synovitis / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000453:epidemiology*; D018608:Ultrasonography, Doppler / Q000706:statistics & numerical data; D014955:Wrist Joint / Q000000981:diagnostic imaging
chemical_list: D018501:Antirheumatic Agents; D008727:Methotrexate