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Emergence of Musculoskeletal Ultrasound Use in Pediatric Rheumatology

  • Imaging (D Mintz, Section Editor)
  • Published:
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Abstract

Purpose of Review

To summarize recent international efforts on standardization and validation of pediatric musculoskeletal ultrasound and determine its role in diagnosis and monitoring of disease in pediatric rheumatology.

Recent Findings

Over the past decade, significant progress has been made on building the evidence base for musculoskeletal ultrasound in pediatric rheumatology. This includes the clear definition of the sonographic appearance of the normal pediatric joint and enthesis on ultrasonography, definitions for pathology, and the establishment of a specific scoring system for the pediatric knee. Ultrasonography has been shown to have an important role in the detection of subclinical synovitis and can predict flares in children considered to be in remission clinically.

Summary

Musculoskeletal ultrasound is likely going to play an important role in complementing the clinical exam especially in juvenile idiopathic arthritis. Given the powerful therapeutic tools available, it will support early diagnosis and precisely determine remission status. In a treat to target approach, it will greatly help to define the targets that need to be reached.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Minden K, Niewerth M, Listing J, Biedermann T, Bollow M, Schöntube M, et al. Long-term outcome in patients with juvenile idiopathic arthritis. Arthritis Rheum. 2002;46:2392–401.

    Article  PubMed  Google Scholar 

  2. Ravelli A, Martini A. Juvenile idiopathic arthritis. Lancet. 2007;369:767–78.

    Article  CAS  PubMed  Google Scholar 

  3. Ravelli A, Consolaro A, Horneff G, Laxer RM, Lovell DJ, Wulffraat NM, et al. Treating juvenile idiopathic arthritis to target: recommendations of an international task force. Ann Rheum Dis. 2018;77:819–28.

    PubMed  Google Scholar 

  4. Collado P, Jousse-Joulin S, Alcalde M, et al. Is ultrasound a validated imaging tool for the diagnosis and management of synovitis in juvenile idiopathic arthritis? A systematic literature review. Arthritis Care Res. 2012;64:1011–9.

    Google Scholar 

  5. Malattia C, Tzaribachev N, van den Berg M, Magni-Manzoni S. Juvenile idiopathic arthritis - the role of imaging from a rheumatologist’s perspective. Pediatr Radiol. 2018;48:785–91.

    Article  PubMed  Google Scholar 

  6. Lanni S, Martini A, Malattia C. Heading toward a modern imaging approach in juvenile idiopathic arthritis. Curr Rheumatol Rep. 2014;16:416.

    Article  PubMed  CAS  Google Scholar 

  7. Damasio MB, Malattia C, Martini A, Toma P. Synovial and inflammatory diseases in childhood: role of new imaging modalities in the assessment of patients with juvenile idiopathic arthritis. Pediatr Radiol. 2010;40:985e98.

    Article  Google Scholar 

  8. Rosendahl K, Maas M. Update on imaging in juvenile idiopathic arthritis. Pediatr Radiol. 2018;48:783–4.

    Article  PubMed  Google Scholar 

  9. Weiss PF, Chauvin NA, Roth J. Imaging in juvenile spondyloarthritis. Curr Rheumatol Rep. 2016;18:75.

    Article  PubMed  Google Scholar 

  10. •• Roth J, Jousse-Joulin S, Magni-Manzoni S, Rodríguez A, Tzaribachev N, Iagnocco A, et al. Definitions for the sonographic features of joints in healthy children. Arthritis Care Res. 2015;67:136–42. Important contribution to the pediatric literature defining normal joint features first in order to distinguish it from pathology.

    Article  Google Scholar 

  11. Collado P, Windschall D, Vojinovic J, Magni-Manzoni S, Balint P, Bruyn GAW, et al. Amendment of the OMERACT ultrasound definitions of joints’ features in healthy children when using the DOPPLER technique. Pediatr Rheumatol Online J. 2018;16:23.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. • Trauzeddel R, Windschall D, Trauzeddel RF, Nirschl C, Ganser G, Palm-Beden K, et al. Arthrosonographic reference values of the shoulder joint in healthy children and adolescents: a cross-sectional multicentre ultrasound study. Klin Padiatr. 2017;229:293–301. Providing normative data as an important basis for interpretation of findings.

    Article  PubMed  Google Scholar 

  13. • Trauzeddel RF, Lehmann H, Windschall D, Ganser G, Berendes R, Haller M, et al. Age-dependent arthrosonographic reference values of the hip joint in healthy children and adolescents - a cross-sectional multicenter ultrasound study. Pediatr Radiol. 2017;47:1329–36. Providing normative data as an important basis for interpretation of findings.

    Article  PubMed  Google Scholar 

  14. Collado P, Vojinovic J, Nieto JC, Windschall D, Magni-Manzoni S, Bruyn GA, et al. Toward standardized musculoskeletal ultrasound in pediatric rheumatology: normal age-related ultrasound findings. Arthritis Care Res. 2016;68:348–56.

    Article  Google Scholar 

  15. Rohrschneider WK, Fuchs G, Tröger J. Ultrasonographic evaluation of the anterior recess in the normal hip: a prospective study on 166 asymptomatic children. Pediatr Radiol. 1996;26:629–34.

    Article  CAS  PubMed  Google Scholar 

  16. • Rosendahl K, Bruserud IS, Oehme N, et al. Normative ultrasound references for the paediatric wrist; dorsal soft tissues. RMD Open. 2018 Mar 10;4(1):e000642. https://doi.org/10.1136/rmdopen-2017-000642. Providing normative data as an important basis for interpretation of findings.

    Article  PubMed  PubMed Central  Google Scholar 

  17. • Windschall D, Trauzeddel R, Haller M, et al. Pediatric musculoskeletal ultrasound: age- and sex-related normal B-mode findings of the knee. Rheumatol Int. 2016;36:1569–77. Providing normative data as an important basis for interpretation of findings.

    Article  PubMed  Google Scholar 

  18. • Trauzeddel R, Lehman H, Trauzeddel RF, et al. Age dependent ultrasound B-mode findings of the elbow joint in healthy children and adolescents. Rheumatol Int. 2019 Jun;39(6):1007-1018. Providing normative data as an important basis for interpretation of findings.

    Article  PubMed  Google Scholar 

  19. Windschall D, Collado P, Vojinovic J, Magni-Manzoni S, Balint P, Bruyn GAW, et al. Age-related vascularization and ossification of joints in children: an international pilot study to test multi-observer ultrasound reliability. Arthritis Care Res (Hoboken). 2017 Aug 4. https://doi.org/10.1002/acr.23335.

    Article  Google Scholar 

  20. Spannow AH, Pfeiffer-Jensen M, Andersen NT, Herlin T, Stenbøg E. Ultrasonographic measurements of joint cartilage thickness in healthy children: age- and sex-related standard reference values. J Rheumatol. 2010;37:2595–601.

    Article  PubMed  Google Scholar 

  21. Pradsgaard DØ, Fiirgaard B, Spannow AH, Heuck C, Herlin T. Cartilage thickness of the knee joint in juvenile idiopathic arthritis: comparative assessment by ultrasonography and magnetic resonance imaging. J Rheumatol. 2015;42:534–40.

    Article  PubMed  Google Scholar 

  22. •• Roth J, Ravagnani V, Backhaus M, Balint P, Bruns A, Bruyn GA, et al. Preliminary definitions for the sonographic features of synovitis in children. Arthritis Care Res (Hoboken). 2017;69:1217–23. First definitions of ultrasound pathology in synovitis providing a basis for future studies.

    Article  Google Scholar 

  23. • Lanni S, Bovis F, Ravelli A, Viola S, Magnaguagno F, Pistorio A, et al. Delineating the application of ultrasound in detecting synovial abnormalities of the subtalar joint in juvenile idiopathic arthritis. Arthritis Care Res. 2016;68:1346–53. Important comprehensive assessment of subtalar joint, an often forgotten joint.

    Article  Google Scholar 

  24. Torp-Pedersen S, Christensen R, Szkudlarek M, Ellegaard K, D'Agostino MA, Iagnocco A, et al. Power and color Doppler ultrasound settings for inflammatory flow: impact on scoring of disease activity in patients with rheumatoid arthritis. Arthritis Rheum. 2015;67:386–95.

    Article  Google Scholar 

  25. Haslam K, McCann L, Wyat S, et al. The detection of subclinical synovitis by ultrasound in oligoarticular juvenile idiopathic arthritis: a pilot study. Rheumatology. 2010;49:123–7.

    Article  PubMed  Google Scholar 

  26. Magni-Manzoni S, Epis O, Ravelli A, Klersy C, Veisconti C, Lanni S, et al. Comparison of clinical versus ultrasound-determined synovitis in juvenile idiopathic arthritis. Arthritis Rheum. 2009;61:1497–504.

    Article  PubMed  Google Scholar 

  27. Breton S, Jousse-Joulin S, Cangemi C, et al. Comparison of clinical and ultrasonographic evaluations for peripheral synovitis in juvenile idiopathic arthritis. Semin Arthritis Rheum. 2011;41:272–8.

    Article  PubMed  Google Scholar 

  28. Filippou G, Cantarini L, Bertoli I, Picerno V, Frediani B, Galeazzi M. Ultrasonography vs. clinical examination in children with suspected arthritis. Does it make sense to use polyarticular ultrasonographic screening? Clin Exp Rheumatol. 2011;29:345–50.

    CAS  PubMed  Google Scholar 

  29. Rebollo-Polo M, Koujok K, Weisser C, Jurencak BA, Roth J. Ultrasound findings in patients with juvenile idiopathic arthritis in clinical remission. Arthritis Care Res. 2011;63:1013–9.

    Article  Google Scholar 

  30. •• Lanni S, van Dijkhuizen EHP, Vanoni F, Viola S, Magnaguagno F, Magnano GM, et al. Ultrasound changes in synovial abnormalities induced by treatment in juvenile idiopathic arthritis. Clin Exp Rheumatol. 2018;36:329–34. Only longitudinal study so far on subclinical findings.

    PubMed  Google Scholar 

  31. Anandarajah A, Thiele R, Giampoli E, Monu J, Seo GS, Feng C, et al. Patients with rheumatoid arthritis in clinical remission manifest persistent joint inflammation on histologic and imaging studies. J Rheumatol. 2014;41:2153–60.

    Article  PubMed  Google Scholar 

  32. Magni-Manzoni S, Scirè CA, Ravelli A, Klersy C, Rossi S, Muratore V, et al. Ultrasound-detected synovial abnormalities are frequent in clinically inactive juvenile idiopathic arthritis, but do not predict a flare of synovitis. Ann Rheum Dis. 2013 Feb;72:223–8.

    Article  PubMed  Google Scholar 

  33. •• De Lucia O, Ravagnani V, Pregnolato F, Hila A, Pontikaki I, Gattinara M, et al. Baseline ultrasound examination as possible predictor of relapse in patients affected by juvenile idiopathic arthritis (JIA). Ann Rheum Dis. 2018;77:1426–31. Important study illustrating the relevance of subclinical findings.

    Article  PubMed  Google Scholar 

  34. •• Collado P, Naredo E, Calvo C, ECO-JIA Study Group, et al. Reduced joint assessment vs comprehensive assessment for ultrasound detection of synovitis in juvenile idiopathic arthritis. Rheumatology (Oxford). 2013;52:1477–84. Important study demonstrating a minimal set of joints to be scanned in order to capture pathology.

    Article  Google Scholar 

  35. •• Ting TV, Vega-Fernandez P, Oberle EJ, De Ranieri D, Bukulmez H, Lin C, et al. A novel ultrasound image acquisition protocol and scoring system for the pediatric knee. Arthritis Care Res. 2019;71:977–85. First comprehensively evaluated pediatric ultrasound scoring system.

    Article  Google Scholar 

  36. Keshava S, Gibikote S, Mohanta A, Doria AS. Refinement of a sonographic protocol for assessment of haemophilic arthropathy. Haemophilia. 2009;15:1168–71.

    Article  CAS  PubMed  Google Scholar 

  37. Xavier F, Zhang N, Mohanta M, et al. Sonography for assessment of elbows in haemophilic children: a systematic protocol. Rheumatology (Current Research). 2012;2161-1149(Suppl 2):1–9.

    Google Scholar 

  38. Martinoli C, Della Casa Alberighi O, Di Minno G, et al. Development and definition of a simplified scanning procedure and scoring method for Haemophilia Early Arthropathy Detection with Ultrasound (HEAD-US). Thromb Haemost. 2013;109:1170–9.

    Article  CAS  PubMed  Google Scholar 

  39. Wakefield RJ, Gibbon WW, Conaghan PG, O'Connor P, McGonagle D, Pease C, et al. The value of sonography in the detection of bone erosions in patients with rheumatoid arthritis: a comparison with conventional radiography. Arthritis Rheum. 2000;43:2762–70.

    Article  CAS  PubMed  Google Scholar 

  40. Ventura-Ríos L, Faugier E, Barzola L, De la Cruz-Becerra LB, Sánchez-Bringas G, García AR, et al. Reliability of ultrasonography to detect inflammatory lesions and structural damage in juvenile idiopathic arthritis. Pediatr Rheumatol Online J. 2018;16:58.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Karmazyn B, Bowyer SL, Schmidt KM, Ballinger SH, Buckwalter K, Beam TT, et al. US findings of metacarpophalangeal joints in children with idiopathic juvenile arthritis. Pediatr Radiol. 2007;37:475–82.

    Article  PubMed  Google Scholar 

  42. • Weiss PF, Chauvin NA, Klink AJ, et al. Detection of enthesitis in children with enthesitis-related arthritis: dolorimetry compared to ultrasonography. Arthritis Rheum. 2014;66:218–27. Demonstrating significant subclinical findings on the entheses of children with enthesitis related arthritis.

    Article  Google Scholar 

  43. • Roth J, Stinson SE, Chan J, Barrowman N, Di Geso L. Differential pattern of Doppler signals at lower-extremity entheses of healthy children. Pediatr Radiol. 2019;49:1335–43. Emphasizing the fact that ultrasound findings may not be specific for inflammatory pathology and that this may also depend on the enthesis examined.

    Article  PubMed  Google Scholar 

  44. Rooney ME, McAllister C, Burns JF. Ankle disease in juvenile idiopathic arthritis: ultrasound findings in clinically swollen ankles. J Rheumatol. 2009;36:1725–9.

    Article  PubMed  Google Scholar 

  45. Ringold S, Torgerson TR, Egbert MA, et al. Intraarticular corticosteroid injections of the temporomandibular joint in juvenile idiopathic arthritis. J Rheumatol. 2008;35:1157–64.

    PubMed  Google Scholar 

  46. Neidel J, Boehnke M, Küster RM, et al. The efficacy and safety of intraarticular corticosteroid therapy for coxitis in juvenile rheumatoid arthritis. Arthritis Rheum. 2002;46:1620–8.

    Article  CAS  PubMed  Google Scholar 

  47. Young CM, Shiels WE 2nd, Coley BD, et al. Ultrasound-guided corticosteroid injection therapy for juvenile idiopathic arthritis: 12-year care experience. Pediatr Radiol. 2012;42:1481–9.

    Article  PubMed  Google Scholar 

  48. Favier LA, Ting TV, Modi AC. Feasibility of a musculoskeletal ultrasound intervention to improve adherence in juvenile idiopathic arthritis: a proof-of concept trial. Pediatr Rheumatol Online J. 2018;22:75.

    Article  Google Scholar 

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Authors and Affiliations

  1. University of Ottawa, Ottawa, Canada

    Johannes Roth

  2. Division of Pediatric Dermatology & Rheumatology, Children’s Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada

    Johannes Roth

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Correspondence to Johannes Roth.

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Dr. Roth reports receiving consultant and speakers fees from Abbvie and Novartis related to pediatric MSK ultrasound.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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Roth, J. Emergence of Musculoskeletal Ultrasound Use in Pediatric Rheumatology. Curr Rheumatol Rep 22, 14 (2020). https://doi.org/10.1007/s11926-020-0889-7

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