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.


High Frequency of Subclinical Ultrasound-Detected Synovitis in Juvenile Idiopathic Arthritis Patients with Clinically-Defined Inactive Disease.

Magni-Manzoni1,  Silvia, Scire3,  Carlo A., Ravelli2,  Angelo, Klersy4,  Catherine, Rossi3,  Silvia, Muratore1,  Valentina, Visconti1,  Chiara

Dep.Pediatrics, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
II Pediatric Unit, IRCCS Gaslini, Genova, Italy
Reumatology Unit, Fondazione IRCCS Policlinico S.Matteo, Pavia, Italy
Scientific Dep, Fondazione IRCCS Policlinico S.Matteo, Pavia, Italy

Background:

In children with juvenile idiopathic arthritis (JIA), it is unclear whether clinically-defined remission couples with absence of synovitis on imaging studies. Subclinical synovitis, as detected with US, has been found to be common in JIA.

Objectives:

To investigate the frequency of US-detected subclinical synovitis in JIA patients with clinically-defined inactive disease (ID) and the role of US abnormalities in predicting a subsequent flare of synovitis.

Methods:

The clinician established the presence of ID (active joint count =0, physician's global assessment on a 0–10 cm visual analog scale <=0.5, and negative acute phase reactants) in 28 consecutive JIA patients. On the same day, a sonographer scanned independently 52 joints in each patient for synovial hyperplasia (SH), synovial fluid (SF), power Doppler signal (PDS), and tenosynovitis (TS). Patients were followed-up for at least 6 months; based on the subsequent disease course, they were classified having persistent ID at the last follow-up visit or a relapse of arthritis during the follow-up period (defined as a recurrence of clinically-defined active synovitis in 1 or more joints).

Results:

The frequency of SH, SF, PDS, and TS in the 28 patients with ID was 75%, 71.4%, 32.1%, and 14.3%, respectively. Following the diagnosis of ID, 21 patients had persistent ID after a median of 12 months, whereas 7 patients experienced a relapse of arthritis a after a median of 6 months. The frequency of US abnormalities at the time of the diagnosis of ID in the 7 patients who had a subsequent disease flare was 100% for SH, 87.5% for SF, 14.3% for PDS, and 28.6% for TS. The main joints involved in the baseline US abnormalities were the knee and the wrist.

Conclusion:

JIA patients with clinically-defined ID had a high frequency of US-detected synovial abnormalities, namely SH and SF. Of the US features, SH and SF may have a greater role in predicting a future relapse of synovitis, especially when detected in the knee and the wrist.

To cite this abstract, please use the following information:
Magni-Manzoni, Silvia, Scire, Carlo A., Ravelli, Angelo, Klersy, Catherine, Rossi, Silvia, Muratore, Valentina, et al; High Frequency of Subclinical Ultrasound-Detected Synovitis in Juvenile Idiopathic Arthritis Patients with Clinically-Defined Inactive Disease. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :2220
DOI: 10.1002/art.29984

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