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Rheumatology Advance Access published online on November 20, 2009
Rheumatology, doi:10.1093/rheumatology/kep339
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© The Author 2009. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

The detection of subclinical synovitis by ultrasound in oligoarticular juvenile idiopathic arthritis: a pilot study

Kirsty E. Haslam1, Liza J. McCann2, Susan Wyatt1 and Richard J. Wakefield3

1Department of Paediatric Rheumatology, Leeds Teaching Hospitals NHS Trust, Leeds, 2Royal Liverpool NHS Trust, Alder Hey, Liverpool and 3Academic Department of Musculoskeletal Disease, Chapel Allerton Hospital, Leeds, UK.

Correspondence to: Richard J. Wakefield, Section of Musculoskeletal Disease, Leeds Institute of Molecular Medicine, 2nd Floor, Chapel Allerton Hospital, Chapeltown Road, Leeds LS7 4SA, UK. E-mail: medrjw{at}leeds.ac.uk


  Abstract

Objectives. Adult studies have demonstrated that ultrasonography (US) is more sensitive at detecting synovitis than clinical examination. The detection of subclinical disease has implications for deciding which patients receive more aggressive therapy from the outset. This study aimed to determine whether children with clinically diagnosed oligoarticular juvenile idiopathic arthritis (JIA) had US-detectable subclinical synovitis.

Methods. This was a cross-sectional pilot study conducted in a tertiary paediatric rheumatology clinic. Seventeen children with a median age of 10 years (range 3–13 years) and with oligoarticular disease of duration <12 months (median 5 months) were recruited. All subjects were DMARD and oral/i.v. corticosteroid naïve. A core set of 40 joints was clinically examined for synovitis and then scanned by a rheumatologist trained in joint US and blinded to all clinical data, at the same appointment.

Results. In total, 680 joints were examined both clinically and by US. Twenty-three joints were found to have clinical synovitis, and of these only 17 had synovitis confirmed by US. A further 15 joints were found to have synovitis on US examination alone. Overall, subclinical synovitis was detected in 6/17 children, mostly in the hands and feet. One child was reclassified as having polyarticular disease.

Conclusions. This pilot study has highlighted a discrepancy between clinical examination and ultrasound when assessing the joints of children with JIA. US is a feasible tool for examining multiple joints and identifying subclinical synovitis, particularly when considering the small joints of the hands and feet.

KEY WORDS: Ultrasound, Subclinical synovitis, Juvenile idiopathic arthritis, Oligoarticular, Paediatric

Submitted 11 September 2009; revised version accepted 22 September 2009.
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