Clinical and ultrasound assessment of the knee in children with juvenile rheumatoid arthritis.

OBJECTIVE: To correlate clinical features with ultrasound (USG) findings in the detection, quantification and follow up of inflammatory signs of knee in children with mono or pauciarticular juvenile rheumatoid arthritis (JRA). METHODS: Thirty patients (11 girls, 19 boys) with pauciarticular JRA (14 with monoarticular and 16 with bilateral knee involvement) were studied. Mean disease duration was 10 months (range 2 months to 5 yr). All knees were classified into two groups, according to the presence or absence of acute inflammation. Clinical assessment and ultrasound was done in all patients on the same day. All the patients received naproxen (15-20 mg/Kg/day) for a period of six months, after which clinical assessment and ultrasound study was repeated. RESULTS: Synovial proliferation and effusion, was demonstrated in a much higher frequency in those clinically active (Group A) as compared to these in clinical remission (Group B). Statistically significant differences between clinical and USG indices were seen. CONCLUSION: USG of knee is more sensitive than clinical assessment in detection of synovial effusion and thickening and plays a useful role in monitoring evolution of the inflammatory process, its quantification and for follow up.

High resolution sonography for analysis of meniscal injuries.

High resolution ultrasonography was done prospectively in 51 adult patients with clinically suspected meniscal injuries to evaluate the sensitivity and specificity of ultrasonography as a primary diagnostic tool and to see if it was possible to evaluate the site, extent and size of the tear. All cases were confirmed arthroscopically; ultrasonographic examination revealed inhomogenecity in 45 cases and this was accurate in 40 cases; in 3 cases ultrasonography gave a false positive result and in 2 cases the wrong meniscus was shown to be torn. The six cases with no findings on ultrasonography were proven to have no meniscal tear. The sensitivity of ultrasonography as a screening test to rule out meniscal injuries was thus 100%; on the other hand the specificity (false positive screening test) was 54%. It was no possible to determine the site, size or extent of the tear by the ultrasonographic examination. Even though magnetic resonance imaging is more accurate in giving an exact diagnosis, ultrasonography is an excellent primary diagnostic tool which is inexpensive with no side-effects, is readily available and has very good sensitivity and a reasonable specificity.