Elsevier

Joint Bone Spine

Volume 68, Issue 3, May 2001, Pages 222-230
Joint Bone Spine

ORIGINAL ARTICLE
Ultrasound versus MRI in the evaluation of juvenile idiopathic arthritis of the knee

https://doi.org/10.1016/S1297-319X(01)00269-XGet rights and content

Abstract

Objective. To examine the role of ultrasound versus magnetic resonance imaging (MRI) in assessing joint inflammation in patients with juvenile idiopathic arthritis (JIA) of the knee. Methods. This study was conducted on 38 patients with juvenile idiopathic arthritis (25 girls and 13 boys), whose ages ranged between 2–17 years (mean 8 years), presenting with joint swelling, tenderness, pain on motion and/or limitation of movement. Plain radiography, high-resolution ultrasound and MRI examinations of the knee (before and after contrast administration) were made on all patients. A control group of ten subjects was also examined. Results. Compared to the control group, sonographic examination was found to be of great value as regards the joint effusion, popliteal cysts, lymph nodes and to a lesser extent, the degree of affection of the articular cartilage. MRI was superior in evaluating the extent of synovial proliferation (pannus), thinning out and erosions of articular cartilage, loculated effusions as well as hypoplastic menisci and ligaments, especially after contrast enhancement. Conclusion. Ultrasound is a simple, inexpensive and valuable tool in evaluating the initial stages of JIA. In more advanced stages of JIA and also for monitoring the progression of the disease process and response to therapy, MRI examination following gadolinium proved to be superior in evaluation of the joint affection.

Section snippets

Patients and methods

Thirty-eight patients with JIA who had clinical signs of knee joint involvement were consecutively gathered from those attending outpatient rheumatology clinics, Ain Shams University Hospitals. All patients met the International League of Associations for Rheumatology (ILAR) criteria for the diagnosis of juvenile idiopathic arthritis (Durban 1997) 〚10〛. They were 25 girls and 13 boys aged 2–17 years (mean 8 years), with the onset of JIA before the age of 16 and a disease duration of at least 6

Results

Acute synovitis in at least one knee joint was present in 15/38 (39.5%) of patients, while chronic synovitis was evident in the rest of the patients 23/38 (60.5%). Table I shows patterns of arthritis included in this study and their characteristic lab results. Table II presents the different clinical presentations of the 38 patients encountered in our study.

By US examination synovial proliferation (pannus) was detected in 18/38 cases; it appeared as a hypoechoic or heterogenous thickening of

Discussion

Juvenile idiopathic arthritis is a chronic collagen disease with variable multisystem manifestations. Most children with JIA develop symptoms at or about the age of 4–7 years 〚12〛. The knee was found to be the most commonly affected joint in JIA and in many ways accounts for the most disability 〚2〛. Acute synovitis that becomes chronic leads to synovial proliferation and the formation of highly cellular pannus that erodes bone at the osteochondral junction, invades marrow space, undermines

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