Skip to main content
SpringerLink
Log in

Do patients with juvenile idiopathic arthritis in remission exhibit active synovitis on joint ultrasound?

  • Original Article
  • Published:
Rheumatology International Aims and scope Submit manuscript

Abstract

The aim of the study was to assess the presence and characteristics of subclinical synovitis using power Doppler (PD) ultrasonography on patients with juvenile idiopathic arthritis (JIA) in clinical remission and compare the findings with those of healthy children. A cross-sectional study was carried out involving the clinical (physical exam, functional capacity and laboratory tests) and ultrasonography evaluation of 34 joints (synovial fluid/hypertrophy, PD signal and bone erosion). Subclinical synovitis was defined as the presence of synovial hypertrophy/joint effusion with or without any PD signal. Thirty-six patients (11.5 ± 3.74 years) and 36 controls (sex and age matched) were evaluated (2,448 joints). Twenty-seven patients were in remission on medication (mean duration: 1.8 ± 2.2 years). Subclinical synovitis was detected in 41.7 % patients and 11.1 % controls (p = 0.003). Erosion was detected in three patients (8.3 %). Subclinical synovitis was found in 38/1,224 (3.1 %) joints in the patients (most affected: radiocarpal wrist, anterior elbow and tibiotalar ankle) and 8/1,224 (0.6 %) joints in the controls (most affected: radiocarpal wrist). Differences in subclinical synovitis between patients and controls were found in the elbows (p = 0.033) and ankles (p = 0.006). A greater frequency of subclinical synovitis was found in patients with the extended oligoarticular or polyarticular subtypes (p = 0.013), those at an older age at disease onset (p = 0.007) and using methotrexate (p = 0.049). Patients with JIA in remission exhibit subclinical synovitis more frequently than controls. Subclinical synovitis was more frequent in patients with the polyarticular involvement and those at an older age at disease onset.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Hahn YS, Kim JG (2010) Pathogenesis and clinical manifestations of juvenile rheumatoid arthritis. Korean J Pediatr 53:921–930

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  2. Cassidy JT, Petty RE, Laxer R, Lindsley C (eds) (2011) Textbook of pediatric rheumatology, 6th edn. WB Saunders, Philadelphia, pp 177–192

    Google Scholar 

  3. Prakken B, Albani S, Martini A (2011) Juvenile idiopathic arthritis. Lancet 377:2138–2149

    Article  PubMed  Google Scholar 

  4. Doria AS, Kiss MH, Lotito AP, Molnar LJ, de Castro CC, Medeiros CC et al (2001) Juvenile rheumatoid arthritis of the knee: evaluation with contrast-enhanced color Doppler ultrasound. Pediatr Radiol 31:524–531

    Article  CAS  PubMed  Google Scholar 

  5. Frosch M, Foell D, Ganser G, Roth J (2003) Arthrosonography of hip and knee joints in the follow up of juvenile rheumatoid arthritis. Ann Rheum Dis 62:242–244

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  6. Kakati P, Sodhi KS, Sandhu MS, Singh S, Katariya S, Khandelwal N (2007) Clinical and ultrasound assessment of the knee in children with juvenile rheumatoid arthritis. Indian J Pediatr 74:831–836

    Article  PubMed  Google Scholar 

  7. Magni-Manzoni S, Epis O, Ravelli A, Klersy C, Veisconti C, Lanni S et al (2009) Comparison of clinical versus ultrasound-determined synovitis in juvenile idiopathic arthritis. Arthritis Rheum 61:1497–1504

    Article  PubMed  Google Scholar 

  8. Haslam KE, McCann LJ, Wyatt S, Wakefield RJ (2010) The detection of subclinical synovitis by ultrasound in oligoarticular juvenile idiopathic arthritis: a pilot study. Rheumatology (Oxford) 49:123–127

    Article  Google Scholar 

  9. Hendry GJ, Gardner-Medwin J, Steultjens MP, Woodburn J, Sturrock RD, Turner DD (2012) Frequent discordance between clinical and musculoskeletal ultrasound examinations of foot disease in juvenile idiopathic arthritis. Arthritis Care Res (Hoboken) 64:441–447

    Article  Google Scholar 

  10. Magni-Manzoni S, Malattia C, Lanni S, Ravelli A (2012) Advances and challenges in imaging in juvenile idiopathic arthritis. Nat Rev Rheumatol. doi:10.1038/nrreum.2012

    PubMed  Google Scholar 

  11. Spârchez M, Fodor D, Miu N (2010) The role of power Doppler ultrasonography in comparison with biological markers in the evaluation of disease activity in Juvenile Idiopathic Arthritis. Med Ultrason 12:97–103

    PubMed  Google Scholar 

  12. Damasio MB, Malattia C, Martini A, Tomà P (2010) Synovial and inflammatory diseases in childhood: role of new imaging modalities in the assessment of patients with juvenile idiopathic arthritis. Pediatr Radiol 40:985–998

    Article  PubMed  Google Scholar 

  13. Collado P, Jousse-Joulin S, Alcalde M, Naredo E, D’Agostino MA (2012) Is ultrasound a validated imaging tool for the diagnosis and management of synovitis in juvenile idiopathic arthritis? A systematic literature review. Arthritis Care Res (Hoboken). doi:10.1002/acr.21644

    Google Scholar 

  14. Rebollo-Polo M, Koujok K, Weisser C, Jurencak R, Bruns A, Roth J (2011) Ultrasound findings on patients with juvenile idiopathic arthritis in clinical remission. Arthritis Care Res (Hoboken) 63:1013–1019

    Article  Google Scholar 

  15. Magni-Manzoni S, Scirè CA, Ravelli A, Klersy C, Rossi S, Muratore V et al (2012) Ultrasound detected synovial abnormalities are frequent in clinically inactive juvenile idiopathic arthritis, but do not predict a flare of synovitis. Ann Rheum Dis. doi:10.1136/annrheumdis-2011-201264

    Google Scholar 

  16. Brown AK, Conaghan PG, Karim Z, Quinn MA, Ikeda K, Peterfy CG et al (2008) An explanation for the apparent dissociation between clinical remission and continued structural deterioration in rheumatoid arthritis. Arthritis Rheum 58:2958–2967

    Article  CAS  PubMed  Google Scholar 

  17. Scirè CA, Montecucco C, Codullo V, Epis O, Todoerti M, Caporali R (2009) Ultrasonographic evaluation of joint involvement in early rheumatoid arthritis in clinical remission: power Doppler signal predicts short-term relapse. Rheumatology (Oxford) 48:1092–1097

    Article  Google Scholar 

  18. Foltz V, Gandjbakhch F, Etchepare F, Rosenberg C, Tanguy ML, Rozenberg S et al (2012) Power Doppler ultrasound, but not low-field magnetic resonance imaging, predicts relapse and radiographic disease progression in rheumatoid arthritis patients with low levels of disease activity. Arthritis Rheum 64:67–76

    Article  PubMed  Google Scholar 

  19. Yoshimi R, Hama M, Takase K, Ihata A, Kishimoto D, Terauchi K et al (2012) Ultrasonography is a potent tool for the prediction of progressive joint destruction during clinical remission of rheumatoid arthritis. Mod Rheumatol. doi:10.1007/s10165-012-0690-1

    PubMed  Google Scholar 

  20. Petty RE, Southwood TR, Manners P, Baum J, Glass DN, Goldenberg J et al (2004) International League of Associations for Rheumatology classification of juvenile idiopathic arthritis: second revision, Edmonton, 2001. J Rheumatol 31:390–392

    PubMed  Google Scholar 

  21. Wallace CA, Giannini EH, Huang B, Itert L, Ruperto N (2011) American College of Rheumatology provisional criteria for defining clinical inactive disease in select categories of juvenile idiopathic arthritis. Arthritis Care Res (Hoboken) 63:929–936

    Article  Google Scholar 

  22. Machado CS, Ruperto N, Silva CH, Ferriani VP, Roscoe I, Campos LM et al (2001) The Brazilian version of the Childhood Health Assessment Questionnaire (CHAQ) and the Child Health Questionnaire (CHQ). Clin Exp Rheumatol 19(S23):25–29

    Google Scholar 

  23. Backhaus M, Burmester GR, Gerber T et al (2001) Guidelines for musculoskeletal ultrasound in rheumatology. Ann Rheum Dis 60:641–649

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  24. Wakefield RJ, Balint PV, Szkudlarek M, Grassi W, Machold KP, Swen WA et al (2005) Musculoskeletal ultrasound including definitions for ultrasonographic pathology. J Rheumatol 32:2485–2487

    PubMed  Google Scholar 

  25. Backhaus M (2009) Ultrasound and structural changes in inflammatory arthritis: synovitis and tenosynovitis. Ann N Y Acad Sci 1154:139–151

    Article  PubMed  Google Scholar 

  26. Szkudlarek M, Court-Payen M, Jacobsen S, Klarlund M, Thomsen HS, Østergaard M (2003) Interobserver agreement in ultrasonography of the finger and toe joints in rheumatoid arthritis. Arthritis Rheum 48:955–962

    Article  PubMed  Google Scholar 

  27. Karmazyn B, Bowyer SL, Schmidt KM, Ballinger SH, Buckwalter K, Beam TT et al (2007) US findings of metacarpophalangeal joints in children with idiopathic juvenile arthritis. Pediatr Radiol 37:475–482

    Article  PubMed  Google Scholar 

  28. Fedrizzi MS, Ronchezel MV, Hilario MO, Lederman HM, Sawaya S, Goldenberg J (1997) Ultrasonography in the early diagnosis of hip joint involvement in juvenile rheumatoid arthritis. J Rheumatol 24:1820–1825

    CAS  PubMed  Google Scholar 

  29. Miotto e Silva VB, Faquin G, Nicácio A, Regacini R, Lederman HM, Hilario MO et al (2013) Association between sonographic and clinical findings in hip of patients with juvenile idiopathic arthritis. Rev Bras Reumatol 53(4):322–327

    Google Scholar 

  30. Collado P, Naredo E, Calvo C, Crespo M (2007) Assessment of the joint recesses and tendon sheaths in healthy children by high-resolution B-mode and power Doppler sonography. Clin Exp Rheumatol 25:915–921

    CAS  PubMed  Google Scholar 

  31. Algergawy S, Haliem T, Al-Shaer O (2011) Clinical, laboratory, and ultrasound assessment of the knee in juvenile rheumatoid arthritis. Clin Med Insights Arthritis Musculoskelet Disord 4:21–27

    Article  PubMed Central  PubMed  Google Scholar 

  32. Terslev L, Torp-Pedersen S, Qvistgaard E, von der Recke P, Bliddal H (2004) Doppler ultrasound findings in healthy wrists and finger joints. Ann Rheum Dis 63:644–648

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  33. Breton S, Jousse-Joulin S, Cangemi C, de Parscau L, Colin D, Bressolette L et al (2011) Comparison of clinical and ultrasonographic evaluations for peripheral synovitis in juvenile idiopathic arthritis. Semin Arthritis Rheum 41:272–278

    Article  PubMed  Google Scholar 

  34. Müller LS, Avenarius D, Damasio B, Eldevik OP, Malattia C, Lambot-Juhan K et al (2011) The pediatric wrist revisited: redefining MR findings in healthy children. Ann Rheum Dis 70:605–610

    Article  PubMed  Google Scholar 

  35. Boavida P, Hargunani R, Owens CM, Rosendahl K (2012) Magnetic resonance imaging and radiographic assessment of carpal depressions in children with juvenile idiopathic arthritis: normal variants or erosions? J Rheumatol 39:645–650

    Article  PubMed  Google Scholar 

  36. Wallace CA, Huang B, Bandeira M, Ravelli A, Giannini EH (2005) Patterns of clinical remission in select categories of juvenile idiopathic arthritis. Arthritis Rheum 52:3554–3562

    Article  PubMed  Google Scholar 

  37. Fantini F, Gerloni V, Gattinara M, Cimaz R, Arnoldi C, Lupi E (2003) Remission in juvenile chronic arthritis: a cohort study of 683 consecutive cases with a mean 10 year follow up. J Rheumatol 30:579–584

    PubMed  Google Scholar 

  38. Lurati A, Salmaso A, Gerloni V, Gattinara M, Fantini F (2009) Accuracy of Wallace criteria for clinical remission in juvenile idiopathic arthritis: a cohort study of 761 consecutive cases. J Rheumatol 36:1532–1535

    Article  PubMed  Google Scholar 

  39. Shahin AA, El-Mofty SA, El-Sheikh EA, Hafez HA, Ragab OM (2001) Power Doppler sonography in the evaluation and follow-up of knee involvement in patients with juvenile idiopathic arthritis. Z Rheumatol 60:148–155

    Article  CAS  PubMed  Google Scholar 

  40. Janow GL, Panghaal V, Trinh A, Badger D, Levin TL (2011) Detection of active disease in juvenile idiopathic arthritis: sensitivity and specificity of the physical examination vs ultrasound. J Rheumatol 38:2671–2674

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We would like to thank the State of São Paulo Research Assistance Foundation (FAPESP), process number 2010/50128-5 for the support provided to carry out our study.

Conflict of interest

None.

Ethical standards

The study was approved by Human Research Ethics Committee of São Paulo Hospital, Universidade Federal de São Paulo/Escola Paulista de Medicina, São Paulo, Brazil (CEP1995/09).

Author information

Authors and Affiliations

  1. Pediatric Rheumatology Unit, Allergy, Immunology and Rheumatology Division, Pediatric Department, Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM), Rua Ipê, 112/111, Vila Clementino, São Paulo, SP, CEP 04022-005, Brazil

    Vanessa Bugni Miotto e Silva, Maria Odete Esteves Hilário & Maria Teresa Terreri

  2. Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM), São Paulo, Brazil

    Carolina de Freitas Tavares da Silva

  3. Imaging Diagnostics Department, Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM), São Paulo, Brazil

    Sônia de Aguiar Vilela Mitraud

  4. Rheumatology Division, Department of Medicine, Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM), São Paulo, Brazil

    Rita Nely Vilar Furtado & Jamil Natour

Authors
  1. Vanessa Bugni Miotto e Silva
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Carolina de Freitas Tavares da Silva
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sônia de Aguiar Vilela Mitraud
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Rita Nely Vilar Furtado
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Maria Odete Esteves Hilário
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jamil Natour
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Maria Teresa Terreri
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Maria Teresa Terreri.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bugni Miotto e Silva, V., de Freitas Tavares da Silva, C., de Aguiar Vilela Mitraud, S. et al. Do patients with juvenile idiopathic arthritis in remission exhibit active synovitis on joint ultrasound?. Rheumatol Int 34, 937–945 (2014). https://doi.org/10.1007/s00296-013-2909-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00296-013-2909-7

Keywords

Search

Navigation