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Open Access Highly Accessed Research

Ultrasonography and color Doppler in juvenile idiopathic arthritis: diagnosis and follow-up of ultrasound-guided steroid injection in the wrist region. A descriptive interventional study

Louise Laurell1*, Michel Court-Payen2, Susan Nielsen3, Marek Zak4 and Anders Fasth5

Author Affiliations

1 Department of Pediatrics, Skåne University Hospital, Lund University, Lund, Sweden

2 Department of Diagnostic Imaging, Gildhøj Private Hospital, University of Copenhagen, Copenhagen, Denmark

3 Department of Pediatrics, Rigshospital, University of Copenhagen, Copenhagen, Denmark

4 Department of Pediatrics, Rigshospital, University of Copenhagen, Copenhagen, Denmark

5 Department of Pediatrics, University of Gothenburg, Gothenburg, Sweden

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Pediatric Rheumatology 2012, 10:11  doi:10.1186/1546-0096-10-11

Published: 21 April 2012

Abstract

Background

The wrist region is one of the most complex joints of the human body. It is prone to deformity and functional impairment in juvenile idiopathic arthritis (JIA), and is difficult to examine clinically. The aim of this study was to evaluate the role of ultrasonography (US) with Doppler in diagnosis of synovitis, guidance of steroid injections, and follow-up examinations of the wrist in JIA.

Methods

In 11 patients (median age 12.5 years, range 2-16), 15 wrists with clinically active arthritis were assessed clinically by US and color Doppler (Logiq 9, GE, 16-4 MHz linear transducer) prior to and 1 and 4 weeks after US-guided steroid injection.

Results

US detected synovitis in the radio-carpal joints, the midcarpal joints, and the tendon sheaths in 87%, 53% and 33% of the wrists, respectively. Multiple compartments were involved in 67%. US-guidance allowed accurate placement of steroid in all 21 injected compartments, with a low rate of subcutaneous atrophy. Synovial hypertrophy was normalized in 86% of the wrists, hyperemia in 91%, and clinically active arthritis in 80%.

Conclusions

US enabled detection of synovial inflammation in compartments that are difficult to evaluate clinically and exact guidance of injections, and it was valuable for follow-up examinations. Normalization of synovitis was achieved in most cases, which supports the notion that US is an important tool in management of wrist involvement in JIA.

Keywords:
Ultrasonography; Color Doppler; Juvenile idiopathic arthritis; US-guided steroid injection; Wrist