Rheumatology, Ghent University Hospital, Ghent, Belgium.
Faculty of Medicine and Health Sciences, Dept. of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium.
Pediatr Rheumatol Online J. 2023 Sep 19;21(1):105. doi: 10.1186/s12969-023-00895-8.
Musculoskeletal ultrasound is a well accessible technique to assess disease activity in children with juvenile idiopathic arthritis. Knowledge of reference values of joint structures is indispensable to differentiate between physiological and pathological finding. The aim of this study was to assess the structural sonographic features of joints and tendons in healthy children from several age groups (0.2-18 year), and develop a set of normative data.
Greyscale ultrasound was performed in 500 healthy children (age 0.2-18 years) according to a predefined scanning protocol (Additional file 1) including the shoulder, elbow, wrist, second metacarpophalangeal joint, hip, knee, ankle, and first metatarsophalangeal joint). Demographic data and values of cartilage thickness, tendon diameters, and the degree of capsular distention measured by bone-capsular distance (BCD) were collected. Differences according to the sex were assessed by unpaired t-test. Single and multiple regression analyses were performed between the ultrasound outcomes and covariates such as age, height, weight and body mass index. Growth charts and tables were developed with respect to age. Nonparametric quantile regression was applied using the R-packages quantreg and quantregGrowth.
A total of 195 male and 305 female volunteers were included between the age of 0 and 18 years (mean age 8.9; range: 0.2-17.9 years). Cartilage diminished markedly as children aged, and cartilage of the boys was significantly thicker compared to the girls in all joints (p < 0.001). In addition, cartilage became thinner as children's height and weight increased (beta regression coefficients between - 0.27 and - 0.01, p < 0.0001). Capsular distention (i.e., BCD > 0 mm) was uncommon in the ankle, wrist and MCP2 (resp. in 3, 6, and 3% of cases). It was more common in the suprapatellar and parapatellar knee, MTP1 and posterior recess of the elbow (resp. in 34, 32, 46, and 39% of cases). In the hip, some capsular distention was always present. Age was found to be the best predictor for BCD (beta regression coefficients between 0.05 and 0.13, p < 0.0001). Height was, in addition to age, a good predictor of tendon diameter (beta regression coefficients between 0.03 and 0.14, p < 0.0001). Growth curves and tables for each variable were developed.
Reference values of sonographic cartilage thickness, BCD and diameters of tendons at several joints were established from 500 healthy children, aged between 0.2 and 18 years. Growth charts and tables were developed to distinguish normal findings from pathology in children with complaints suspicious of arthritis.
肌肉骨骼超声是评估幼年特发性关节炎儿童疾病活动的一种易于获得的技术。了解关节结构的参考值对于区分生理和病理发现是必不可少的。本研究的目的是评估来自多个年龄组（0.2-18 岁）的健康儿童关节和肌腱的结构超声特征，并制定一套正常参考值数据。
根据预定义的扫描方案（附加文件 1）对 500 名健康儿童（0.2-18 岁）进行灰阶超声检查，包括肩、肘、腕、第二掌指关节、髋、膝、踝和第一跖趾关节。收集了关节软骨厚度、肌腱直径和通过骨-囊距离（BCD）测量的囊扩张程度等参数的数据。使用未配对 t 检验评估了性别差异。对超声结果与年龄、身高、体重和体重指数等协变量进行了单因素和多因素回归分析。制定了与年龄相关的图表和表格。使用 R 包 quantreg 和 quantregGrowth 进行了非参数分位数回归。
共纳入 195 名男性和 305 名女性志愿者，年龄 0 至 18 岁（平均年龄 8.9 岁；范围：0.2-17.9 岁）。随着儿童年龄的增长，软骨明显变薄，男孩的软骨在所有关节中都比女孩厚（p<0.001）。此外，随着儿童身高和体重的增加，软骨变薄（β回归系数在-0.27 至-0.01 之间，p<0.0001）。在踝关节、腕关节和 MCP2 中，囊扩张（即 BCD>0 毫米）很少见（分别为 3%、6%和 3%的病例）。在髌上和髌旁膝关节、MTP1 和肘后隐窝中更为常见（分别为 34%、32%、46%和 39%的病例）。在髋关节中，囊始终存在一些扩张。年龄被发现是 BCD 的最佳预测因子（β回归系数在 0.05 至 0.13 之间，p<0.0001）。除了年龄之外，身高也是肌腱直径的良好预测因子（β回归系数在 0.03 至 0.14 之间，p<0.0001）。为每个变量制定了生长曲线和图表。
从 500 名 0.2-18 岁的健康儿童中建立了几个关节的超声软骨厚度、BCD 和肌腱直径的参考值。制定了生长图表和表格，以区分有疑似关节炎症状的儿童的正常表现和病理表现。
