Background For several years, some adult studies have already shown the interest of joint evaluation by ultrasound in diagnostic and therapeutic adjustment in inflammatory rheumatic diseases. In juvenile idiopathic arthritis (JIA), several authors have demonstrated that ultrasonography (US) is more sensitive to detect synovitis than clinical examination
Objectives This study aims to determine joint ultrasonography’s interest in diagnostic classification and therapeutic management of JIA children.
Methods This is a unicentric, open cross-sectional study, led on twenty-sevenoutpatients with JIA between March 2010 and January 2012. Ultrasound evaluations were always carried out by the same rheumatologist, trained in joint US. Wrists, hands and feet were systematically analysed and also any painful joint. US was either carried out before beginning disease modifying anti-rheumatic drugs(DMARDs) or corticosteroids therapy, or after their setting-up, in the follow-up. The ultrasound scanner is an Esaote Mylab 60.
Results Among the twenty-seven children followed, US have been carried out in thirteen of them. 53,8% of the thirteen children are oligoarticular JIA and 46,2% are polyarticular onset. Between March 2010 and January 2012, thirty US have been realized on thirteen children. Subclinical synovitis was brought to light in 80% of cases. The average number of ultrasonography’s synovitis was 5,33 against 1,3 clinical synovitis. On the 27 JIA, 2 children had a change in their classification from oligoarticular to extend oligoarticular disease.
Seven children benefit of an ultrasonography before DMARD or corticosteroid therapy establishment. with an average number of ultrasonography’s synovitis of 8,1 against 2,1 clinical synovitis.
Twenty US has been carried out at eleven children treated by DMARD or corticosteroid. The US led on therapeutic intensification in 45% of cases, in face of subclinical synovitis. This setting up is a dose increase adjustment in 55,6% and a change of therapy in 44,4% of cases.
Conclusions This study confirms interest of achievement joint US in detection of subclinical synovitis and suggests its interest in therapeutic management of JIA children.
Magni-Manzoni S et al. Arthritis Rheum. 2009;61:1497–1504
Breton S et al. Semin Arthritis Rheum. 2011;41(2):272-8
Disclosure of Interest M. Halbwachs: None Declared, G. Durand: None Declared, E. Solau-Gervais Grant/Research support from: ROCHE