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Value of ultrasound in detecting subclinical synovitis in polyarticular juvenile idiophatic arthritis (PJIA) in clinical remission (CR)

Introduction

Ultrasonography (US) is a useful tool to determine synovial inflammatory involvement, anatomical damage, and “subclinical synovitis” in adult and juvenile pts with RA.

Objectives

To describe US findings in pJIA pts in CR.

Methods

Prospective study.

Inclusion criteria

pJIA patients (ILAR'01) with inactive disease (according to Wallace criteria). All patients underwent an ultrasound assessment within the week when clinical examination was done. The U.S. examiner was blinded to clinical findings and the US were carried out on previously affected joints. A Toshiba equipment, model Nemio, transducer 6-12 Hz was used. The following findings were considered pathological in U.S: synovial hypertrophy, effusion and tenosynovitis (by gray scale) and positive Power Doppler (PD). Subclinical synovitis was defined as synovial hypertrophy and positive PD, in absence of clinical arthritis. Demographic, clinical- functional, laboratory and therapeuthical variables were analyzed.

Results

A total of 19 patients were included, 15 females (79 %), median age 12.9 years (IQR 11.4-6.2), median disease duration 6.04 years (IQR 3.5-8.5) and median remission period 1.53 years (IQR 1.18-2.32). Sixteen out of 19 patients (84%) were in CRM (17 MTX, 6 anti-TNF), and 3 in CR. The CHAQ score mean value was 0.02 (SD ± 0.06). Two hundred joints were systematically evaluated (clinical + US): structural alterations were found in 11/19 (58%) pts and in 14/ 200 (7%) joints (see table 1).

Table 1 Table 1

Conclusion

In our series, subclinical synovitis was not detected by U.S. The prevalence of abnormalities by grayscale was 58% pts (11/19), these findings suggest the possibility of persistent inflammation (in US exam) in spite of the absence of clinical finding related with “active disease”.

Disclosure of interest

None declared.

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Correspondence to Silvia Meiorin.

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This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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Meiorin, S., Barzola, M.L., Espada, G. et al. Value of ultrasound in detecting subclinical synovitis in polyarticular juvenile idiophatic arthritis (PJIA) in clinical remission (CR). Pediatr Rheumatol 12, P165 (2014). https://doi.org/10.1186/1546-0096-12-S1-P165

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Keywords

  • Synovitis
  • Gray Scale
  • Clinical Remission
  • Structural Alteration
  • Tenosynovitis