Quesada-Masachs Estefania, Lopez-Corbeto Mireia, Moreno-Ruzafa Estefania
Department of Rheumatology, Pediatric Rheumatology Unit, Dexeus University Hospital, Barcelona, Spain.
Department of Rheumatology, Pediatric Rheumatology Unit, Vall D'Hebron University Hospital, Barcelona, Spain.
Eur J Rheumatol. 2022 Mar 11;11(3):S348-S357. doi: 10.5152/eujrheum.2022.21119.
Musculoskeletal ultrasound (MSUS) is a powerful tool of major importance in rheumatology. MSUS is ideally suited for the evaluation of pediatric patients because it is a safe technique with a high patient acceptability, it does not require sedation, and it is excellent for exploring multiple joints. It is also the most operator-dependent imaging modality, and assessing joints in patients with juvenile idiopathic arthritis (JIA) is particularly challenging due to the unique features of the growing skeleton. Years ago, MSUS was already extensively used to manage rheumatoid arthritis (RA), which allowed pediatric rheumatologists to apply the knowledge generated in adult studies. It was a good starting point to study the joints of healthy children and JIA patients. Luckily, there is increasing evidence regarding the possibilities of MSUS in the management of JIA patients, with recent definitions for synovitis, descriptions of the sonographic features of joints in healthy children, and a better understanding of the role of subclinical synovitis. This review highlights the differences in normality and in pathological findings between children and adults assessed by MSUS. Specifically, this provides a summary of the current information on characteristics, scores, and definitions that are frequently different between JIA and RA patients. Despite the existence of several unresolved questions in the field, the value that MSUS adds to clinical examination in JIA has already been demonstrated, and we believe that MSUS may be included in the near future in treatment to target strategies.
肌肉骨骼超声（MSUS）是风湿病学中一项极为重要的有力工具。MSUS非常适合用于评估儿科患者，因为它是一种安全的技术，患者接受度高，无需镇静，且在探查多个关节方面表现出色。它也是最依赖操作者的成像方式，由于生长中的骨骼具有独特特征，评估幼年特发性关节炎（JIA）患者的关节尤其具有挑战性。多年前，MSUS就已广泛用于类风湿关节炎（RA）的管理，这使得儿科风湿病学家能够应用成人研究中产生的知识。这是研究健康儿童和JIA患者关节的一个良好起点。幸运的是，关于MSUS在JIA患者管理中的可能性，有越来越多的证据，包括最近对滑膜炎的定义、健康儿童关节超声特征的描述，以及对亚临床滑膜炎作用的更好理解。本综述强调了通过MSUS评估的儿童和成人在正常情况及病理发现方面的差异。具体而言，本文总结了当前关于JIA和RA患者之间经常不同的特征、评分及定义的信息。尽管该领域存在一些未解决的问题，但MSUS对JIA临床检查的价值已经得到证明，我们相信MSUS可能在不久的将来被纳入治疗靶向策略中。
