Role of Power Doppler sonography in evaluation of therapeutic response of the knee in juvenile rheumatoid arthritis

Abstract

The objective is to study the role of power Doppler sonography (PDS) in assessment of therapeutic response in juvenile rheumatoid arthritis (JRA) of knee joint. Thirty patients (age range 3-11 years) of JRA with knee joint involvement were selected for this study. Clinical assessment and ultrasound was done on the same day and repeated at the end of second and sixth month of therapy. All patients received naproxen (15-20 mg/kg/day) for a period of 6 months. Total clinical score (TCS) was calculated as sum of scores of pain, articular swelling and functional impairment. PDS was performed and degree of vascularity was assessed and graded. Total USG score was obtained by adding sum of scores of synovial effusion, synovial thickening and PDS. Results were compared between the total clinical score and the total ultrasound score and between clinical groups at baseline, end of second month and end of sixth month. There were statistically significant differences between clinical and ultrasound indices and confirmed that PDS is more sensitive in detection and follow-up of clinically silent cases of JRA. PDS holds great promise for detection of active synovial inflammatory disease in sub-clinical cases of JRA and is useful in objective assessment of therapeutic response.

Diagnostic Value of Non Stress Test in Latent Phase of Labor and Maternal and Fetal Outcomes

“…Daily fetal movement counting in the 9th month of pregnancy decreased perinatal mortality (Gurneesh & Ellora, 2009). Similarly, in a study by Sidha and Singh (2008), in the absence of any other risk factors interfering in early delivery, daily fetal movement counting was found to be useful in diagnosing at- risk fetuses in low risk pregnancies (Sing & Sidhumk, 2008). This study showed that NST is a useful technique in recognizing high risk fetuses during the latent phase of delivery.…”

“…It has been shown that improved DFM management along with uniform information to women decrease stillbirths (Tveit, Saastad, Stray-Pedersen, Børdahl, Flenady, Fretts, & Frøen, 2009). Several case control studies using daily count chart for fetal movements have shown significant differences between that first minute Apgar score below 7, and mortality rate between case and control groups (Shanmugavel, Sodhi, Sandhu, Sidhu, Singh, Katariya, & Khandelwal, 2008). Similarly, in our study, significant differences were found between two groups in terms of morality rate, and the first minute Apgar score below 7.…”

Ultrasonography and color Doppler in juvenile idiopathic arthritis: diagnosis and follow-up of ultrasound-guided steroid injection in the ankle region. A descriptive interventional study

“…An advantage of MRI is its ability to demonstrate bone marrow edema [32] a predictor of bone erosions in RA [33], and erosions in difficult-to-assess regions. Doppler-US adds further information by depicting articular and para-articular soft tissue hyperemia [10,12,34]. The Doppler signal can distinguish between active and inactive synovitis in RA, correlating to clinical and laboratory data [35], MRI [10] and histology [36].…”

Role of musculoskeletal ultrasound in juvenile idiopathic arthritis

“…A significant correlation was found between the degree of vascularity detected by PD and Juvenile Arthritis Functional Assessment Report (JAFAR) score and also between PD and a numerical knee score based on pain, swelling and limitation [14]. Another study of 30 JIA patients with bilateral knee arthritis demonstrated a statistically significant correlation between clinical and US PD findings of arthritis and response to treatment over time [16]. Some sonographers have also studied the use of contrast-enhanced color Doppler.…”

“…Unlike conventional radiography, an established imaging technique for identifying progressive joint damage, US is sensitive to soft tissue lesions and can detect early erosive bone lesions [1,2]. The development of higher frequency probes (12)(13)(14)(15)(16)(17)(18) and portable US machines has led to better resolution of small joints and the increased use of MSK-US in patients with rheumatologic disease. Improvements in color Doppler (CD) and power Doppler (PD) imaging, where the amount of color is related to degree of blood flow, allow for better assessment of soft tissue inflammation [1,3,4].…”