Role of power Doppler sonography in evaluation of therapeutic response of the knee in juvenile rheumatoid arthritis.

The objective is to study the role of power Doppler sonography (PDS) in assessment of therapeutic response in juvenile rheumatoid arthritis (JRA) of knee joint. Thirty patients (age range 3-11 years) of JRA with knee joint involvement were selected for this study. Clinical assessment and ultrasound was done on the same day and repeated at the end of second and sixth month of therapy. All patients received naproxen (15-20 mg/kg/day) for a period of 6 months. Total clinical score (TCS) was calculated as sum of scores of pain, articular swelling and functional impairment. PDS was performed and degree of vascularity was assessed and graded. Total USG score was obtained by adding sum of scores of synovial effusion, synovial thickening and PDS. Results were compared between the total clinical score and the total ultrasound score and between clinical groups at baseline, end of second month and end of sixth month. There were statistically significant differences between clinical and ultrasound indices and confirmed that PDS is more sensitive in detection and follow-up of clinically silent cases of JRA. PDS holds great promise for detection of active synovial inflammatory disease in sub-clinical cases of JRA and is useful in objective assessment of therapeutic response.

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.

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.

Microcephaly with plate-like cortical calcification.

Congenital malformations of the central nervous system have varied presentations depending on the stage of embryological development when the insult occurred. We report a neonate with microcephaly associated with plate-like cortical calcification, probably secondary to an unidentified insult at around 11-12 weeks post-conceptional age causing an arrest of the proliferative phase. The associated vasculopathy probably caused diffuse cortical calcification.