Comparison of Clinical Examination and Ultrasound for Ankle Disease in Juvenile Idiopathic Arthritis

pediatric ankle exam, JIA
Researchers compared the frequency of joint and tendon disease on ultrasound and clinical examination in active juvenile idiopathic arthritis.

A combination of clinical examination and ultrasound may improve diagnosis of active ankle disease in juvenile idiopathic arthritis (JIA), according to study results published in Arthritis Care & Research.

Ultrasound has increasingly replaced clinical examinations in the management of JIA, but it is unclear how the results of these methods compare. Investigators of this study aimed to compare the frequency of joint and tendon disease on ultrasound and clinical examination and evaluate the level of agreement between the 2 methods in ankle disease among patients with clinically active JIA.

A total of 78 children (67.9% girls; median age, 8.1 years) were included in the study. Of the 105 ankles with clinically active disease, active synovitis was identified by clinical examination in 184 joints and by ultrasound in 163 joints in 89 ankles.

The most frequently affected joint identified by both methods was the tibiotalar joint. Tenosynovitis was identified in 34 ankles (32.4%) by clinical examination and 74 ankles (70.5%) by ultrasound, most frequently in the medial and lateral tendon compartments. Involvement of the anterior tendon compartment was not observed. The tibialis posterior was the most frequently affected tendon identified on ultrasound, followed by the peroneal and flexor digitorum longus tendons. Concordance between clinical examination and ultrasound for the presence of active disease was found in 56 ankles (53.3%) and for the absence of disease in 10 ankles (9.5%) for the tibiotalar joint.

Ultrasound identified active synovitis in 50 joints that were considered normal on clinical evaluation, and 71 joints were deemed affected on clinical examination that did not display disease activity on ultrasound. Concordance was similarly low for tenosynovitis.

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Study limitations included the unavailability of established cutoff values on ultrasound for disease in children because of which published values for adults were used for analysis.

“Our observation suggests that [clinical evaluation] does not allow a proper evaluation of ankle disease activity, as it is not able to establish precisely the location of joint and tendon inflammation,” the researchers concluded. “Coupling [clinical evaluation] with [ultrasound] aids to identify correctly the inflamed sites in the ankle region, which enhances significantly the quality of the clinical assessment and may increase the effectiveness of local injection therapy.”


Lanni S, Marafon DP, Civino A, et al. Comparison between clinical and ultrasound assessment of the ankle region in juvenile idiopathic arthritis [published April 27, 2020]. Arthritis Care Res (Hoboken). doi:10.1002/acr.24241