Department of Rheumatology, ASST Centro Traumatologico Ortopedico G Pini-CTO, Milan, Italy.
Department of Internal Medicine, ASST Mantova Ospedale C Poma, Mantua, Italy.
Ann Rheum Dis. 2018 Oct;77(10):1426-1431. doi: 10.1136/annrheumdis-2017-211696. Epub 2018 Feb 6.
To define the correlation between joint ultrasonography and clinical examination in patients with juvenile idiopathic arthritis (JIA) and to assess whether synovitis detected by ultrasonography in clinically inactive patients predicts arthritis flares.
88 consecutive patients with JIA-46 (52%) with persistent oligoarthritis, 15 (17%) with extended oligoarthritis, 15 (17%) with rheumatoid factor-negative polyarthritis and 12 (14%) with other forms of JIA, all clinically inactive for a minimum of 3 months-underwent ultrasound (US) assessment of 44 joints. Joints were scanned at study entry for synovial hyperplasia, joint effusion and power Doppler (PD) signal. Patients were followed clinically for 4 years.
US was abnormal in 20/88 (22.7%) patients and in 38/3872 (0.98%) joints. Extended oligoarthritis and rheumatoid factor-negative polyarthritis were more frequent in US-positive than in US-negative patients (35.0% vs 11.8% and 30.0% vs 13.2%, respectively; P=0.005). During 4 years of follow-up, 41/88 (46.6%) patients displayed a flare; 26/68 (38.2%) were US-negative and 15/20 (75%) were US-positive at baseline. Abnormality on US examination, after correction for therapy modification, significantly increased the risk of flare (OR=3.8, 95% CI 1.2 to 11.5). The combination of grey scale and PD abnormalities displayed a much higher predictive value of relapse (65%, 13/20) than grey scale alone (33%, 6/18).
US abnormalities are a strong predictor of relapse at individual patient level. Irrespective of treatment, the risk of flare in US-positive versus US-negative patients was almost four times higher. In case of US abnormalities, patients should be carefully followed regardless of both the International League of Associations for Rheumatology and Wallace categories.
定义关节超声与幼年特发性关节炎（JIA）患者临床检查之间的相关性，并评估超声检查发现的临床静止期患者的滑膜炎是否预示关节炎发作。
88 例 JIA-46（52%）持续性少关节炎、15 例（17%）扩展少关节炎、15 例（17%）类风湿因子阴性多关节炎和 12 例（14%）其他类型 JIA 的患者，所有患者均至少 3 个月处于临床静止状态，进行 44 个关节的超声（US）评估。在研究入组时，关节接受滑膜增生、关节积液和功率多普勒（PD）信号扫描。患者接受了 4 年的临床随访。
88 例患者中有 20 例（22.7%）和 3872 个关节中有 38 个（0.98%）存在 US 异常。与 US 阴性患者相比，US 阳性患者中扩展少关节炎和类风湿因子阴性多关节炎更为常见（分别为 35.0%比 11.8%和 30.0%比 13.2%；P=0.005）。在 4 年的随访期间，41 例（46.6%）患者出现发作；68 例（38.2%）患者 US 阴性，20 例（75%）患者 US 阳性。在调整治疗措施后，US 检查异常显著增加了发作的风险（OR=3.8，95%CI 1.2 至 11.5）。灰阶和 PD 异常的联合检查对复发的预测价值（65%，13/20）高于单纯灰阶（33%，6/18）。
US 异常是个体患者复发的强预测指标。无论治疗如何，US 阳性患者与 US 阴性患者的发作风险几乎高四倍。在存在 US 异常的情况下，无论采用国际风湿病联盟（ILAR）还是 Wallace 分类，都应密切关注患者。
