AB1168 Is my clinical examination adequate to evaluate disease activity in children with juvenile idiopathic arthritis (JIA)? a comparative assessment of clinical and ultrasound (US) examination of 40 knees and ankles in 10 children with JIA
Authors: A. Shivpuri, M. Agarwal, S. Sawhney
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> JIA is the commonest rheumatologic disease of childhood with a quoted prevalence of 1:1000. Assessment of children with JIA includes:Clinical, laboratory and more recently US evaluation of joints. Rapid attainment of inactive disease is critical for a good long term outcome. There is a debate in the rheumatology community about added advantage of US examination over clinical assessment of joints. This study was done to compare clinical versus US evaluation of knees and ankles in children with JIA. <h3>Objectives</h3> 1. To clinically examine and scan knees and ankles of 10 children with JIA 2. To determine sensitivity and specificity of clinical examination of knees and ankles vis a vis US scan findings 3. To compare results of knee and ankle examination both clinical and US <h3>Methods</h3> 1. 10 consecutive children with JIA were evaluated for active arthritis of knees and ankles and documented on a pre designed proforma. 2. Children were then examined with US on same day by same observer and joint effusion and or synovitis was captured using an E9/S7 GE machine with a linear transducer 6–15 MHz. <h3>Results</h3> 10 children aged 6–16 years, (6F and 4M) who attended the out-patient paediatric rheumatology clinic at our hospital with JIA were clinically evaluated and US examination performed on same day by same examiner with prior consent. Using the standard ESSR protocols, US knee and ankle joints were examined in longitudinal view and if any effusion or synovitis detected was confirmed on transverse view. The presence of grey scale synovial proliferation or anechoic effusion was taken as a positive US finding. Knee-Sensitivity of clinical examination-100%, specificity-91.7%. Ankles-Clinically 8 had swollen ankle, On US only 5 children had swollen ankle(tibio talar TT) joint. 3 who had a swollen ankle clinically had no synovial hypertrophy or effusion in the TT joint but had tenosynovitis(TS) of adjacent tendons: 1 each has a TS of the Extensor Digitorum Longus, Tibialis Anterior, Tibialis Posterior. Sensitivity-60% and specificity-66.7%. <h3>Conclusions</h3> With gold standard as US for detection of synovitis, sensitivity of clinical examination-100% for knee, specificity-91.7%. For clinical examination of ankles, sensitivity-60% and specificity-66.7% suggesting possibility of mistaking an adjacent tendon sheath swelling for a TT joint disease. This has important implications for systemic therapies and intervention. The US is a valuable addition to clinical examination of the joints. Clinical examination alone in this pilot study of 10 children with JIA is inadequate to assess disease of the ankles. Evidence shows US to be superior to the clinical examination alone, but the lack of validated US findings, scoring systems and treatment algorithms exposes the need for further research. <h3>Disclosure of Interest</h3> None declared