Abstract
This study aimed to investigate the correlation of ultrasonography (US) of synovitis with disease activity and clinical response to etanercept (ETN) in juvenile idiopathic arthritis (JIA) patients. Eighty-two JIA patients who underwent ETN treatment for 24 weeks were consecutively enrolled. US evaluations of 28 joints (shoulder, elbow, wrist, metacarpophalangeal, and proximal interphalangeal of hands and knee) at baseline were performed using grey-scale US and power doppler (PD) US, and US synovitis was defined as grey-scale abnormalities or PD abnormalities. Clinical response was assessed according to the ACRpedi 50 response criteria. In total, 2296 joints were scanned and 608 (26.5%) joints presented US synovitis, which was numerically higher than clinical synovitis (513 (22.3%)). The mean number of joints showing synovitis on US was 7.42±3.35, which was also numerically higher than that of clinical synovitis (6.26±2.70). The number of joints showing synovitis on US was positively correlated with C-reactive protein, erythrocyte sedimentation rate, number of joints with active disease, number of joints with limited range of motion, physician's global assessment of disease activity, parent/patient global assessment of overall well-being, and childhood health assessment questionnaire score. Most interestingly, the baseline number of joints showing synovitis on US was increased in ACRpedi 50 response JIA patients compared to non-response JIA patients, and it serves as an independent predictive factor for higher clinical response to ETN treatment. In conclusion, US is a more sensitive test to evaluate subclinical synovitis and disease activity in JIA patients, and US synovitis might serve as a marker for predicting increased clinical response rate to ETN treatment.
Highlights
Juvenile idiopathic arthritis (JIA), as a chronically inflammatory and autoimmune disease, is a critical health issue affecting children and adolescents worldwide [1,2]
We found that in JIA patients who underwent ENT treatment: 1) US synovitis occurrence was 26.5%, and the detection rate was higher compared to clinical synovitis; 2) US synovitis was correlated with increased disease activity; 3) US synovitis predicted higher clinical response to ETN treatment
Along with the wide utilization of US imaging in several chronic arthritis diseases such as osteoarthritis and rheumatoid arthritis [8,17], its application has been gradually introduced to JIA management [14]
Summary
Juvenile idiopathic arthritis (JIA), as a chronically inflammatory and autoimmune disease, is a critical health issue affecting children and adolescents worldwide [1,2]. Great treatment improvements have been achieved with imaging technology progress, novel drugs application (especially TNF-a inhibitors such as etanercept (ETN)), and efficient treating strategies, there are still a proportion of JIA patients that fail to respond or relapse in a short time [5,6]. Exploration of potential markers for disease monitoring and treatment efficacy prediction is essential to further improve outcomes of JIA patients. Ultrasonography (US), initially applied and recommended for evaluation of subclinical synovitis, disease activity, and treatment response in rheumatoid arthritis, has been introduced for JIA examination recently [7,8]. Due to the above-mentioned benefits, US was proposed to be applied in JIA disease monitoring and management as a feasible imaging technology, especially for detection of synovitis [10]. Few studies have assessed the correlation of US synovitis with comprehensive clinical
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