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Ultrasound can detect subclinical synovitis in patients with juvenile idiopathic arthritis, Italian researchers report in the November 15th issue of Arthritis and Rheumatism. Dr. Silvia Magni-Manzoni of Fondazione IRCCS Policlinico San Matteo, Pavia and colleagues observe that therapeutic decisions clinical examinations for synovitis may miss important inflammation.

To examine the utility of ultrasound in this connection, the researchers had an experienced sonographer scan 52 joints in each of 32 pediatric patients. The children were also examined by 2 rheumatologists. In all, 1664 joints were assessed clinically and with ultrasound.

A total of 104 joints (6.3%) had clinical synovitis and 167 (10.0%) had synovitis on ultrasound. Of the 1560 clinically normal joints, 86 (5.5%) had subclinical synovitis.

Subclinical synovitis was more common in small hand and wrist joints, the researchers point out, suggesting that in such joints ultrasound is helpful in identifying subtle inflammatory changes that may be overlooked by clinical assessment.

Nevertheless, the team also observes that "an unexpected finding was that clinical examination detected synovitis in 23 joints that were recorded as normal on ultrasound examination."

Five patients who were classified on clinical examination as having oligoarthritis or no synovitis were re-classified as having polyarthritis based on ultrasound findings.

Ultrasound variables, say the investigators, were moderately correlated with clinical measures of joint swelling, but poorly correlated with those of joint tenderness and pain on motion, and of restricted motion.

The researchers conclude that subclinical synovitis is common in these children and may have "important implications for patient classification and may affect the choice of the optimal therapeutic strategy in individual patients."

Source: Reuters

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