Ultrasound in juvenile idiopathic arthritis

Abstract

BackgroundIn the recent years, musculoskeletal ultrasound (MSUS) has been regarded as especially promising in the assessment of juvenile idiopathic arthritis (JIA), as a reliable method to precisely document and monitor the synovial inflammation process.Main contentMSUS is particularly suited for examination of joints in children due to several advantages over other imaging modalities. Some challenges should be considered for correct interpretation of MSUS findings in children, due to the peculiar features of the growing skeleton. MSUS in JIA is considered particularly useful for its ability to detect subclinical synovitis, to improve the classification of patients in JIA subtypes, for the definition of remission, as guidance to intraarticular corticosteroid injections and for capturing early articular damage. Current evidence and applications of MSUS in JIA are documented by several authors. Recent advances and insights into further investigations on MSUS in healthy children and in JIA patients are presented and discussed in the present review.ConclusionsMSUS shows great promise in the assessment and management of children with JIA. Nonetheless, anatomical knowledge of sonographic changes over time, underlying immunopathophysiology, standardization and validation of MSUS in healthy children and in patients with JIA are still under investigation. Further research and educational efforts are required for expanding this imaging modality to more clinicians in their daily practice.

Baseline ultrasound examination as possible predictor of relapse in patients affected by juvenile idiopathic arthritis (JIA)

“…US in paediatrics has some additional pitfalls 39. For instance, the epiphysial cartilage is anechoic as the synovial fluid.…”

“…A grey scale alteration (particularly a small amount of synovial fluid) may not be associated with an inflammatory state. Moreover, PD may be easily misinterpreted 39. We tried to minimise these limitations by enrolling healthy subjects and active patients and by harmonising the US interpretation.…”

Correction: Prevalence, incidence and progression of hand osteoarthritis in the general population: the Framingham Osteoarthritis Study

“…39 For instance, the epiphysial cartilage is anechoic as the synovial fluid. A grey scale alteration (particularly a small amount of synovial fluid) may not be associated with an inflammatory state.…”

“…Moreover, PD may be easily misinterpreted. 39 We tried to minimise these limitations by enrolling healthy subjects and active patients and by harmonising the US interpretation.…”

What’s new in musculoskeletal ultrasound in pediatric rheumatology?

“…MSUS in the diagnosis of JIA For many years now, there is supporting evidence that MSUS is more sensitive than physical examination and plain radiography for the detection of synovitis in children with JIA [34][35][36][37][38]. These findings have an implication in classifying the patients into the ILAR subtype of JIA and therefore therapeutic interventions.…”