FRI0331 Comparison of clinical and ultrasonographic examination of 7200 joints in 100 JIA patients satisfying wallace criteria of inactive disease (ID), suggests to add ultrasonography as a new criteria of ID. (23rd January 2014) - Donati, C.
Abstract : Background: ultrasonography (US) is useful to detect synovial inflammation in JIA but still seldom used by pediatric rheumatologists to confirm the clinical definition of inactive synovitis Objectives: US and Power Doppler Signal (PDS) can better identify subclinical synovitis than physical examination and could be added to Wallace criteria of ID to better identify JIA patients on Clinical Remission (CR) Methods: 100 randomized patients with JIA (age 18mo-25yrs) according to ILAR classification, followed at the Pediatric Rheumatology Unit of our Department, who were inactive according to Wallace criteria, were submitted to the ultrasound examination of 72 joints for each patient. US was performed immediately after clinical evaluation, by 2 trained sonographers, blinded to clinical findings, who recorded: synovial hyperplasia, joint effusion and PDS. Apparatus used: GE Logiq P5.8-12MHz multifrequency linear probe. Intraobserver reproducibility of US was assessed. Synovial hyperplasia was defined as an abnormally hypoechoic joint space, distinct from the intra-articular fat pad and no compressible with the transducer. Joint effusion was defined as the presence of an abnormally anechoic space within the joint that was compressible. PDS was considered positive in the presence of vessel dots on PD images. In each joint, synovial hyperplasia and joint effusion were graded as follows: 0=absent, 1=mild, 2=moderate and 3=marked. PDS was graded as follows: 0=absent, 1=presence of single vessel dot, 2=presence of confluent vessel dots in less than half of the synovial area and 3=presence of confluent vessel dots in more than half of the synovial area. A joint with US synovitis was defined as a joint in which any of the 3 US abnormalities was detectable. PDS alone was considered pathologic only if far from the growth plate cartilage. The US examination technique as well as the definitions and scoring of US features were based on published guidelines or descriptions, particularly those provided by the OMERACT Results: ultrasound examination revealed the presence of 1 or more alterations of the synovial structures (effusion, hyperplasia or positive PDS) in 23 out of 100 pts who satisfied the clinical criteria of ID according to Wallace definition (23%). 9 pts (39% out of 23 active pts & 9% out of all 100 pts) have only one joint involved. The other 14 pts (61% out of 23 active pts & 14% out of all 100 pts) presented US activity in more than 1 joint. 43 of the 7200 examined joints were active at US (0.06%). In 17 of these 43 joints (32%) US revealed joint effusion and hyperplasia and PDS. In 29 joints (67%) there were only two of these US features Conclusions: our data confirm the usefulness of US in pediatric joint examination to correctly identify in JIA patients the presence of still active joints, to set up an appropriate treatment and to define the condition of inactive disease in a more accurate way than referring only to Wallace criteria References: Comparison of Clinical and Ultrasonographic Evaluations for Peripheral Synovitis in Juvenile Idiopathic Arthritis S Breton MD, S Jousse-Joulin MD, C Cangemi MD, L de Parscau PhD, D Colin MD, L Bressolette PhD, A Saraux PhD and V Devauchelle-Pensec PhD Disclosure of Interest: None Declared