Correspondence to Dr Silvia Magni-Manzoni, Istituto di Ricovero e Cura a Carattere Scientifico Ospedale Pediatrico Bambino Gesù, Rome, 00165, Italy.
Ann Rheum Dis. 2013 Feb;72(2):223-8. doi: 10.1136/annrheumdis-2011-201264. Epub 2012 Jun 26.
To investigate whether children with juvenile idiopathic arthritis (JIA) in clinical remission have subclinical synovial disease on ultrasound, and whether ultrasound abnormalities predict an early flare of synovitis.
Thirty-nine consecutive children who had clinically defined inactive disease (ID) for a minimum of 3 months underwent ultrasound assessment of 52 joints. All joints were scanned for synovial hyperplasia, joint effusion, power Doppler (PD) signal and tenosynovitis. Patients were then followed clinically for up to 2 years until a flare of synovitis occurred in one or more joints, or until the 2-year visit if the disease remained in clinical remission.
Synovial hyperplasia, joint effusion, PD signal and tenosynovitis in at least one joint were detected in 76.9%, 66.7%, 33.3% and 15.4% of patients, respectively. During the 2-year follow-up, 24 patients (61.5%) experienced sustained ID, whereas 15 patients (38.5%) had a flare of synovitis in a total of 45 joints after a median of 10.6 months (range 6.3-13.7 months). At study entry, the rate of synovial hyperplasia, joint effusion and tenosynovitis was comparable between patients with persistent ID and patients with synovitis flare, whereas patients with persistent ID had a greater frequency of PD signal than patients with synovitis flare. Only 17 of the 45 flared joints had ultrasound abnormalities at study entry.
The authors found that ultrasound-detected synovial abnormalities are common in children with JIA in clinical remission. However, the presence of ultrasound pathology did not predict an early flare of synovitis in the affected joints.
探讨处于临床缓解期的幼年特发性关节炎（JIA）患儿是否存在亚临床滑膜病变，以及超声异常是否预示着滑膜炎症的早期复发。
39 例临床定义的疾病缓解期（ID）至少持续 3 个月的患儿进行了 52 个关节的超声评估。所有关节均进行滑膜增生、关节积液、能量多普勒（PD）信号和腱鞘炎的扫描。然后对患儿进行临床随访，最长达 2 年，直到一个或多个关节出现滑膜炎复发，或疾病持续处于临床缓解期时达到 2 年就诊时间。
76.9%、66.7%、33.3%和 15.4%的患儿分别至少有 1 个关节存在滑膜增生、关节积液、PD 信号和腱鞘炎。在 2 年的随访中，24 例（61.5%）患儿持续 ID，而 15 例（38.5%）患儿在中位时间 10.6 个月（范围 6.3-13.7 个月）后共 45 个关节出现滑膜炎复发。在研究开始时，持续 ID 患儿与滑膜炎复发患儿的滑膜增生、关节积液和腱鞘炎发生率相当，而持续 ID 患儿的 PD 信号频率高于滑膜炎复发患儿。在 45 个复发关节中，只有 17 个在研究开始时存在超声异常。
作者发现，处于临床缓解期的 JIA 患儿存在超声检测到的滑膜异常很常见。然而，超声病理的存在并不能预测受影响关节的滑膜炎早期复发。
