Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.
The Role of Ultrasound in B Mode and Power Doppler Sonography in the Diagnosis of Enthesitis in Children.
Toib1, Dana, French1, Anthony R., Dahiya2, Nirvikar, Middleton2, William D., Brasington1, Richard, White1, Andrew J.
Enthesitis is a distinctive feature of Juvenile SpA (JSpA). Recently, ultrasound in B mode and power Doppler sonography has been suggested to be a valuable tool in the assessment of enthesitis. The aim of this study was to compare the physical exam (PE) with ultrasonography (US) in the assessment of enthesitis in children.
20 JSpA patients, 19 polyarticular/pauciarticular JIA patients, 8 adolescent patients with idiopathic arthralgias and 9 healthy pediatric controls underwent US exam of 16 peripheral entheses using Terason t3000 equipment with 12-MHz linear array transducer. The US images were interpreted independently by two radiologists and abnormalities were quantified using a modification of the Madrid sonographic enthesitis index (MASEI). Entheseal PE was completed independently by two pediatric rheumatologists. Current treatment, inflammatory markers and CHAQ scores were recorded on all patients.
Sonographic evidence of enthesitis was most common in the JSpA group (53% of patients; 6.9% of examined entheses), but was also found in all other study groups, including pauciarticular/polyarticular JIA (37% of patients; 5.0% of entheses), idiopathic arthralgias (38% of patients; 2.7% of entheses) and healthy controls (28% of patients; 2.1% of entheses).
PE evidence of enthesitis was most common in the idiopathic arthralgias group (56% of patients; 18.4% of entheses), followed by the JSpA group (43% of patients; 7.8% of entheses) and the polyarticular/pauciarticular JIA group (26% of patients; 3.0% of entheses). None of the healthy controls had PE evidence of enthesitis.
Sonographic severity of enthesitis was highest in the JSpA group with an enthesitis score of 4.7, followed by 1.6 in the polyarticular/pauciarticular JIA group, 1.1 in the idiopathic arthralgias group and 0.8 in healthy controls.
Follow-up PE and US were performed on two of the JSpA patients who had the highest US enthesitis scores and were the only patients who at the initial study visit time were untreated or treated only with NSAIDs. Repeat US revealed resolution of entheseal vascularization and development of calcifications consistent with post-inflammatory changes corresponding with clinical improvement. The PE did not correlate with these changes.
Agreement on presence of enthesitis between two examiners in PE and US were 26% and 41% respectively. Agreement on presence of enthesitis between PE and US was only 3%.
Neither the PE nor the US enthesitis scores correlated with other measures of disease activity including white blood cell count, hemoglobin, platelet count, ESR, CRP or CHAQ score.
US detected the highest frequency of enthesitis among the JSpA group whereas PE detected the highest frequency of enthesitis among the idiopathic arthralgias group. Agreement on presence of enthesitis between PE and US was poor. US interobserver agreement was limited, but superior to that of the PE. Sonographic findings consistent with mild enthesitis were found in healthy controls. These findings suggest that although US might have a role in the diagnosis of enthesitis in children, it should be used cautiously due to a limited inter observer reliability and specificity.
To cite this abstract, please use the following information:
Toib, Dana, French, Anthony R., Dahiya, Nirvikar, Middleton, William D., Brasington, Richard, White, Andrew J.; The Role of Ultrasound in B Mode and Power Doppler Sonography in the Diagnosis of Enthesitis in Children. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :1633