Role of musculoskeletal ultrasonography in the detection of subclinical synovitis in oligo and polyarticular juvenile idiopathic arthritis children

Aim of the work: To study the ability of ultrasound to detect subclinical synovitis in children with oligoarticular and polyarticular juvenile idiopathic arthritis (JIA) and to assess the disease activity according to the clinical, laboratory, and musculoskeletal ultrasonographic (MSUS) evaluation. Patients and methods: The study included 40 children with oligoarticular or polyarticular JIA diagnosed according to the ILAR criteria. 800 joints (20 joints for each patient: knees, wrists, 2nd-5th metacarpophalangeal and 2nd-5th proximal interphalangeal joints) were subjected to MSUS scanning for synovial hypertrophy, joint effusion and power Doppler (PD) signals. Disease activity assessment using Juvenile Arthritis Disease Activity Score (JADAS-10), and functional assessment By Childhood Health Assessment Questionnaire (CHAQ) were done for all patients. Results: The mean age of patients was 10.3 +/- 3.9 (3-16) years, 24 females and 16 males and the disease duration was 3.7 +/- 2.8 (0.5-12) years. There was a significant difference between number of clinically (n = 192; 24%) and MSUS (440 by gray scale and 240 by PD) affected joints (p < 0.001). Comparing clinical and ultrasound activity, 70 joints were clinically inactive but showed PDUS signals. There was a significant (p < 0.05) correlation of the MSUS findings with the disease duration, number of clinically activite joints, JADAS10, CHAQ and acute phase reactants. Conclusion: MSUS is superior to clinical examination in early detection of synovitis. It is a reliable method for disease activity assessment in JIA patients, so it can be used in association with standard clinical examination for better classification, diagnosis, treatment strategy and prognosis of JIA subtypes. (C) 2018 Egyptian Society of Rheumatic Diseases. Publishing services provided by Elsevier B.V.