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Comparison of clinical versus ultrasound-determined synovitis in juvenile idiopathic arthritis
Arthritis Care and Research , 11/02/09

Magni-Manzoni S et al. – Goal of this study was to compare clinical evaluation and ultrasonography (US) in the assessment of joint synovitis in children with juvenile idiopathic arthritis (JIA). We found that subclinical synovitis as detected by US is common in children with JIA. This finding may have important implications for patient classification and may affect the choice of the optimal therapeutic strategy in individual patients.

Methods

32 patients underwent clinical evaluation of 52 joints by 2 pediatric rheumatologists
Same joints scanned independently by experienced sonographer for synovial hyperplasia, joint effusion, and power Doppler (PD) signal

Results

1,664 joints assessed both clinically and with US
98 joints swollen, 59 joints tender, and 40 joints had restricted motion
On US evaluation, 125 joints had synovial hyperplasia, 153 joints had joint effusion, and 53 joints had PD signal
Total of 104 and 167 joints had clinical and US synovitis, respectively
Of 1,560 clinically normal joints, 86 had subclinical synovitis
US led to classifying 5 patients as having polyarthritis who were classified as having oligoarthritis or were found to have no synovitis on clinical evaluation
US variables moderately correlated with clinical measures of joint swelling, but poorly correlated with those of joint tenderness/pain on motion and restricted motion
Overall, correlations lower for PD signal than for synovial hyperplasia and joint effusion

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