Associations between power Doppler ultrasound findings and B-mode synovitis and clinical arthritis in juvenile idiopathic arthritis using a standardised scanning approach and scoring system

Abstract

Objectives: 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.

Methods: 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).

Results: 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.

Conclusion: 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.

Keywords: Arthritis, Juvenile; Inflammation; Synovial fluid; Synovitis; Ultrasonography.

Figure 1

(A). Power Doppler (PD) ultrasound findings (grades 0–3) in 129 joint regions with B-mode (BM) synovitis (grades 1–3) in patients with juvenile idiopathic arthritis (JIA). (B). Distribution of PD ultrasound findings (grades 0–3) in 129 joint regions with BM synovitis in patients with JIA. ant, anterior; MCP, metacarpophalangeal; MTP, metatarsophalangeal; para, parapatellar recess; PIP, proximal interphalangeal; Post, posterior; supra, suprapatellar recess.

Figure 2

Illustration of variations in power Doppler (PD) ultrasound findings in two joint regions of the knee in a 10-year-old with juvenile idiopathic arthritis (JIA). Longitudinal dorsal scan of the knee joint (suprapatellar recess) showing B-mode (BM) synovitis (A), and BM synovitis without abnormal PD signals (grade 0) (B). Longitudinal dorsal scan of the knee joint (lateral parapatellar recess) showing BM synovitis (C), and BM synovitis with abnormal PD signals (grade 3) (D).