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

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.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%.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.The wrist region is one of the most complex joints of the human body, and it is prone to deformity and functional impairment in juvenile idiopathic arthritis (JIA) [1,2] and is difficult to examine clinically. Inflammation in the wrist region is an indicator of poor outcome in JIA [3]. In the first detailed account of the natural history of wrist arthritis in children, Chaplin and colleagues [4] described late changes, visualized on plain radiographs, in 59% of the patients they studied. The trend towards early suppression of inflammation has probably improved the outcomes in many patients with JIA [5], but it has also increased the need for more sensitive imaging techniques.The aim of the present study was to investigate the usefulness of ultrasonography (US) with Doppler in JIA, focusing on diagnosis of synovitis, guidance of steroid injections, and follow-up examinations of the wrist region.This study was conducted during 2009 and 2010 at the Department of Pediatrics, Un