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Intra- and interobserver reliability of ultrasonographic cartilage thickness assessments in small and large joint in healthy children

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There is an increasing interest among paediatric rheumatologist for using ultrasonography (US) in the daily clinical examination of children with JIA. Loss of joint cartilage may be an early feature of destructive disease in JIA. However, US still needs validation before it can be used as a diagnostic bedside tool in a pediatric setting.


This study aims to assess the inter- and intraobserver reliability of US measurements of cartilage thickness in the joints of healthy children.

Materials and methods

740 joints of 74 healthy children (27 girls/47 boys), mean aged 11.3 years were examined with bilateral US in 5 preselected joints to assess the interobserver variability. In 17 of these children (6 girls/11 boys), mean aged 10.1 years, 170 joints was examined in an intraobserver substudy, with a 2 week interval between the first and second examination. All US measurements were obtained blinded.


Knee 0.26 mm**diff. interobserver), Ankle -0.14 mm*, Wrist 0.09 mm*

MCP-0.11 mm* and PIP -0.09 mm*. Intraobserver similar results was found.

No statistical significant difference between/within observers.


We found a good inter- and intraobserver agreement expressed in CV less than 10% in 3 out of 5 examined joints. The inter- and intraobserver variation seemed not to related to joint size. This suggest that positioning of the joint and the transducer is of major importance for reproducible US measurements and that US is a feasible method for CTh measurements in a paediatric setting.

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Correspondence to AH Spannow.

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Open Access This article is published under license to BioMed Central Ltd. This is an Open Access article is distributed under the terms of the Creative Commons Attribution 2.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Spannow, A., Stenboeg, E., Jensen, M. et al. Intra- and interobserver reliability of ultrasonographic cartilage thickness assessments in small and large joint in healthy children. Pediatr Rheumatol 6, P96 (2008) doi:10.1186/1546-0096-6-S1-P96

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  • Healthy Child
  • Statistical Significant Difference
  • Interobserver Variability
  • Interobserver Reliability
  • Cartilage Thickness