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Sonologic enthesitis in children with enthesitis-related arthritis
Sajjan Shenoy1, Amita Aggarwal2
1Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
Insights
Ultrasound (US) is more sensitive than clinical exams for detecting enthesitis in juvenile idiopathic enthesitis-related arthritis (JIA-ERA). US identified subclinical enthesitis in a significant proportion of JIA-ERA patients, proving its diagnostic value.
Area of Science:
- Pediatric Rheumatology
- Diagnostic Imaging
- Musculoskeletal Ultrasound
Background:
- Enthesitis is a key feature and diagnostic criterion for juvenile idiopathic enthesitis-related arthritis (JIA-ERA).
- Ultrasound (US) is highly sensitive for detecting enthesitis in adult spondyloarthropathies.
- Limited data exists on US performance compared to clinical examination in JIA-ERA.
Purpose of the Study:
- To compare the accuracy of US and clinical examination in diagnosing enthesitis in JIA-ERA patients.
- To evaluate the utility of US as a diagnostic tool in JIA-ERA.
Main Methods:
- 30 male patients with JIA-ERA (ILAR criteria) were enrolled.
- Enthesitis was assessed clinically and via ultrasound at six specific entheseal sites on both sides.
- Features of acute and chronic enthesitis were recorded using the Madrid Sonology Enthesitis Index (MSEI).
Main Results:
- US detected enthesitis in 25 of 30 patients, while clinical examination found it in only 15.
- US identified 20 more enthesitis sites than clinical examination (47 vs. 27).
- High concordance (89.4%) was observed, with discordance noted at tibial tuberosity, superior patellar pole, and Achilles tendon entheses.
Conclusions:
- Ultrasonography effectively detects subclinical enthesitis in JIA-ERA patients.
- US is a valuable, cost-effective, and safe diagnostic tool for evaluating JIA.
- US enhances the diagnostic capability for enthesitis in pediatric arthritis.
Objectives:
Enthesitis is an important clinical manifestation and is a diagnostic criterion for juvenile idiopathic enthesitis-related arthritis (JIA-ERA). Ultrasound (US) is a highly sensitive method of detection of enthesitis in adult spondyloarthropathies. However, since the data on JIA and the preformance of US compared to clinical examination is limited, we aimed to compare the accuracy of US and clinical examination in JIA-ERA.
Methods:
Patients with JIA-ERA (ILAR criteria) were enrolled in the study after consent. Besides data on disease variables, enthesitis was evaluated clinically as well as by ultrasound. Six entheseal sites (iliac crest, superior pole patella, inferior pole patella, tibial tuberosity, tendoachilles and plantar fascia) on both sides of the body were examined in each patient. Features of acute and chronic enthesitis were noted.
Results:
360 entheseal sites in 30 male patients (26 positive for HLA-B27), with a median age of 16 years and median disease duration of 4 years were evaluated. Median Madrid Sonology Enthesitis Index (MSEI) was 2.0 (MSEI-Acute) (IQR 0-3) and 1.0 (MSEI-Chronic) (IQR 0-1). Ultrasound enthesitis was seen in 25 of 30 patients whereas clinical enthesitis was present in 15 patients only. USG picked up 20 (47 vs. 27) more sites of enthesitis as compared to clinical examination. The concordance rate was 89.4%. Discordance was more at tibial tuberosity, superior pole patella and tendoachilles entheses.
Conclusions:
Ultrasonography detects subclinical enthesitis in a proportion of patients with JIA-ERA. It can be a useful, cost-effective and safe diagnostic tool in the workup of JIA patients.
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