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Detection of active disease in juvenile idiopathic arthritis: Sensitivity and specificity of the physical examination vs ultrasound
Journal of Rheumatology, 09/19/2011
Clinical Article
Janow GL et al. – PE is neither highly sensitive nor specific for identifying active synovitis when compared to US, and screening with US can identify subclinical disease. In joints with both non–bony swelling and limitation of motion with pain on motion or tenderness, and in the knee joint, little additional information is gained by US. This has implications for classification and treatment of JIA.
Methods- 19 patients with JIA were referred for US
- Both knees and ankles examined using US with and without power Doppler
- Active arthritis on PE was defined as (1) non–bony swelling or (2) limitation of motion with either pain on motion or tenderness to palpation
- Active arthritis on US was defined as synovial hyperplasia, effusion, or increased vascularity on power Doppler scan
- There was agreement between US and PE in 75% of cases
- PE was 64% sensitive and 86% specific for identifying active arthritis
- PE was 100% specific if (1) the patient was positive for both PE criteria or (2) if arthritis was present on PE in the knees
- When PE was negative and US was positive, 21.4% developed active disease on PE within 6 months
- In cases where PE was positive and US was negative, joint involved was most often the ankle and frequently the subtalar joint