Barbuti D, Bergami G, Vecchioli Scaldazza A
Servizio di Radiologia, Ospedale Pediatrico, Bambino Gesu, Roma.
Radiol Med. 1997 Jan-Feb;93(1-2):27-32.
Juvenile rheumatoid arthritis is a chronic disease, with the synovium as the target tissue. We made 594 US examinations of the knee in 240 children (mean age: 9 years) with juvenile rheumatoid arthritis. All patients underwent at least one US exam and 156 patients underwent many US examinations during 3 years' follow-up. In our series mean synovial thickness was 6 mm (range: 2.5-11 mm) while in normal subjects mean synovial thickness is 2.7 mm (range: 1-4.5 mm). The mean thickness of the suprapatellar bursa was 9 mm (range: 4-18 mm) versus 2.8 mm (range: 1-5 mm) in normal subjects. The mean length of the suprapatellar bursa was 27 mm (range: 13-44 mm) versus 14.3 mm (range: 8-23.5 mm) in normal children. Cartilage thickness was 3.3 mm (range: 1.2-5.8 mm) at the intercondylar notch, and 3 mm (range: 0.8-5.3 mm) at the femoral condyles. Cartilage thickness is 3.5 mm (range: 2-6 mm) at the intercondylar notch, and 3.2 mm (range: 1.8-5.4 mm) at the femoral condyles in normal subjects. The articular cartilage outline was blurred in 36% of patients with active knee involvement. A Baker cyst was found in 24 patients (10%). The mean volume was 3 ml (range: 1-40 ml). No tendinous alterations were observed. Changes in synovial membrane (synovial thickness), the presence of fluid in the suprapatellar bursa, and blurring of the articular cartilage outline showed statistically significant differences between juvenile rheumatoid arthritis patients with active knee involvement and subjects in clinical remission. On the contrary, articular cartilage thickening or thinning showed no statistically significant differences between juvenile rheumatoid arthritis patients with active knee involvement and subjects in clinical remission. In conclusion, US is a simple, rapid, inexpensive and accurate method for the staging and follow-up of joint inflammation in patients with juvenile rheumatoid arthritis of the knee.
青少年类风湿性关节炎是一种以滑膜为靶组织的慢性疾病。我们对240名（平均年龄：9岁）青少年类风湿性关节炎患儿的膝关节进行了594次超声检查。所有患者至少接受了一次超声检查，156名患者在3年的随访期间接受了多次超声检查。在我们的研究系列中，滑膜平均厚度为6毫米（范围：2.5 - 11毫米），而正常受试者的滑膜平均厚度为2.7毫米（范围：1 - 4.5毫米）。髌上囊的平均厚度为9毫米（范围：4 - 18毫米），而正常受试者为2.8毫米（范围：1 - 5毫米）。髌上囊的平均长度为27毫米（范围：13 - 44毫米），正常儿童为14.3毫米（范围：8 - 23.5毫米）。髁间切迹处软骨厚度为3.3毫米（范围：1.2 - 5.8毫米），股骨髁处为3毫米（范围：0.8 - 5.3毫米）。正常受试者髁间切迹处软骨厚度为3.5毫米（范围：2 - 6毫米），股骨髁处为3.2毫米（范围：1.8 - 5.4毫米）。36%有膝关节活动受累的患者关节软骨轮廓模糊。24名患者（10%）发现有腘窝囊肿。平均体积为3毫升（范围：1 - 40毫升）。未观察到肌腱改变。滑膜（滑膜厚度）的变化、髌上囊内积液情况以及关节软骨轮廓模糊在膝关节活动受累的青少年类风湿性关节炎患者与临床缓解的受试者之间存在统计学显著差异。相反，膝关节活动受累的青少年类风湿性关节炎患者与临床缓解的受试者之间关节软骨增厚或变薄无统计学显著差异。总之，超声是一种用于膝关节青少年类风湿性关节炎患者关节炎症分期和随访的简单、快速、廉价且准确的方法。
