Discordance between Clinical and Ultrasound Examinations in Juvenile Idiopathic Arthritis: An Experimental Approach
Francesco Licciardi,
Marco Petraz,
Carlotta Covizzi,
Francesca Santarelli,
Carlotta Cirone,
Roberta Mulatero,
Francesca Robasto,
Marta Dellepiane,
Silvana Martino,
Davide Montin,
Viviana Ravagnani
Affiliations
Francesco Licciardi
Division of Pediatric Immunology and Rheumatology, Department of Public Health and Pediatrics Sciences, Regina Margherita Children’s Hospital, University of Turin, 10126 Turin, Italy
Marco Petraz
Città della Salute e della Scienza, Department of Radiology, Regina Margherita Children’s Hospital, 10126 Turin, Italy
Carlotta Covizzi
Division of Pediatric Immunology and Rheumatology, Department of Public Health and Pediatrics Sciences, Regina Margherita Children’s Hospital, University of Turin, 10126 Turin, Italy
Francesca Santarelli
Division of Pediatric Immunology and Rheumatology, Department of Public Health and Pediatrics Sciences, Regina Margherita Children’s Hospital, University of Turin, 10126 Turin, Italy
Carlotta Cirone
Division of Pediatric Immunology and Rheumatology, Department of Public Health and Pediatrics Sciences, Regina Margherita Children’s Hospital, University of Turin, 10126 Turin, Italy
Roberta Mulatero
Division of Pediatric Immunology and Rheumatology, Department of Public Health and Pediatrics Sciences, Regina Margherita Children’s Hospital, University of Turin, 10126 Turin, Italy
Francesca Robasto
Division of Pediatric Immunology and Rheumatology, Department of Public Health and Pediatrics Sciences, Regina Margherita Children’s Hospital, University of Turin, 10126 Turin, Italy
Marta Dellepiane
Division of Pediatric Immunology and Rheumatology, Department of Public Health and Pediatrics Sciences, Regina Margherita Children’s Hospital, University of Turin, 10126 Turin, Italy
Silvana Martino
Division of Pediatric Immunology and Rheumatology, Department of Public Health and Pediatrics Sciences, Regina Margherita Children’s Hospital, University of Turin, 10126 Turin, Italy
Davide Montin
Division of Pediatric Immunology and Rheumatology, Department of Public Health and Pediatrics Sciences, Regina Margherita Children’s Hospital, University of Turin, 10126 Turin, Italy
Viviana Ravagnani
SSD Allergologia ed Immunologia Clinica, Ospedale C. Poma, ASST Mantova, 46100 Mantova, Italy
Clinical examination (CE) and musculoskeletal ultrasound (MSUS) of ten joints (knee, ankle, wrist, elbow, II-MCP) and their extra-articular (EA) compartments (tendons and bursae) were performed on 35 consecutive patients with active juvenile idiopathic arthritis (JIA) (active group) to test how the extension of MSUS examinations to EA changes the concordance between MSUS and CE. The overall concordance between CE and MSUS, measured with Cohen’s Kappa (k), was moderate (k = 0.43); the addition of EA MSUS increased the concordance in all joints, with the exclusion of II-MCP (k = 0.49). In the ankle and wrist, the k increase was relevant (k from 0.13 to 0.27 and 0.11 to 0.41). In the active group patients, we observed 44 subclinical synovitis; the number of subclinical synovitis per patient was correlated with JADAS-27 (p = 0.03) and was higher in a control group composed of 15 patients with persistent disease remission (1.3 vs. 0.4 p = 0.03). Our results show that EA compartments should always be evaluated during MSUS. Furthermore, we demonstrate a moderate concordance between CE and MSUS in JIA; the finding of subclinical synovitis is common in patients with active diseases and is related to disease activity.
