Ultrasound Detects Silent Enthesitis in Arthritis

Power Doppler ultrasound detects clinically silent enthesitis in juvenile idiopathic arthritis

WEDNESDAY, Feb. 23 (HealthDay News) -- Ultrasonography with power Doppler (US-PD) may detect clinically silent enthesitis in patients with juvenile idiopathic arthritis (JIA) and other enthesitis-related arthritis, according to research published online Feb. 10 in Arthritis Care & Research.

Sandrine Jousse-Joulin, M.D., from Université de Bretagne Occidentale in Brest, France, and colleagues evaluated 26 patients with JIA and 41 healthy controls for enthesitis. Standardized clinical and US-PD examinations were compared for five entheseal sites (Achilles tendon, proximal and distal patellar ligament, quadricepital tendon, and plantar fascia insertions). The presence of cartilage vascularization, bursitis, and erosions was recorded.

The investigators found that clinical enthesitis was exhibited in 12.5 percent of sites in the JIA group, with 45 percent at the distal patellar ligament. In 10.5 percent of sites, US-PD enthesitis was displayed with 50 percent at clinically normal sites. US-PD was also seen in patients with oligoarthritis or polyarthritis. A significant association was found between clinical enthesitis and HLA-B27-positive status and US-PD enthesitis. In the JIA group, US-PD enthesitis was associated with erosion and bursitis, but not with tendon thickening or cartilage vascularization. No clinical or US-PD enthesitis, erosion, or bursitis, was detected at any of the 410 entheseal sites in controls, but grade 1 cartilage vascularization was found at 6 percent of sites.

"Given the limited sensitivity of the physical examination for detecting enthesitis and the long time required for radiographic signs of enthesitis to develop, US-PD may deserve to be included in the initial evaluation of JIA," the authors write.

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