Background Musculoskeletal symptoms in children are one of the most frequent presented in primary care and certain number of patients are referred to pediatric rheumatologist as having reactive arthritis.Reactive arthritis (ReA) is an autoimmune condition that develops in response to an infection in other part of the body but time is needed for final diagnosis. Although clinical examination is first and foremost, musculoskeletal ultrasound (MSUS) is emerging as a powerful tool for detecting subclinical synovial pathology helping physician to diagnose, treat and monitor the patient with greater certainty. It is a non-invasive method, quickly accessible bedside, does not require sedation and should be combined with clinical examination in pediatric rheumatology.
Objectives To evaluate the role of MSUS in combination with clinical exam in monitoring children referred to single pediatric rheumatology center as reactive arthritis
Methods The charts of 88 children referred to Department of Rheumatology at Chlidren's Hospital Srebrnjak, Zagreb, Croatia with reactive arthritis diagnosis (ReA) by their primary physician over period of 3 years were analyzed and clinical findings were compared with MSUS together with patient outcome.
Results Over the period from 2012-2014 88 children were referred to our Department as reactive arthritis by their primary physician. 64 patients had clinical symptoms such as swelling, limping and limited range of motions. All were evaluated by experienced pediatric rheumatologists. In 62 (70.45%) patients at least one MSUS was performed, 43/62 (69.35%) had further MSUS controls. In 17/88 (19.31%) patients eventually juvenile idiopathic arthritis (JIA) was diagnosed and all of them were monitored by MSUS at all visits. In 26 patients with ReA MSUS was performed at follow up visits and only 2 had persistent pathological MSUS findings (OMERACT synovial hypertrophy grade 1, Power Doppler 1/3) at their last check-up. In 54/64 (84.37%) patients with clinical symptoms MSUS was preformed, 17/54 (31.48%) were eventually diagnosed with JIA, 2/54 (3.7%) with other diseases and 35/54 (64.81%) with ReA. ReA patients had between 1-3 MSUS (mean 1.72). Patients who were diagnosed as JIA were monitored between 1-9 months prior to diagnosis (mean 5.05 months).
Conclusions The importance of clinical competence in ensuring that patients with articular symptoms are diagnosed and treated early is evident. MSUS has been proven to detected synovitis in earlier stage than clinical examination thus becoming a complementary tool in routine pediatric rheumatology practice. Even though evidence in favor of this is accumulating further investigations on larger cohort are needed.
Disclosure of Interest None declared