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Ultrasonography and colour Doppler in juvenile idiopathic arthritis: Diagnosis and follow-up of ultrasound-guided steroid injection in the wrist


Wrist inflammation commonly causes growth deformation and is an indicator of poor outcome in JIA [1]. Due to the anatomical complexity of the wrist, defining the exact anatomical location of synovial inflammation and performing palpation-guided injections are difficult.


To assess the usefulness of ultrasonography (US) of the wrist for detection of synovial hypertrophy and hyperaemia, as well as for guidance and efficacy evaluation of steroid injections in patients with JIA.


15 symptomatic wrists in 11 patients with JIA, 10 girls and 1 boy between 2 and 16 years (median 12.5 years), were assessed clinically and by Doppler-US before and after (1 - 4 weeks) US-guided steroid injection. The presence (no normalization) or absence (normalization) of synovial hypertrophy and Doppler flow (hyperaemia) after treatment was recorded.


Inflammation was found in all 15 wrists. Table 1-2 show involved anatomical structures and the effects of US-guided steroid injections.

Table 1 US diagnosis of synovial hypertrophy and hyperaemia in 15 wrists before injection
Table 2 Effect on synovial hypertrophy 1 week and 4 weeks after US-guided steroid injection


US enabled exact anatomical location of synovial inflammation, guidance of steroid injections and was valuable for follow-up examinations. Our findings suggest that in children with JIA US should be performed before wrist injections and to guide those procedures.


  1. 1.

    Ravelli A, Martini A: Juvenile Idiopathic Arthritis. Lancet. 2007, 369: 767-78. 10.1016/S0140-6736(07)60363-8.

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Correspondence to Louise Laurell.

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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 (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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About this article


  • Public Health
  • Arthritis
  • Steroid
  • Juvenile Idiopathic Arthritis
  • Anatomical Structure