Document Detail

Ultrasonography for detecting enthesitis in juvenile idiopathic arthritis.
MedLine Citation:
PMID:  21312344     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: Enthesitis is a major feature of juvenile idiopathic arthritis (JIA) but is difficult to diagnose clinically. Our objective was to compare the accuracy of ultrasonography with power Doppler (US-PD) versus clinical examination for diagnosing enthesitis in patients with JIA and healthy controls.
METHODS: Twenty-six consecutive patients with JIA and 41 healthy volunteers underwent standardized clinical and US-PD examinations of 5 entheseal sites (proximal and distal quadricepital tendon insertions, Achilles tendon, and plantar fascia). US-PD reproducibility was evaluated. US-PD enthesitis was defined as a PD signal at the enthesis insertion. Bursitis, erosions, and cartilage vascularization were recorded.
RESULTS: In the JIA group, 27 (12.5%) of the entheseal sites exhibited clinical enthesitis (distal patellar ligament in 45% of cases) and 20 (9.4%) exhibited US-PD enthesitis (distal patellar tendon in 30%), including 10 clinically normal sites (50%). US-PD enthesitis was found in several patients with oligoarthritis or polyarthritis. Clinical enthesitis (P < 0.0001) and HLA-B27-positive (P = 0.05) status were significantly associated with US-PD enthesitis. Erosion and bursitis, but not tendon thickening, were associated with US-PD enthesitis. US-PD enthesitis was not found at any of the 410 entheseal sites in controls; grade 1 cartilage vascularization was noted at 6% of the control sites.
CONCLUSION: Enthesitis is a rare phenomenon in JIA. Clinically silent enthesitis is detected by US-PD and can be found in JIA categories other than enthesitis-related arthritis. Tendon thickening and cartilage vascularization can be detected in healthy controls. These findings may have implications for patient classification of the use of US-PD.
Sandrine Jousse-Joulin; Sylvain Breton; Claire Cangemi; Bertrand Fenoll; Luc Bressolette; Loic de Parscau; Alain Saraux; Valérie Devauchelle-Pensec
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Arthritis care & research     Volume:  63     ISSN:  2151-4658     ISO Abbreviation:  Arthritis Care Res (Hoboken)     Publication Date:  2011 Jun 
Date Detail:
Created Date:  2011-06-01     Completed Date:  2011-08-02     Revised Date:  2011-12-09    
Medline Journal Info:
Nlm Unique ID:  101518086     Medline TA:  Arthritis Care Res (Hoboken)     Country:  United States    
Other Details:
Languages:  eng     Pagination:  849-55     Citation Subset:  IM    
Copyright Information:
Copyright © 2011 by the American College of Rheumatology.
Centre Hospitalier Universitaire Brest and Université de Bretagne Occidentale, Brest, France.
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MeSH Terms
Arthritis, Juvenile Rheumatoid / blood,  complications,  ultrasonography*
Rheumatic Diseases / blood,  complications,  ultrasonography
Tendinopathy / blood,  complications,  ultrasonography*
Ultrasonography, Doppler / methods

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