Published: 2018-10-25

Role of imaging in evaluation and management of juvenile idiopathic arthritis: a prospective cohort study

Devi K. Bhanu, Joseph Varghese


Background: This study was aimed to evaluate the role of imaging in diagnosis and management of juvenile idiopathic arthritis by comparing the evaluation findings of clinical and ultrasound of all 14 joints in arthritis affected patients under 16 years of age.

Methods: Prospectively study was done on patients in age group of 0-16years, who referred to radiology department based on clinical assessment. USG is done in both shoulder, elbow, wrist, hip, knee, ankle and subtalar joints of each patient to assess the following parameters Synovial hypertrophy, joint effusion, power doppler signal, tenosynovitis, enthesitis, cartilage thinning, bone erosions and bursitis.

Results: Out of 980 joints assessed 344 joints (35.1% of all joints) had clinical synovitis, while USG evidence was in 382 joints (38.9% of all joints). Among the 344 clinically positive joints (35.1% of all joints), 223 joints (64.8%) had features of synovitis in USG and the rest 121 (35.2%) joints were clinically positive turned out to be ultrasound negative. Out of 980 joints 636 joints (64.8%) were clinically negative, of these 159 joints (25%) was found to have synovitis in ultrasound and 477 joints (75%) turned out to be negative on ultrasound examination.

Conclusions: The sensitivity and specificity of ultrasound over clinical examination in shoulder joint was 47.6% and 89.1% respectively, in elbow joint 53.8% and 92.1%, in wrist joint 64.3% and 72.6%, in hip joint 65.1% and 64.9%, in knee joint 74.7% and 61.2%, in ankle joint 67.2% and 59.2% and in subtalar joint 56.7% and 71.8%, respectively.


Chronic uveitis, Juvenile idiopathic arthritis, Rheumatologic disease, Synovitis

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Lanni S, Wood M, Ravelli A, Magni Manzoni S, Emery P, Wakefield RJ. Towards a role of ultrasound in children with juvenile idiopathic arthritis. Rheumatol. 2012 Nov 10;52(3):413-20.

Restrepo R, Lee EY, Babyn PS. Juvenile idiopathic arthritis: current practical imaging assessment with emphasis on magnetic resonance imaging. Radiologic Clin. 2013 Jul 1;51(4):703-19.

Boros C, Whitehead B. Juvenile idiopathic arthritis. Australian Fam Physician. 2010;39(9):630-6.

Sheybani EF, Khanna G, White AJ, Demertzis JL. Imaging of juvenile idiopathic arthritis: a multimodality approach. Radiographics. 2013 Aug 30;33(5):1253-73.

Janow GL, Panghaal V, Trinh A, Badger D, Levin TL, Ilowite NT. Detection of active disease in juvenile idiopathic arthritis: sensitivity and specificity of the physical examination vs ultrasound. J Rheumatol. 2011 Sep 15;38:2671-4.

Lanni S, Bovis F, Magnaguagno F, Ravelli A, Viola S, Von Scheven-Gȇte A, et al. Is it worth including subtalar joint in ultrasound ankle assessment of patients with juvenile idiopathic arthritis?. Pediatric Rheumatol. 2014 Sep;12(1):36.

Cimmino MA, Grassi W. What is new in ultrasound and magnetic resonance imaging for musculoskeletal disorders?. Best Practice Res Clin Rheumatol. 2008 Dec 1;22(6):1141-8.

De Zordo T, Mlekusch SP, Feuchtner GM, Mur E, Schirmer M, Klauser AS. Value of contrast-enhanced ultrasound in rheumatoid arthritis. European J Radiol. 2007 Nov 1;64(2):222-30.

Taljanovic MS, Melville DM, Gimber LH, Scalcione LR, Miller MD, Kwoh CK, et al. High-Resolution US of Rheumatologic Diseases. Radiographics. 2015;35:2026-48.

Ignee A, Atkinson NS, Schuessler G, Dietrich CF. Ultrasound contrast agents. Endosc Ultrasound. 2016;5(6):355-62.

Zhao CY, Jiang YX, Li JC, Xu ZH, Zhang Q, Su N, et al. Role of Contrast-enhanced Ultrasound in the Evaluation of Inflammatory Arthritis. Chin Med J (Engl). 2017;130(14):1722-30.

Bray C, Bell LN, Liang H, Haykal R, Kaiksow F, Mazza JJ, et al. Erythrocyte sedimentation rate and c-reactive protein measurements and their relevance in clinical medicine. WMJ. 2016;115(6):317-21.

Litao MK, Kamat D. Erythrocyte sedimentation rate and C-reactive protein: how best to use them in clinical practice. Pediatric Ann. 2014 Oct 1;43(10):417-20.

Sbong S, Feldman M. Frequency and causes of C‐reactive protein and erythrocyte sedimentation rate disagreements in adults. Int J Rheumatic Dis. 2015 Jan;18(1):29-32.

Wu JF, Yang YH, Wang LC, Lee JH, Shen EY, Chiang BL. Comparative usefulness of C-reactive protein and erythrocyte sedimentation rate in juvenile rheumatoid arthritis. Clinical Experimental Rheumatol. 2007 Sep 1;25(5):782.