Ultrasound abnormalities may be a strong predictor of relapse in patients with juvenile idiopathic arthritis (JIA), according to a prospective study in the Annals of the Rheumatic Diseases.
Tools for predicting relapse in JIA are urgently needed, and the role of ultrasound-detected synovitis when clinical manifestations are absent is unknown. Therefore, to determine the value of ultrasound in clinical remission and its ability to predict flares, researchers enrolled 88 consecutive patients with JIA (52% with persistent oligoarthritis, 17% with extended oligoarthritis, 17% with rheumatoid factor-negative polyarthritis, and 14% with other forms of JIA). Participants were clinically inactive for a minimum of 3 months, underwent a baseline ultrasound assessment of 44 joints, and were followed for 4 years.
In 22.7% of patients and in 0.98% of joints, the baseline ultrasound examination was abnormal. Extended oligoarthritis and rheumatoid factor-negative polyarthritis were almost 3 times more frequent in patients who were ultrasound-positive than in patients who were ultrasound-negative (35.0% vs 11.8% and 30.0% vs 13.2%, respectively; P =.005). During the 4 years of follow-up, 46.6% of patients displayed a flare; 38.2% were ultrasound-negative and 75% were ultrasound-positive at baseline. Irrespective of treatment, abnormality on ultrasound examination significantly increased the risk for flare in ultrasound-positive vs ultrasound-negative patients (odds ratio [OR], 3.8; 95% CI, 1.2-11.5).
“In conclusion, [ultrasound] could be a predictor of relapse at the patient level since a subclinical synovitis increased by about four times the risk of flare” stated the authors. Further studies are needed to confirm these findings, but ultrasound examination may become a useful tool for stratifying the risk for disease flare in patients with JIA who are in full clinical remission.
De Lucia O, Ravagnani V, Pregnolato F, et al. Baseline ultrasound examination as possible predictor of relapse in patients affected by juvenile idiopathic arthritis (JIA) [published online February 6, 2018]. Ann Rheum Dis. doi:10.1136/annrheumdis-2017-211696