Rheumatology International

, Volume 28, Issue 6, pp 573–578

Role of Power Doppler sonography in evaluation of therapeutic response of the knee in juvenile rheumatoid arthritis

  • C. Shanmugavel
  • Kushaljit Singh Sodhi
  • Manavjit Singh Sandhu
  • R. Sidhu
  • Surjit Singh
  • Sudha Katariya
  • N. Khandelwal
Original Article
  • 98 Downloads

Abstract

The objective is to study the role of power Doppler sonography (PDS) in assessment of therapeutic response in juvenile rheumatoid arthritis (JRA) of knee joint. Thirty patients (age range 3–11 years) of JRA with knee joint involvement were selected for this study. Clinical assessment and ultrasound was done on the same day and repeated at the end of second and sixth month of therapy. All patients received naproxen (15–20 mg/kg/day) for a period of 6 months. Total clinical score (TCS) was calculated as sum of scores of pain, articular swelling and functional impairment. PDS was performed and degree of vascularity was assessed and graded. Total USG score was obtained by adding sum of scores of synovial effusion, synovial thickening and PDS. Results were compared between the total clinical score and the total ultrasound score and between clinical groups at baseline, end of second month and end of sixth month. There were statistically significant differences between clinical and ultrasound indices and confirmed that PDS is more sensitive in detection and follow-up of clinically silent cases of JRA. PDS holds great promise for detection of active synovial inflammatory disease in sub-clinical cases of JRA and is useful in objective assessment of therapeutic response.

References

  1. 1.
    Cellerini M, Salti S, Trapani S et al (1999) Correlation between clinical and ultrasound assessment of the knee in children with mono-articular (or) pauciarticular juvenile ultrasound rheumatoid arthritis. Pediatric Radiol 29:117–123CrossRefGoogle Scholar
  2. 2.
    Jacobs JC (1995) Juvenile rheumatoid arthritis. In: Jacobs JC (ed) Pediatric rheumatology for the practitioner. Springer, Berlin, pp 231–259Google Scholar
  3. 3.
    Cassidy JT, Pretty RE (1995) Juvenile rheumatoid arthritis. In: Cassidy JT, Pretty RE (eds) Text book of Pediatric rheumatology, 3rd edn. WB Saunders, Philadelphia, pp 133–223Google Scholar
  4. 4.
    Ansell BM (1987) Chronic arthritis in childhood. Ann Rheum Dis 37:107–120CrossRefGoogle Scholar
  5. 5.
    Strunk J, Hienemen E, Neeck G, Schmidt Kl, Lange U (2004) A new approach to studying angiogenesis in rheumatoid arthritis by means of power Doppler ultrasonography and measurement of serum vascular endothelial growth factor. Rheumatology 43:1480–1483PubMedCrossRefGoogle Scholar
  6. 6.
    Scaller J, Wedwod RJ (1969) Pauciarticular rheumatoid arthritis. Arthritis Rheum 12:330Google Scholar
  7. 7.
    Buchanan WW, Jugwell P (1983) Traditional assessment of articular diseases. Clin Rheum Dis 9:515–529PubMedGoogle Scholar
  8. 8.
    Spiegel TM, King W, Weiner SR, Paulus HE (1987) Measurement of disease activity and compression of joint tenderness, swelling and ultrasonography in rheumatoid arthritis. Arthritis Rheum 30:1283–1288PubMedCrossRefGoogle Scholar
  9. 9.
    Newman JS, Timothy Jl, McCarthy C et al (1996) Power Doppler sonography of synovitis: assessment of therapeutic response—preliminary observations. Radiology 198:582–584PubMedGoogle Scholar
  10. 10.
    Teh J, Stevens K, Williamson L, Leung J, McNally EG (2003) Power Doppler ultrasound of rheumatoid synovitis: quantification of therapeutic response. Br J Radiol 76(912):875–879PubMedCrossRefGoogle Scholar
  11. 11.
    Adler RS, Newman JS, Bude RO et al (1994) Detection of soft tissue hyperemia: value of power Doppler sonography. AJR Am J Roentgenol 163:385–389PubMedGoogle Scholar
  12. 12.
    Rubin JM, Casson PL, Bree RL, Adler RS (1994) Power Doppler—a potentially useful alternative to mean frequency based colour Doppler sonography. Radiology 190:853–856PubMedGoogle Scholar
  13. 13.
    Wilkinson RH, Weissman BN (1988) Arthritis in children. Radiol Clin North Am 26:1247–1265PubMedGoogle Scholar
  14. 14.
    Ostegaard M, Lorenzen I, Henriksen O et al (1994) Dynamic gadolinium enhanced MR imaging in active and inactive immune inflammatory gonarthritis. Acta Radiol 35(Fasc 3):19–26Google Scholar
  15. 15.
    Raymond HW, Zaiebel WJ, Swartz JD (2000) Musculoskeletal ultrasonography. Semin Ultrasound CT MR 21(3):248–249Google Scholar
  16. 16.
    Ferrari FS, Saloni E, Sihonegoverni Poggiauti G (1997) Ultrasound findings in rheumatoid arthritis. Ultrasound Intervent 3:146–156Google Scholar
  17. 17.
    Naredo E, Bonilla G, Gamero F, Uson J, Carmona L, Laffon A (2005) Assessment of inflammatory activity in rheumatoid arthritis: a comparative study of clinical evaluation with grey scale and power Doppler ultrasonography. Ann Rheum Dis 64(3):375–381PubMedCrossRefGoogle Scholar
  18. 18.
    Salaffi F, Carotti M, Manganelli P, Filippucci E, Giuseppetti GM, Grassi W (2004) Contrast-enhanced power Doppler sonography of knee synovitis in rheumatoid arthritis: assessment of therapeutic response. Clin Rheumatol 23(4):285–290PubMedCrossRefGoogle Scholar
  19. 19.
    Sureda D, Quiroga S, Arnal C et al (1994) Juvenile rheumatoid arthritis of the knee. evaluation with ultrasonography. Radiology 190:403–406PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • C. Shanmugavel
    • 1
  • Kushaljit Singh Sodhi
    • 1
  • Manavjit Singh Sandhu
    • 1
  • R. Sidhu
    • 1
    • 2
  • Surjit Singh
    • 3
  • Sudha Katariya
    • 1
  • N. Khandelwal
    • 1
  1. 1.Department of RadiodiagnosisPostgraduate Institute of Medical Education and Research (PGIMER)ChandigarhIndia
  2. 2.Division of Diagnostic and Interventional Neuroradiology, Department of RadiologyUniversity of RochesterRochesterUSA
  3. 3.Department of PediatricsPostgraduate Institute of Medical Education and Research (PGIMER)ChandigarhIndia

Personalised recommendations