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Baseline ultrasound examination as possible predictor of relapse in patients affected by juvenile idiopathic arthritis (JIA)
  1. Orazio De Lucia1,
  2. Viviana Ravagnani2,
  3. Francesca Pregnolato3,
  4. Arvena Hila1,
  5. Irene Pontikaki4,
  6. Maurizio Gattinara4,
  7. Micol Romano4,
  8. Valeria Gerloni4,
  9. Sara Pieropan5,
  10. Antonella Murgo1,
  11. Maurizio Rossini5,
  12. Rolando Cimaz6,
  13. Pier Luigi Meroni1,3,7
  1. 1 Department of Rheumatology, ASST Centro Traumatologico Ortopedico G Pini-CTO, Milan, Italy
  2. 2 Department of Internal Medicine, ASST Mantova Ospedale C Poma, Mantua, Italy
  3. 3 Immunorheumatology Research Laboratory, Istituto Auxologico Italiano, Milan, Italy
  4. 4 Department of Rheumatology, Pediatric Rheumatology Unit, ASST Centro Traumatologico Ortopedico G Pini-CTO, Milan, Italy
  5. 5 Rheumatology Unit, Azienda Ospedaliera Universitaria di Verona, Verona, Italy
  6. 6 Department of Pediatric Rheumatology, Ospedale Meyer, Florence, Italy
  7. 7 Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
  1. Correspondence to Dr Orazio De Lucia, Divisione e Cattedra di Reumatologia, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Milan 20122, Italy; orazio.delucia{at}


Objectives To define the correlation between joint ultrasonography and clinical examination in patients with juvenile idiopathic arthritis (JIA) and to assess whether synovitis detected by ultrasonography in clinically inactive patients predicts arthritis flares.

Methods 88 consecutive patients with JIA—46 (52%) with persistent oligoarthritis, 15 (17%) with extended oligoarthritis, 15 (17%) with rheumatoid factor-negative polyarthritis and 12 (14%) with other forms of JIA, all clinically inactive for a minimum of 3 months—underwent ultrasound (US) assessment of 44 joints. Joints were scanned at study entry for synovial hyperplasia, joint effusion and power Doppler (PD) signal. Patients were followed clinically for 4 years.

Results US was abnormal in 20/88 (22.7%) patients and in 38/3872 (0.98%) joints. Extended oligoarthritis and rheumatoid factor-negative polyarthritis were more frequent in US-positive than in US-negative patients (35.0% vs 11.8% and 30.0% vs 13.2%, respectively; P=0.005). During 4 years of follow-up, 41/88 (46.6%) patients displayed a flare; 26/68 (38.2%) were US-negative and 15/20 (75%) were US-positive at baseline. Abnormality on US examination, after correction for therapy modification, significantly increased the risk of flare (OR=3.8, 95% CI 1.2 to 11.5). The combination of grey scale and PD abnormalities displayed a much higher predictive value of relapse (65%, 13/20) than grey scale alone (33%, 6/18).

Conclusions US abnormalities are a strong predictor of relapse at individual patient level. Irrespective of treatment, the risk of flare in US-positive versus US-negative patients was almost four times higher. In case of US abnormalities, patients should be carefully followed regardless of both the International League of Associations for Rheumatology and Wallace categories.

  • musculoskeletal ultrasound
  • articular
  • power doppler ultrasound
  • juvenile
  • idiopathic arthritis
  • remission
  • flare

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  • RC and PLM contributed equally.

  • Handling editor Tore K Kvien

  • Contributors All listed authors have provided a significant contribution to the study by participating in design and conduct, data entering, data analysis, manuscript preparation, or patient enrolment and assessment.

  • Funding The study was supported in part by Ricerca Corrente - IRCCS Istituto Auxologico Italiano 2016 (to PLM).

  • Competing interests None declared.

  • Ethics approval The study was approved by the local ethics committee, Milano Area 2, protocol n 740_2016bis.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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