Lung Ultrasonography Provides Alternative Imaging for Systemic Juvenile Idiopathic Arthritis with Lung Disease

Lung ultrasonography effectively identified pleural abnormalities that correlated with high-resolution computed tomography (HRCT) findings in children with systemic juvenile idiopathic arthritis with lung disease (sJIA-LD), according to study findings published in Arthritis Care and Research (Hoboken).

Researchers conducted a study between May 2020 and October 2021 to examine the efficacy of lung ultrasonography in the evaluation of interstitial lung disease (ILD) in 9 children younger than 18 years of age with sJIA-LD compared with 6 healthy control participants.

The researchers used lung ultrasonography to assess 14 different lung positions, which took an average time of 12 minutes to perform. Lung ultrasonography successfully evaluated 97% of these lung positions (122 of 126), and showed thickened, irregular, fine and/or course granular hyperechoic abnormalities in 106 pleural locations (87%).

Across the 122 successfully evaluated locations, 86 (70%) were diffuse in nature, 20 (16%) were focal, 106 (87%) showed B-lines, and 44 (36%) contained subpleural consolidations. Among the healthy control participants, lung ultrasonography did not show pleural thickening, granularity, effusions, or consolidations.

Of the 9 study patients, 7 had previous HRCT imaging results available for comparison. The past HRCT results showed frequent subpleural and peribronchovascular consolidations in the lower lobes, anterior right middle lobe and/or lingula, and anterior upper lobe. Ground-glass opacity, interlobular septal thickening, and cysts were less frequent findings.

Since lung ultrasonography findings appeared to correspond with HRCT findings, the researchers suggested lung ultrasonography as a cost-effective alternative to HRCT, which repeatedly exposes pediatric patients with sJIA-LD to ionizing radiation. Lung ultrasonography also provides a feasible imaging alternative because lung disease presents in children as young as 2 years of age who are unable to participate in the standard screening assessments for sJIA-LD, such as the 6-Minute-Walk-Test, pulmonary function tests, or non-sedated HRCTs.

Limitations of the study included the small sample size and the potential increased lung disease severity in this study’s cohort compared with undiagnosed children with sJIA-LD.

The study authors concluded, “[Lung ultrasonography] in sJIA-LD reveals highly conspicuous abnormalities in the pleura and subpleural that appear to correlate with peripheral lung findings on HRCT…. This study suggests a potential role of [lung ultrasonography] in sJIA-LD screening, diagnosis, and/or prognostication.”

Reference

Vega-Fernandez P, Ting TV, Mar DA, et al. Lung ultrasound in children with systemic juvenile idiopathic arthritis associated interstitial lung disease. Arthritis Care Res (Hoboken). Published online May 23, 2022. doi:10.1002/acr.24957