Department of Rheumatology, Oslo University Hospital, Oslo, Norway
Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
RMD Open. 2024 Mar 1;10(1):e003965. doi: 10.1136/rmdopen-2023-003965.
To assess the validity of an ultrasonographic scoring system in juvenile idiopathic arthritis (JIA) by comparing ultrasound detected synovitis with whole-body MRI and clinical assessment of disease activity.
In a cross-sectional study, 27 patients with active JIA underwent clinical 71-joints examination, non-contrast enhanced whole-body MRI and ultrasound evaluation of 28 joints (elbow, radiocarpal, midcarpal, metacarpophalangeal 2-3, proximal interphalangeal 2-3, hip, knee, tibiotalar, talonavicular, subtalar and metatarsophalangeal 2-3). One rheumatologist, blinded to clinical findings, performed ultrasound and scored synovitis (B-mode and power Doppler) findings using a semiquantitative joint-specific scoring system for synovitis in JIA. A radiologist scored effusion/synovial thickening on whole-body MRI using a scoring system for whole-body MRI in JIA. At patient level, associations between ultrasound synovitis sum scores, whole-body MRI effusion/synovial thickening sum scores, clinical arthritis sum scores, and the 71-joints Juvenile Arthritis Disease Activity Score (JADAS71) were calculated using Spearman's correlation coefficients (r). To explore associations at joint level, sensitivity and specificity were calculated for ultrasound using whole-body MRI or clinical joint examination as reference.
Ultrasound synovitis sum scores strongly correlated with whole-body MRI effusion/synovial thickening sum scores (r=0.74,p<0.01) and the JADAS71 (r=0.71,p<0.01), and moderately with clinical arthritis sum scores (r=0.57,p<0.01). Sensitivity/specificity of ultrasound in detecting synovitis were 0.57/0.96 and 0.55/0.96 using whole-body MRI or clinical joint examination as reference, respectively.
Our findings suggest that ultrasound is a valid instrument to detect synovitis, and that ultrasound synovitis sum scores can reflect disease activity and may be an outcome measure in JIA.
通过比较超声检测滑膜炎与全身 MRI 和疾病活动的临床评估，评估青少年特发性关节炎 (JIA) 超声评分系统的有效性。
在一项横断面研究中，27 例活动期 JIA 患者接受了临床 71 个关节检查、非增强全身 MRI 和 28 个关节（肘部、桡腕、腕中、掌指 2-3、近指间 2-3、髋关节、膝关节、胫距、距跟、距下和跖趾 2-3）的超声评估。一位盲于临床发现的风湿病学家使用 JIA 关节特异性滑膜炎半定量评分系统对超声滑膜炎（B 模式和功率多普勒）进行评分。一位放射科医生使用 JIA 全身 MRI 评分系统对全身 MRI 上的积液/滑膜增厚进行评分。在患者水平，使用 Spearman 相关系数 (r) 计算超声滑膜炎总分、全身 MRI 积液/滑膜增厚总分、临床关节炎总分与 71 个关节青少年关节炎疾病活动评分 (JADAS71) 之间的相关性。为了探索关节水平的相关性，使用全身 MRI 或临床关节检查作为参考，计算了超声的敏感性和特异性。
超声滑膜炎总分与全身 MRI 积液/滑膜增厚总分 (r=0.74,p<0.01) 和 JADAS71 (r=0.71,p<0.01) 高度相关，与临床关节炎总分中度相关 (r=0.57,p<0.01)。使用全身 MRI 或临床关节检查作为参考，超声检测滑膜炎的敏感性/特异性分别为 0.57/0.96 和 0.55/0.96。
我们的研究结果表明，超声是一种检测滑膜炎的有效工具，超声滑膜炎总分可以反映疾病活动度，可能成为 JIA 的一种疗效评估指标。
