Abstract
BackgroundThe ankle region is frequently involved in juvenile idiopathic arthritis (JIA) but difficult to examine clinically due to its anatomical complexity. The aim of the study was to evaluate the role of ultrasonography (US) of the ankle and midfoot (ankle region) in JIA. Doppler-US detected synovial hypertrophy, effusion and hyperemia and US was used for guidance of steroid injection and to assess treatment efficacy.MethodsForty swollen ankles regions were studied in 30 patients (median age 6.5 years, range 1-16 years) with JIA. All patients were assessed clinically, by US (synovial hypertrophy, effusion) and by color Doppler (synovial hyperemia) before and 4 weeks after US-guided steroid injection.ResultsUS detected 121 compartments with active disease (joints, tendon sheaths and 1 ganglion cyst). Multiple compartments were involved in 80% of the ankle regions. The talo-crural joint, posterior subtalar joint, midfoot joints and tendon sheaths were affected in 78%, 65%, 30% and 55% respectively. Fifty active tendon sheaths were detected, and multiple tendons were involved in 12 of the ankles. US-guidance allowed accurate placement of the corticosteroid in all 85 injected compartments, with a low rate of subcutaneous atrophy (4,7%). Normalization or regression of synovial hypertrophy was obtained in 89%, and normalization of synovial hyperemia in 89%. Clinical resolution of active arthritis was noted in 72% of the ankles.ConclusionsUS enabled exact anatomical location of synovial inflammation in the ankle region of JIA patients. The talo-crural joint was not always involved. Disease was frequently found in compartments difficult to evaluate clinically. US enabled exact guidance of steroid injections, gave a low rate of subcutaneous atrophy and was proved valuable for follow-up examinations. Normalization or regression of synovial hypertrophy and hyperemia was achieved in most cases, which supports the notion that US is an important tool in the management of ankle involvement in JIA.
Highlights
The ankle region is frequently involved in juvenile idiopathic arthritis (JIA) but difficult to examine clinically due to its anatomical complexity
The ankle region is frequently diseased in juvenile idiopathic arthritis (JIA) [1,2] but the anatomical complexity of this area makes it difficult to evaluate clinically which of the numerous joints and surrounding tendons are involved in the inflammatory process
The clinical response to a palpationguided intra-articular steroid injection is poorer in the ankle than in other joints [16,17], which may be due to the anatomical complexity of this region preventing accurate placement of the needle tip
Summary
The ankle region is frequently involved in juvenile idiopathic arthritis (JIA) but difficult to examine clinically due to its anatomical complexity. Doppler-US detected synovial hypertrophy, effusion and hyperemia and US was used for guidance of steroid injection and to assess treatment efficacy. The ankle region (ankle and midfoot) is frequently diseased in juvenile idiopathic arthritis (JIA) [1,2] but the anatomical complexity of this area makes it difficult to evaluate clinically which of the numerous joints and surrounding tendons are involved in the inflammatory process. We investigated the usefulness of US of the ankle region in children with JIA for detection of synovial hypertrophy and hyperemia, for guidance of steroid injection and for assessment of treatment efficacy The clinical response to a palpationguided intra-articular steroid injection is poorer in the ankle than in other joints [16,17], which may be due to the anatomical complexity of this region preventing accurate placement of the needle tip.
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