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Abstract Number: 1447

Positive Power Doppler Signal Increases the Risk of Clinical Flare of Patients with Juvenile Idiopathic Arthritis in Clinical Remission: A Prospective Study

Vanessa B Miotto e Silva1, Octavio Peracchi2, Claudio A. Len3, Sônia A.V. Mitraud4, Rita NV Furtado5, Jamil Natour6 and Maria Teresa Terreri7, 1Pediatrics, Universidade Federal de São Paulo / UNIFESP, São Paulo, Brazil, 2Pediatric Rheumatology, Assistent Doctor, Sao Paulo, Brazil, 3Pediatrics, Universidade Federal de São Paulo, São Paulo,, Brazil, 4Radiology and Diagnostic Imaging, Escola Paulista de Medicina/ Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brazil, 5Medicine, Universidade Federal de Sao Paulo, Sao Paulo, Brazil, 6Rheumatology Division, Federal University of Sao Paulo, Sao Paulo, Brazil, 7Pediatrics, Universidade Federal de Sao Paulo, São Paulo, Brazil

Meeting: 2015 ACR/ARHP Annual Meeting

Date of first publication: September 29, 2015

Keywords: Doppler ultrasound, juvenile idiopathic arthritis (JIA) and synovitis

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Session Information

Date: Monday, November 9, 2015

Session Title: Pediatric Rheumatology - Clinical and Therapeutic Aspects Posters. Juvenile Arthritis and Miscellaneous Rheumatic Diseases

Session Type: ACR Poster Session B

Session Time: 9:00AM-11:00AM

Background/Purpose: Prior ultrasound (US) studies in patients with juvenile idiopathic arthritis (JIA) in clinical remission have demonstrated the presence of subclinical synovitis. However, the significance of subclinical synovitis and positive power Doppler (PD) signal in these patients  is still not well understood. The objectives of this study were to evaluate possible factors associated with clinical flare over a 30-month evaluation in a group of patients with JIA in remission and assess if the presence of US features could predict disease flares.

Methods: In this two years longitudinal, single-center study we performed clinical, laboratory (every 6 months) and US evaluations (initial, after 12 and 24 months) in 35 JIA patients in clinical remission according to Wallace criteria (34 joints/60 articular recesses).  US parameters included synovial hypertrophy, PD signal and evidence of bone erosions. Subclinical synovitis was defined by the presence of synovial hypertrophy and/or positive PD signal. Flare was defined according to Wallace criteria.

Results: Of the 35 patients (80% female), 14 (40%) had persistent oligoarticular, 12 (34.3%) extended oligoarticular and 9 (25.7%) polyarticular JIA. Twenty patients (57.1%) were antinuclear antibodies (ANA) positive and none were rheumatoid factor (RF) positive. The mean age was 11.6 ± 3.8 years, the mean age of onset of JIA was 4.4 ± 3.2 years and the mean disease duration was 7.1 ± 3.5 years. Twenty-six (74.3%) patients were in remission on treatment and 9 (25.7%) were in remission off medication, for a median of 1.9 years. Twenty (57.1%) patients flared during the 30 months follow-up. Knees and ankles were most commonly affected. Eighteen (90%) were on treatment at the time of clinical flare. Of the 20 clinical flare patients, 7 (35%) had subclinical synovitis, 10 (50%) had synovial hypertrophy and 2 (10%) had positive PD signal at the time of flare. A Cox regression  analysis found that both a positive PD signal (p=0.046) and the use of medications (p <0.001) were significantly associated with flare, and the risk of flare in patients with a positive PD signal was five times greater than in patients without  a PD signal. Patients who were in remission on treatment showed a 14 times higher risk of clinical flare than patients off treatment.

Conclusion: The presence of subclinical synovitis detected by US in JIA patients in clinical remission did not predict flare of the disease. On the other hand, a positive PD signal showed a greater risk of JIA clinical flare. The remission on medication was also a risk factor for JIA flare. Patients in remission on treatment with a positive PD signal should be cautiously tapered due to the higher risk of clinical flares.


Disclosure: V. B. Miotto e Silva, None; O. Peracchi, None; C. A. Len, None; S. A. V. Mitraud, None; R. N. Furtado, None; J. Natour, None; M. T. Terreri, None.

To cite this abstract in AMA style:

Miotto e Silva VB, Peracchi O, Len CA, Mitraud SAV, Furtado RN, Natour J, Terreri MT. Positive Power Doppler Signal Increases the Risk of Clinical Flare of Patients with Juvenile Idiopathic Arthritis in Clinical Remission: A Prospective Study [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/positive-power-doppler-signal-increases-the-risk-of-clinical-flare-of-patients-with-juvenile-idiopathic-arthritis-in-clinical-remission-a-prospective-study/. Accessed March 3, 2021.
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