title: Impact of musculoskeletal ultrasound on clinical practice in paediatric rheumatology.
abstract: OBJECTIVE
  Musculoskeletal ultrasound (MSUS) is an imaging technique increasingly used in paediatric rheumatology. The aim of our study was to evaluate the extent to which MSUS may influence the diagnosis and management decisions in daily clinical practice in paediatric rheumatology.
  
  
  METHODS
  All child patients attending our PR unit over a 3-month period were included. A consultant rheumatologist assessed juvenile patients and weighted the need for MSUS assessment under a Likert scale from 0 (not necessary) to 5 (very necessary) with scanning performed when the Likert score was greater than 0. The rheumatologist completed a questionnaire used to report previous and current diagnosis, therapeutic decisions and disease activity. An assistant rheumatologist who was blinded to the questionnaire carried out the MSUS scanning of selected joints. After MSUS examination, a second questionnaire was completed by the consultant rheumatologist reporting changes in diagnosis and systemic and local treatment, if applicable.
  
  
  RESULTS
  We included 111 patients [73 (65.8%) female]. Fifteen (13.5%) were new patients and 96 (86.5%) follow-up patients. Fifty-one (45.9%) patients were diagnosed with JIA. 65 (58.6%) patients qualified for MSUS. A total of 108 joints from 65 patients were clinically assessed with 93 (86.1%) joints deemed to require complementary MSUS assessment (mean assessed joints 1.4 per patient). Of the 65 patients undergoing MSUS, 38 (58.5%) patients there was a change in diagnosis, therapeutic decisions or both following the MSUS information.
  
  
  CONCLUSIONS
  MSUS may play a significant role in local diagnosis and therapeutic decisions among follow-up JIA patients and could help in the management of rheumatic diseases in children. Further longitudinal studies are needed to confirm the impact of MSUS in paediatric rheumatology.
authors.affiliation: Rheumatology Department, Paediatric Rheumatology Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Nieto-González
authors.affiliation: Rheumatology Department, Paediatric Rheumatology Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Indalecio
authors.initials: I
authors.lastname: Monteagudo
authors.affiliation: Immunology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Loreto
authors.initials: L
authors.lastname: Vargas-Henny
authors.affiliation: Rheumatology Department, Paediatric Rheumatology Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Iustina
authors.initials: I
authors.lastname: Janta
authors.affiliation: Rheumatology Department, Paediatric Rheumatology Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Esperanza
authors.initials: E
authors.lastname: Naredo
authors.affiliation: Rheumatology Department, Paediatric Rheumatology Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: Carreño
mesh_terms: D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D019468:Disease Management; D006801:Humans; D007223:Infant; D009141:Musculoskeletal System / Q000000981:diagnostic imaging / Q000473:pathology; D062072:Patient Acuity; D015203:Reproducibility of Results; D012216:Rheumatic Diseases / Q000175:diagnosis / Q000628:therapy; D013030:Spain; D014463:Ultrasonography / Q000379:methods; D018084:Ultrasonography, Interventional / Q000379:methods