Background/Purpose:

Over several years, numerous studies have been published on the interest of joint ultrasound in juvenile idiopathic arthritis. Several authors have demonstrated that ultrasonography is more sensitive in synovitis detection than clinical examination. As of today, we do not know whether or not joint ultrasonography has an impact on therapeutic decisions. The objective of this study is to determine the interest of joint ultrasonography in therapeutic management of juvenile idiopathic arthritis.

Methods:

This was a monocentric, open cross-sectional study, conducted on twenty-seven outpatients with JIA between March 2010 and January 2012. Ultrasound (US) evaluations were always carried out by the same rheumatologist, who had been trained in joint US. The ultrasound scanner was an EsaoteMylab 60. The wrists, hands and feet were systematically analysed, as was any painful joint. Therapeutic decisions were taken following clinical examination and joint ultrasound. In the second step of the study, all of the consultations with ultrasound evaluation were summarized in the form of scenarios and submitted to clinicians, without the US results. Three physicians then expressed their therapeutic decisions (no modification, treatment enhancement or reduced treatment), which were subsequently compared with and without ultrasound data.

Results:

Among the twenty-seven children followed, US was carried out in thirteen. 53.8% of the thirteen children had oligoarticular JIA and the other 46.2% had polyarticular onset. Between March 2010 and January 2012, 34 ultrasounds were carried out on thirteen children and thirty-four scenarios were elaborated. Subclinical synovitis was found in 94.1% of the US with a mean of 4.82+/-3.46. Treatment enhancement ensued after 52.8% of the consultations with ultrasound evaluation, with a mean subclinical synovitis of 5.11+/- 3.31. Divergent decisions (29.4%) were found when comparing consultation with ultrasound and scenario without ultrasound. Whether there were more than 2 clinical instances of synovitis or none, the decision remained similar. The divergent decisions came about either when children were symptomatic but with no more than two clinical instances of arthritis or asymptomatic with no clinical synovitis.

Conclusion:

This study strongly confirms the interest of joint ultrasound in therapeutic decision-making. It establishes a usable therapeutic tool by means of accurate articular evaluation and suggests its interest in the therapeutic management of JIA children, especially when the clinical data are not sufficiently explicit.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/should-joint-ultrasound-contribute-to-therapeutic-decisions-in-juvenile-idiopathic-arthritis/