Department of Pediatrics, University of Cincinnati, Division of Rheumatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Department of Pediatrics, University of Cincinnati, Division of Rheumatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Semin Arthritis Rheum. 2024 Dec;69:152545. doi: 10.1016/j.semarthrit.2024.152545. Epub 2024 Sep 1.
To validate the ankle-specific Pediatric Arthritis Ultrasound Scoring System (PAUSS-ankle) in children with juvenile idiopathic arthritis (JIA).
Patients with a diagnosis of JIA prospectively underwent a standard clinical assessment and musculoskeletal ultrasound (MSUS) of one or both ankles. B-mode and Power-Doppler mode MSUS images were acquired and scored according to the PAUSS-ankle protocol. A subset of patients received a contrast-enhanced MRI (ceMRI) of the affected ankle. ceMRI scoring for synovitis was performed according to the Rheumatoid Arthritis MRI System (RAMRIS). Test characteristics of the PAUSS-ankle scores were evaluated with ceMRI as reference. Associations between the findings on physical examination, PAUSS-ankle, and RAMRIS were investigated.
Thirty-two patients with JIA contributed 63 MSUS and 15 ceMRIs of the ankles. The PAUSS-ankle total B-mode score had a moderate correlation with physical examination findings (correlation (r)=0.43, p < 0.001). The PAUSS-ankle B-mode score ≥1 exhibited a sensitivity of 79 % and specificity of 100 %, demonstrating excellent diagnostic accuracy with an area under the curve (AUC)= 0.89 (confidence intervals, CI, 0.78-1.00) while clinical assessment had a sensitivity of 57 % and AUC= 0.71 (CI: 0.58-0.85). The PAUSS-ankle B-mode score had significant strong correlations (r = 0.68-0.90, p < 0.005) with the RAMRIS for the assessment of disease severity for each joint area and the ankle joint as a whole.
Our findings demonstrate excellent diagnostic accuracy of the PAUSS-ankle in detecting the presence and severity of ankle synovitis when compared to ceMRI. The PAUSS-ankle holds significant promise as an accurate measurement that may complement current clinical standards.
验证儿童幼年特发性关节炎（JIA）的踝关节专用关节炎超声评分系统（PAUSS-ankle）。
前瞻性纳入诊断为 JIA 的患者，对其单侧或双侧踝关节进行标准临床评估和肌肉骨骼超声（MSUS）检查。按照 PAUSS-ankle 方案获取 B 型模式和功率多普勒模式 MSUS 图像并进行评分。部分患者接受受累踝关节的对比增强 MRI（ceMRI）检查。根据类风湿关节炎 MRI 系统（RAMRIS）对滑膜炎进行 ceMRI 评分。采用 ceMRI 作为参考，评估 PAUSS-ankle 评分的测试特征。研究体格检查、PAUSS-ankle 和 RAMRIS 之间的相关性。
32 例 JIA 患者共 63 次 MSUS 和 15 次踝关节 ceMRI 检查。PAUSS-ankle 总 B 型模式评分与体格检查结果中度相关（相关系数（r）=0.43，p<0.001）。PAUSS-ankle B 型模式评分≥1 时，灵敏度为 79%，特异性为 100%，曲线下面积（AUC）为 0.89（置信区间，CI，0.78-1.00），具有很好的诊断准确性，而体格检查的灵敏度为 57%，AUC 为 0.71（CI：0.58-0.85）。PAUSS-ankle B 型模式评分与 RAMRIS 评估各关节区域和整个踝关节的疾病严重程度具有显著的强相关性（r=0.68-0.90，p<0.005）。
与 ceMRI 相比，PAUSS-ankle 在检测踝关节滑膜炎的存在和严重程度方面具有很好的诊断准确性。PAUSS-ankle 作为一种可能补充当前临床标准的准确测量方法具有重要意义。
