The inclusion of 2 additional joint components — physiologic vascularity and fat pad tissue — in the definition of healthy pediatric joint features will help improve the identification of joint abnormalities in children with rheumatic diseases, according to a study published in Pediatric Rheumatology Online.

The Outcome Measures in Rheumatology (OMERACT) ultrasonography Pediatric Task Force has recently developed preliminary B-mode ultrasonography definitions for normal components of pediatric joints. The study investigators sought to include Doppler findings in the assessment and definition of normal joint features that can be visualized in healthy children in various age groups. The new definitions, which were developed through a Delphi process, involved 3 steps.

Experts first proposed new additional definitions of joint components at a face-to-face meeting. Second, these new definitions, as well as preliminary B-mode ultrasound definitions, were evaluated for feasibility in an exercise in healthy children in different age groups. Finally, a large panel of ultrasound experts was invited to join a web-based consensus process in order to approve the new definitions with the use of Delphi methodology. A Likert scale of 1 to 5 was utilized to assess agreement.

The 2 additional joint components that were tested in healthy children were physiologic vascularity and fat pad tissue. Because physiologic vascularity changes over time in a child’s growing skeleton, the final definition of Doppler findings consisted of separate statements rather than a single definition.


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Overall, 7 statements were developed and included in a written Delphi questionnaire and used to validate and define the new components. The final definitions for fat pad and physiologic vascularity selected by the group reached 92.9% and 100% agreement, respectively, according to a web-based survey.

The investigators concluded that the inclusion of these 2 additional joint components, which are associated with detection of a Doppler signal in pediatric healthy joints, will help enhance the recognition of joint abnormalities in children with pediatric rheumatic diseases.

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Reference

Collado P, Windschall D, Vojinovic J, et al; OMERACT ultrasound subtask force on pediatric. Amendment of the OMERACT ultrasound definitions of joints’ features in healthy children when using the DOPPLER technique. Pediatr Rheumatol Online J. 2018;16(1):23.