Session Information
Session Type: Abstract Submissions (ACR)
Background/Purpose:
Juvenile idiopathic arthritis (JIA) is the most common chronic rheumatic disease in childhood and has variable prognosis, characterized by periods of activity and remission. Studies in patients with JIA in remission evaluated by ultrasonography (US) demonstrated presence of subclinical synovitis. It is unclear whether subclinical synovitis detected by imaging techniques can predict progressive joint damage and functional deterioration in clinically asymptomatic joints. The aim of our study were: 1) to assess if the presence of subclinical synovitis detected by US in patients with JIA in remission may predict flare over a two years follow up and 2) to detect associations between disease activity and clinical, laboratory, functional and ultrasonographic features.
Methods:
Inclusion criteria: oligoarticular and polyarticular JIA, clinical and laboratory remission, aged between 5 and 18 years. Clinical assessment: active/limited joint count, functional capacity by the Childhood Health Assessment Questionnaire, physician global visual analogue scale (VAS), patient global VAS, medications on use. The clinical, laboratory and ophthalmological evaluations were performed at baseline and every 6 months for up to 30 months. US assessed 17 joints bilaterally at baseline and every 12 months for up to 24 months. The US parameters evaluated were synovial hypertrophy and synovial blood flow on Power Doppler (PD). Subclinical synovitis was considered in the presence of moderate to severe degree of synovial hypertrophy and/or any positive synovial flow on PD. Flare was considered in the presence of at least one joint active until six months after each US evaluation.
Results:
Thirty-five patients, 28 girls, mean age at assessment was 11.5 ± 3.7 years and mean age at disease onset was 4.4 ± 3.2 years, with a total of 1190 joints assessed. Fifiteen patients had persistent oligoarticular JIA, 11 extended oligoarticular and 9 polyarticular with negative rheumatoid factor. Regarding the type of remission, 8 were off medication and 27 were on medication, with an average time of remission of 1.9 ± 2.2 years. So far, a total of 74 evaluations were performed by US and 28 (37.8%) showed subclinical synovitis in at least one joint (28 with synovial hypertrophy and 9 with positive synovial flow on PD). There were 15 flares and in 8 of these episodes the US showed previously subclinical synovitis (p=0,166). There was also no association between positive synovial flow on PD and flares (p=0,676).
Conclusion:
Subclinical synovitis was present in patients with JIA in clinical remission and may predict flare. These data are still preliminary.
Disclosure:
V. B. Miotto e Silva,
None;
S. A. V. Mitraud,
None;
R. N. Furtado,
None;
J. Natour,
None;
M. T. Terreri,
None.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/preliminary-prospective-study-of-ultrasonography-in-patients-with-juvenile-idiopathic-arthritis-in-clinical-remission-subclinical-synovitis-may-predict-flare/