Juvenile rheumatoid arthritis of the knee: evaluation with contrast-enhanced color Doppler ultrasound

Background. Contrast-enhanced color Doppler ultrasonography is a non-radiat ion-bearing tool that can be of value for assessment of inflammatory and va scular synovial changes in juvenile rheumatoid arthritis (JRA). Objectives. To evaluate the effect of contrast-enhanced color Doppler ultra sound (US) in the evaluation of synovial changes in the knees of children w ith JRA. Materials and methods. Sagittal color Doppler sonograms of 31 knees in 22 p atients with JRA and of 10 knees in 5 control subjects were obtained before (at baseline) and after (at peak contrast phase) intravenous injection of SHU 508, Images were assessed for overall mean pixel intensity within the s ynovial tissue and for peak enhancement ratios {[(mean pixel intensity valu es at maximum contrast enhancement-unenhanced mean pixel intensity values)/ unenhanced mean pixel intensity values] x 100}. The joints were classified into three groups by clinical/laboratory criteria: group A (active disease in the knee), n = 9; group B (quiescent disease with serum chemistry levels of active disease), n = 12 and group C (remission disease), n = 10, Results. Mean color pixel intensity values were markedly increased by the u se of US contrast agents in groups A (P = 0.003) and B (P = 0.0001), did no t reach statistical significance in group C (P = 0.06) and remained essenti ally unchanged in the control group (P = 0.25), Enhancement ratios for the three groups of JRA patients were not different (P = 0.38) (mean +/- SD, 72 0 % +/- 402 fur group A, 731% +/- 703 for group B and 314% +/- 263 for grou p C). Conclusion. Contrast-enhanced color Doppler imaging holds promise for the d etection of active synovial inflammatory disease in subclinical cases of JR A, thereby allowing earlier treatment and improved clinical outcome.