Department of Rheumatology, Oslo University Hospital, Oslo, Norway
Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
RMD Open. 2023 Mar;9(1). doi: 10.1136/rmdopen-2022-002937.
To describe power Doppler (PD) ultrasound findings in joint regions with B-mode (BM) synovitis using a standardised scanning protocol and scoring system in patients with juvenile idiopathic arthritis (JIA). Further, to examine associations between PD findings and BM synovitis, clinical arthritis, patient characteristics and disease activity.
In this cross-sectional study, one experienced ultrasonographer, blinded to clinical findings, performed ultrasound examinations in 27 JIA patients with suspected clinical arthritis. The elbow, wrist, metacarpophalangeal 2-3, proximal interphalangeal 2-3, knee, ankle and metatarsophalangeal 2-3 joints were assessed bilaterally and scored semiquantitatively (grades 0-3) for BM and PD findings using a joint-specific scoring system with reference atlas. Multilevel mixed-effects ordered regression models were used to explore associations between PD findings and BM synovitis, clinical arthritis, age, sex, JIA subgroups, disease duration and 10-joint Juvenile Arthritis Disease Activity Score (JADAS10).
Twenty-one girls and six boys, median age (IQR) 8 years (6-12 years) were included. Overall, 971 joint regions were evaluated by ultrasound, 129 had BM synovitis and were assessed for PD. PD findings were detected in 45 joint regions (34.9%), most frequently in the parapatellar recess of the knee (24.4%). Increasing PD grades were associated with higher BM grades (OR=5.0,p<0.001) and with clinical arthritis (OR=7.4,p<0.001) but not with age, sex, JIA subgroups, disease duration or JADAS10.
Increasing severity of PD findings were significantly associated with BM synovitis and with clinical arthritis. This suggests that PD signals detected using a standardised ultrasound examination and scoring system can reflect active disease in JIA patients.
描述使用标准化扫描方案和评分系统在患有幼年特发性关节炎（JIA）的患者中，关节区域的彩色多普勒（PD）超声表现与 B 型（BM）滑膜炎之间的关系。进一步研究 PD 表现与 BM 滑膜炎、临床关节炎、患者特征和疾病活动度之间的相关性。
在这项横断面研究中，一名经验丰富的超声医师在 27 名疑似临床关节炎的 JIA 患者中进行了超声检查，该医师对临床发现不知情。采用关节特异性评分系统和参考图谱对双侧肘、腕、掌指关节 2-3、近指间关节 2-3、膝、踝和跖趾关节 2-3 进行半定量评分（0-3 级），评估 BM 和 PD 发现。采用多级混合效应有序回归模型，探讨 PD 发现与 BM 滑膜炎、临床关节炎、年龄、性别、JIA 亚组、疾病持续时间和 10 关节幼年特发性关节炎疾病活动度评分（JADAS10）之间的相关性。
共纳入 21 名女孩和 6 名男孩，中位年龄（IQR）为 8 岁（6-12 岁）。共评估了 971 个关节区域，其中 129 个有 BM 滑膜炎并进行了 PD 评估。在 45 个关节区域（34.9%）检测到 PD 表现，最常见于膝关节髌旁隐窝（24.4%）。PD 分级增加与 BM 分级升高（OR=5.0，p<0.001）和临床关节炎（OR=7.4，p<0.001）相关，但与年龄、性别、JIA 亚组、疾病持续时间或 JADAS10 无关。
PD 表现严重程度与 BM 滑膜炎和临床关节炎显著相关。这表明使用标准化超声检查和评分系统检测到的 PD 信号可以反映 JIA 患者的活动性疾病。
