Background Musculoskeletal ultrasound (MSU) is a useful, non-invasive, nonionizing, quick and well-tolerated imagine technique, appropriate for assessing children. In the last years, MSU has been increasingly used in pediatric rheumatology. Most studies have been on juvenile idiopathic arthritis (JIA) patients, showing more sensitivity of MSU for detecting synovitis than clinical examination. The impact of MSU in adult patients with rheumatic diseases have been studied, but there is a lack of studies on the impact of MSU in pediatric rheumatology.
Objectives To investigate the impact of MSU in diagnosis and therapeutic decisions in a pediatric rheumatology outpatient clinic.
Methods We included patients who attended consecutively our pediatric rheumatology unit in 11 random days during a 4-month period (September-December 2013). A consultant rheumatologist with 25 years of experience in pediatric rheumatology decided whether MSU was indicated or not, and completed a standard questionaire. This questionnaire was composed of clinical data, previous diagnosis, current global and local diagnosis, global and local treatment decisions and disease activity assessment. The level of Indication of MSU was measure by a Likert scale from 0 (not neccesary) to 5 (very neccesary). MSU of selected joints was performed by a rheumatologist ultrasonographer. MSU findings were provided to the consultant rheumatologist immediately after the MSU examination. The consultant rheumatologist completed a second questionaire with global and local changes in diagnosis and treatment decisions, and changes in disease activity.
Results The study included 111 patients (38 (34,2%) male and 73 (65,8%) female). Fifteen (13,5%) were new patients and 96 (86,5%) were follow-up patients. Fifty-one (45,8%) patients had already been diagnosed with JIA. The consultant rheumatologist asked for a MSU in 66 patients (59,5%) with a mean indication level of 3,48 (SD 1,25) (range 1-5). A clinical joint examination was performed in 67 patients with a total of 107 joints assessed. From these joints, in 92 (86%) a MSU examination was also performed. Table 1 shows number and percentage of changes in diagnosis and treatment decisions, and changes in disease activity. From 51 patients with JIA diagnosis, 42 (82,4%) were assessed with MSU for disease activity with changes in 19 (45,2%) patients.
Conclusions MSU changed global and local diagnosis, treatment decisions, and disease activity in a relevant number of patients in our pediatric rheumatology unit.
Micu MC, Alcalde M, Sáenz JI, Crespo M, Collado P, Bolboacă SD, Naredo E. Impact of musculoskeletal ultrasound in an outpatient rheumatology clinic. Arthritis Care Res 2013;65:615-21.
Disclosure of Interest J. C. Nieto-Gonzalez: None declared, I. Monteagudo Consultant for: Abbvie, Roche Farma, Bristol- Myers Squibb, Pfizer, UCBL, E. Naredo Consultant for: Abbvie, Roche Farma, Bristol- Myers Squibb, Pfizer, UCB, General Electric Healthcare, and EsaoteL, L. Vargas-Henny: None declared, I. Janta: None declared, M. Hinojosa-Davila: None declared, L. Martinez-Estupiñan: None declared, M. Montoro: None declared, J. G. Ovalles-Bonilla: None declared, L. Carreño: None declared
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