The role of Doppler Ultrasonography in evaluating disease activity in a group of juvenile idiopathic arthritis patients

Abstract

The goal of the study is the evaluation of Power Doppler ultrasound (PDUS) ability to detect the disease activity in juvenile idiopathic artheritis (JIA) patients compared to clinical and biological markers. In forty JIA patients, 1120 joints were assessed clinically and with Doppler ultrasonography. The semi quantitative four grade scale (0–3) was used for grading the PDUS. The disease activity was assessed using the 28-joint Disease Activity Score (DAS28-CRP). Synovitis was detected clinically in 17.5% of examined joints, while ultrasound detected synovitis was found in 18.8%; including 3.5% of clinically normal joints. DAS28-CRP was significantly associated with US findings. Ultrasound evidence of synovial hyperplasia significantly correlated with joint swelling r = 0.87, while PDUS was significantly correlated with joints tenderness, r = 0.92. PDUS assessment of synovial vascularization could detect mild disease activity with 100% sensitivity and 75% specificity. Kappa statistics revealed marked agreement (0.83) between tenderness and power Doppler US. Patients showing higher PDUS score (>/=2) are mostly having active disease. ConclusionUltrasound and PDUS are reliable methods for detection of synovitis and disease activity in JIA, early in the disease and during clinical remission.