Juvenile idiopathic arthritis (JIA) is a potentially debilitating disease of early childhood that may carry with it significant physical, psychological, and financial costs. At this time, pediatric rheumatologists rely on physical examination to diagnose JIA. There is an increased interest in the use of musculoskeletal ultrasound (MSUS) to evaluate JIA. MSUS has several advantages over other imaging techniques for use in pediatric subjects, which include non-invasiveness, rapidity of performance, ease of repeatability, high patient acceptability and lack of exposure to ionizing radiation. In addition, it does not require sedation for scanning in younger children. MSUS allow precise and thorough visualization of inflammatory and destructive joint abnormalities, including synovial hyperplasia, joint effusion, cartilage damage, bone erosion, tenosynovitis and enthesopathy. MSUS is more sensitive than physical examination and may detect early disease that is not evident on physical examination. Recent studies in children with JIA have also shown that remission defined by clinical criteria does not always equate to the complete absence of inflammation as measured by MSUS. A high prevalence of US-detected subclinical synovitis was found in joints that were recorded as normal on clinical examination. Thus early detection and treatment may prevent and/or delay adverse outcomes such as joint damage and disability in JIA.
OMERACT definitions are not applicable to pediatric patients, owing to the unique features of the growing skeleton and the changes in joint morphology during development. Thus, Pediatric Ultrasound subtask force of the OMERACT Ultrasound Group was created to develop definitions and standards for MSUS assessment in children. This group has done a great deal of effort and activity to standardize and validate the method for performing MSUS and detecting and scoring MSUS abnormalities in children through several steps: a) Development of definitions for MSUS findings in healthy children by a Delphi consensus process1 and amendment of definitions for the MSUS features in healthy children (manuscript in preparation); b) Development of a standardized MSUS scanning method in children of different age groups and collection of images showing the physiological vascularization in several joints.2; c) Development of definitions for synovitis through a Delphi consensus process and validation of these definitions in a still image exercise (publication in preparation); d) Development of EULAR/PReS recommendations for usage of different imaging modalities in JIA3; e) Evaluation of the multiobserver and intraobserver reliability of the physiological blood vessels present in different age groups of healthy children and new scoring system to graduate maturation of ossification nuclei in healthy children (publication in preparation) and f) Development and validation of a semiqantitative scoring system for synovitis on grey-scale (GS) and Power Doppler (PD) modes. All novel knowledge is presented in details.
Definitions for the sonographic features of joints in healthy children. J Roth, S Jousse-Joulin, S Magni-Manzoni, A Rodriguez, N Tzaribachev, A Iagnocco, E Naredo, MA D'Agostino, P Collado; Outcome Measures in Rheumatology Ultrasound Group. Arthritis Care Res 2015; 67:136–42.
Toward standardized musculoskeletal ultrasound in paediatric rheumatology; age related sonographic normal findings. P Collado, J Vojinovic, JC Nieto, D Windschall, S Magni Manzoni, GAW Bruyn, A Iagnocco, MA D'Agostino, E Naredo, on behalf of the OMERACT Ultrasound Group. Arthritis Care Res 2015; doi: 10.1002/acr.22670
Colebatch-Bourn AN, Edwards CJ, Collado P, D'Agostino MA, Hemke R, Jousse-Joulin S, Maas M, Martini A, Naredo E, Østergaard M, Rooney M, Tzaribachev N, van Rossum MA, Vojinovic J, Conaghan PG, Malattia C. EULAR-PReS points to consider for the use of imaging in the diagnosis and management of juvenile idiopathic arthritis in clinical practice. Ann Rheum Dis. 2015 Nov;74(11):1946–57. doi: 10.1136/annrheumdis-2015-207892.
Disclosure of Interest None declared