Detection of active disease in juvenile idiopathic arthritis: Sensitivity and specificity of the physical examination vs ultrasound

Ginger L. Janow, Vikash Panghaal, Angela Trinh, David Badger, Terry L. Levin, Norman Todd Ilowite

Research output: Contribution to journalArticle

48 Citations (Scopus)

Abstract

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. The Journal of Rheumatology

Original languageEnglish (US)
Pages (from-to)2671-2674
Number of pages4
JournalJournal of Rheumatology
Volume38
Issue number12
DOIs
StatePublished - Dec 2011

Fingerprint

Juvenile Arthritis
Physical Examination
Sensitivity and Specificity
Arthritis
Synovitis
Knee Joint
Ankle
Knee
Joints
Subtalar Joint
Pain
Ankle Joint
Palpation
Rheumatology
Hyperplasia

Keywords

  • Diagnosis
  • Juvenile idiopathic arthritis
  • Screening
  • Ultrasonography

ASJC Scopus subject areas

  • Rheumatology
  • Immunology
  • Immunology and Allergy

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Detection of active disease in juvenile idiopathic arthritis : Sensitivity and specificity of the physical examination vs ultrasound. / Janow, Ginger L.; Panghaal, Vikash; Trinh, Angela; Badger, David; Levin, Terry L.; Ilowite, Norman Todd.

In: Journal of Rheumatology, Vol. 38, No. 12, 12.2011, p. 2671-2674.

Research output: Contribution to journalArticle

Janow, Ginger L. ; Panghaal, Vikash ; Trinh, Angela ; Badger, David ; Levin, Terry L. ; Ilowite, Norman Todd. / Detection of active disease in juvenile idiopathic arthritis : Sensitivity and specificity of the physical examination vs ultrasound. In: Journal of Rheumatology. 2011 ; Vol. 38, No. 12. pp. 2671-2674.
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abstract = "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. The Journal of Rheumatology",
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AB - 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. The Journal of Rheumatology

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