Bugni Miotto e Silva Vanessa, de Freitas Tavares da Silva Carolina, de Aguiar Vilela Mitraud Sônia, Nely Vilar Furtado Rita, Esteves Hilário Maria Odete, Natour Jamil, Terreri Maria Teresa
Pediatric Rheumatology Unit, Allergy, Immunology and Rheumatology Division, Pediatric Department, Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM), Rua Ipê, 112/111, Vila Clementino, São Paulo, SP, CEP 04022-005, Brazil,
Rheumatol Int. 2014 Jul;34(7):937-45. doi: 10.1007/s00296-013-2909-7. Epub 2013 Dec 8.
The aim of the study was to assess the presence and characteristics of subclinical synovitis using power Doppler (PD) ultrasonography on patients with juvenile idiopathic arthritis (JIA) in clinical remission and compare the findings with those of healthy children. A cross-sectional study was carried out involving the clinical (physical exam, functional capacity and laboratory tests) and ultrasonography evaluation of 34 joints (synovial fluid/hypertrophy, PD signal and bone erosion). Subclinical synovitis was defined as the presence of synovial hypertrophy/joint effusion with or without any PD signal. Thirty-six patients (11.5 ± 3.74 years) and 36 controls (sex and age matched) were evaluated (2,448 joints). Twenty-seven patients were in remission on medication (mean duration: 1.8 ± 2.2 years). Subclinical synovitis was detected in 41.7% patients and 11.1% controls (p = 0.003). Erosion was detected in three patients (8.3%). Subclinical synovitis was found in 38/1,224 (3.1%) joints in the patients (most affected: radiocarpal wrist, anterior elbow and tibiotalar ankle) and 8/1,224 (0.6%) joints in the controls (most affected: radiocarpal wrist). Differences in subclinical synovitis between patients and controls were found in the elbows (p = 0.033) and ankles (p = 0.006). A greater frequency of subclinical synovitis was found in patients with the extended oligoarticular or polyarticular subtypes (p = 0.013), those at an older age at disease onset (p = 0.007) and using methotrexate (p = 0.049). Patients with JIA in remission exhibit subclinical synovitis more frequently than controls. Subclinical synovitis was more frequent in patients with the polyarticular involvement and those at an older age at disease onset.
本研究旨在利用能量多普勒（PD）超声检查评估临床缓解期幼年特发性关节炎（JIA）患者亚临床滑膜炎的存在情况及特征，并将结果与健康儿童进行比较。开展了一项横断面研究，对34个关节进行临床（体格检查、功能能力和实验室检查）及超声评估（滑膜液/肥厚、PD信号和骨侵蚀）。亚临床滑膜炎定义为存在滑膜肥厚/关节积液，伴或不伴有任何PD信号。对36例患者（11.5±3.74岁）和36例对照（性别和年龄匹配）进行了评估（共2448个关节）。27例患者药物治疗后处于缓解期（平均病程：1.8±2.2年）。41.7%的患者和11.1%的对照检测到亚临床滑膜炎（p=0.003）。3例患者（8.3%）检测到骨侵蚀。患者组1224个关节中有38个（3.1%）发现亚临床滑膜炎（最常受累部位：桡腕关节、肘前和胫距关节），对照组1224个关节中有8个（0.6%）发现亚临床滑膜炎（最常受累部位：桡腕关节）。患者和对照在肘部（p=0.033）和踝部（p=0.006）的亚临床滑膜炎存在差异。在扩展性少关节型或多关节型亚型患者（p=0.013）、发病年龄较大的患者（p=0.007）和使用甲氨蝶呤的患者（p=0.049）中，亚临床滑膜炎的发生率更高。处于缓解期的JIA患者比对照更频繁地出现亚临床滑膜炎。多关节受累的患者和发病年龄较大的患者亚临床滑膜炎更常见。
