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1.
Clin Exp Rheumatol ; 36(6): 1103-1109, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-30148439

RESUMEN

OBJECTIVES: The metacarpophalangeal (MCP) and metatarsophalangeal (MTP) joints may be involved in juvenile idiopathic arthritis. Our goal was to describe their normal sonoanatomy in healthy children, according to age and gender. METHODS: We studied 41 consecutive healthy children (20 girls, 21 boys; age 2-15 years) divided into four age groups: 2-4 years (n=9), 5-7 years (n=11), 8-12 years (n=12), and 13-15 years (n=9). Longitudinal ultrasound axis of the MCP and MTP joints were obtained. The evolution of the cartilage thickness and vascularisation of these joints were studied according to age and gender. The MCP or MTP joints were the statistical unit. RESULTS: At all sites, on B-mode images, cartilage thickness was associated with age (p<0.0001). Cartilage thickness at different sites was significantly greater in boys than in girls (p≤0.05). Blood vessels were seen within the cartilage, with differences across age groups. CONCLUSIONS: This study provides children's age- and gender-specific sonoanatomy data of MCP and MTP and confirms the importance of using colour Doppler or Power Doppler to study cartilage vascularisation.


Asunto(s)
Cartílago Articular/irrigación sanguínea , Cartílago Articular/diagnóstico por imagen , Articulación Metacarpofalángica/irrigación sanguínea , Articulación Metacarpofalángica/diagnóstico por imagen , Articulación Metatarsofalángica/irrigación sanguínea , Articulación Metatarsofalángica/diagnóstico por imagen , Neovascularización Fisiológica , Ultrasonografía Doppler , Adolescente , Desarrollo del Adolescente , Factores de Edad , Cartílago Articular/crecimiento & desarrollo , Niño , Desarrollo Infantil , Preescolar , Femenino , Humanos , Masculino , Articulación Metacarpofalángica/crecimiento & desarrollo , Articulación Metatarsofalángica/crecimiento & desarrollo , Valor Predictivo de las Pruebas , Valores de Referencia , Estudios Retrospectivos , Factores Sexuales
2.
Eur Radiol ; 25(7): 2143-52, 2015 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-25663311

RESUMEN

OBJECTIVES: To describe the sonoanatomy of paediatric lower-limb entheses according to age and gender. We studied sites that most commonly involved entheses in spondyloarthritis. METHODS: We studied 41 consecutive healthy children (20 girls, 21 boys; age 2-15 years) divided into four age groups: 2-4 years (n = 9), 5-7 years (n = 11), 8-12 years (n = 12) and 13-15 years (n = 9). Ultrasound was used to obtain both transverse and longitudinal views of each enthesis. We assessed the echostructural components of the lower limb entheses and the vascularisation of the entheses and cartilage according to the different anatomical sites and age and gender. RESULTS: At all sites on B-mode, cartilage and tendon thicknesses showed positive or negative correlations with age (P < 0.0001). Side-to-side correlations were good (P < 0.0001 overall) and stronger for cartilage (r, 0.77-0.97) than for tendon thickness (r, 0.58-0.63). Agreement between the two sides for discrete data was very good to excellent (kappa, 0.77-1). Cartilage thickness at the various sites was significantly greater in boys than in girls (P ≤ 0.05). Tendon thickness was not significantly influenced by gender. Blood vessels were seen within the cartilage with differences across age groups. CONCLUSIONS: This study provides the first data on normal entheseal sonoanatomy and vascularisation in children. KEY POINTS: • The tendons of children exhibit the same fibrillar structure as adults • Tendon thickness at enthesis insertion in children is not influenced by gender • Cartilage thickness in children decreases with advancing age and varies with gender.


Asunto(s)
Tendón Calcáneo/diagnóstico por imagen , Cartílago/diagnóstico por imagen , Crecimiento/fisiología , Ligamento Rotuliano/diagnóstico por imagen , Placa Plantar/diagnóstico por imagen , Tendón Calcáneo/anatomía & histología , Tendón Calcáneo/irrigación sanguínea , Adolescente , Adulto , Envejecimiento/fisiología , Cartílago/anatomía & histología , Cartílago/irrigación sanguínea , Niño , Preescolar , Femenino , Humanos , Masculino , Neovascularización Fisiológica , Ligamento Rotuliano/anatomía & histología , Ligamento Rotuliano/irrigación sanguínea , Placa Plantar/anatomía & histología , Placa Plantar/irrigación sanguínea , Caracteres Sexuales , Espondiloartritis/diagnóstico por imagen , Espondiloartritis/patología , Ultrasonografía
3.
Arthritis Care Res (Hoboken) ; 63(6): 849-55, 2011 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-21312344

RESUMEN

OBJECTIVE: Enthesitis is a major feature of juvenile idiopathic arthritis (JIA) but is difficult to diagnose clinically. Our objective was to compare the accuracy of ultrasonography with power Doppler (US-PD) versus clinical examination for diagnosing enthesitis in patients with JIA and healthy controls. METHODS: Twenty-six consecutive patients with JIA and 41 healthy volunteers underwent standardized clinical and US-PD examinations of 5 entheseal sites (proximal and distal quadricepital tendon insertions, Achilles tendon, and plantar fascia). US-PD reproducibility was evaluated. US-PD enthesitis was defined as a PD signal at the enthesis insertion. Bursitis, erosions, and cartilage vascularization were recorded. RESULTS: In the JIA group, 27 (12.5%) of the entheseal sites exhibited clinical enthesitis (distal patellar ligament in 45% of cases) and 20 (9.4%) exhibited US-PD enthesitis (distal patellar tendon in 30%), including 10 clinically normal sites (50%). US-PD enthesitis was found in several patients with oligoarthritis or polyarthritis. Clinical enthesitis (P < 0.0001) and HLA-B27-positive (P = 0.05) status were significantly associated with US-PD enthesitis. Erosion and bursitis, but not tendon thickening, were associated with US-PD enthesitis. US-PD enthesitis was not found at any of the 410 entheseal sites in controls; grade 1 cartilage vascularization was noted at 6% of the control sites. CONCLUSION: Enthesitis is a rare phenomenon in JIA. Clinically silent enthesitis is detected by US-PD and can be found in JIA categories other than enthesitis-related arthritis. Tendon thickening and cartilage vascularization can be detected in healthy controls. These findings may have implications for patient classification of the use of US-PD.


Asunto(s)
Artritis Juvenil/diagnóstico por imagen , Tendinopatía/diagnóstico por imagen , Adolescente , Artritis Juvenil/sangre , Artritis Juvenil/complicaciones , Niño , Femenino , Humanos , Masculino , Enfermedades Reumáticas/sangre , Enfermedades Reumáticas/complicaciones , Enfermedades Reumáticas/diagnóstico por imagen , Tendinopatía/sangre , Tendinopatía/complicaciones , Ultrasonografía Doppler/métodos
4.
Semin Arthritis Rheum ; 41(2): 272-8, 2011 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-21377713

RESUMEN

OBJECTIVES: The characteristics of synovitis in juvenile idiopathic arthritis (JIA) are important to evaluate, as they define several clinical categories. The metacarpophalangeal (MCP) and metatarsophalangeal (MTP) joints are frequently involved. Few studies have investigated peripheral joint evaluation using ultrasonography, a sensitive tool for detecting subclinical synovitis. Our objectives here were to compare clinical and ultrasound evaluations of MCP and MTP joint synovitis and to determine the prevalence of predefined ultrasound abnormalities in JIA patients and healthy controls. METHODS: Standardized physical and ultrasound assessments of the same joints were done in 31 consecutive patients with JIA and 41 healthy volunteers. Joint pain, motion limitation, and swelling were recorded. Ultrasonography was performed on the same joints by 2 trained sonographers who recorded synovial fluid, synovial hypertrophy, erosion, and power Doppler signal. Intraobserver reproducibility of ultrasonography was assessed. RESULTS: Of 558 peripheral joints examined in JIA patients, 69 (12.5%) had ultrasonographic synovitis and 83 (15%) had abnormal physical findings. All the physical abnormalities were significantly associated with ultrasonographic synovitis (P < 0.0001) but agreement was low between ultrasonographic and physical findings. Ultrasonographic synovitis was most common at the feet (59.4%), where it was detected clinically in only 25% of cases. Ultrasonographic synovitis was associated with the presence of synovial fluid. Cartilage vascularization was found in 2 (4.2%) healthy controls. CONCLUSION: Ultrasonography is useful for monitoring synovitis in JIA. Subclinical involvement of the MTP joints is common. Clinicians should be aware of the specific ultrasonographic findings in children.


Asunto(s)
Artritis Juvenil/diagnóstico , Articulaciones/diagnóstico por imagen , Sinovitis/diagnóstico , Adolescente , Artritis Juvenil/diagnóstico por imagen , Artritis Juvenil/fisiopatología , Niño , Preescolar , Femenino , Humanos , Articulaciones/fisiopatología , Masculino , Examen Físico , Rango del Movimiento Articular/fisiología , Índice de Severidad de la Enfermedad , Sinovitis/diagnóstico por imagen , Sinovitis/fisiopatología , Ultrasonografía
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