Subject(s)
Magnetic Resonance Imaging/methods , Methylprednisolone/therapeutic use , Neuromyelitis Optica/complications , Neuromyelitis Optica/diagnostic imaging , Sjogren's Syndrome/complications , Sjogren's Syndrome/diagnostic imaging , Child , Female , Follow-Up Studies , Humans , Neuromyelitis Optica/drug therapy , Prednisone/therapeutic use , Rare Diseases , Risk Assessment , Sjogren's Syndrome/drug therapy , Treatment OutcomeABSTRACT
OBJECTIVE: To determine sensitivity and specificity of the physical examination (PE) for identifying synovitis in the knee and ankle joints of children with juvenile idiopathic arthritis (JIA), and to identify cases in which ultrasound (US) screening augments the PE. METHODS: Nineteen patients with JIA were referred for US. Both knees and ankles were examined using US with and without power Doppler. Active arthritis on PE was defined as (1) non-bony swelling or (2) limitation of motion with either pain on motion or tenderness to palpation. Active arthritis on US was defined as synovial hyperplasia, effusion, or increased vascularity on power Doppler scan. RESULTS: There was agreement between US and PE in 75% of cases. PE was 64% sensitive and 86% specific for identifying active arthritis. PE was 100% specific if (1) the patient was positive for both PE criteria or (2) if arthritis was present on PE in the knees. When the PE was negative and the US was positive, 21.4% developed active disease on PE within 6 months. In cases where the PE was positive and US was negative, the joint involved was most often the ankle and frequently the subtalar joint. CONCLUSION: PE is neither highly sensitive nor specific for identifying active synovitis when compared to US, and screening with US can identify subclinical disease. In joints with both non-bony swelling and limitation of motion with pain on motion or tenderness, and in the knee joint, little additional information is gained by US. This has implications for classification and treatment of JIA.
Subject(s)
Arthritis, Juvenile/diagnostic imaging , Arthritis, Juvenile/diagnosis , Arthritis, Juvenile/pathology , Physical Examination/standards , Adolescent , Ankle Joint/diagnostic imaging , Ankle Joint/pathology , Arthritis, Juvenile/physiopathology , Child , Child, Preschool , Female , Humans , Infant , Knee Joint/diagnostic imaging , Knee Joint/pathology , Male , Sensitivity and Specificity , UltrasonographyABSTRACT
Wasabi nose, a term used to describe the nasopharyngeal discomfort experienced during cyclophosphamide infusions, is a rare phenomenon, previously described in case reports of adult oncology patients typically receiving high-dose chemotherapy regimens. The underlying mechanism by which this phenomenon occurs is unknown. We report four cases of children with rheumatic diseases afflicted by profound nasopharyngeal discomfort secondary to low-dose cyclophosphamide infusions. We additionally review the literature regarding potential medical management of these complications and describe our experience using these interventions.