C Shanmugavel, Abstract Co-Author: Nothing to Disclose

Kushaljit Singh Sodhi MD, Presenter: Nothing to Disclose

Sudha Katariya, Abstract Co-Author: Nothing to Disclose

Ravinder Sidhu, Abstract Co-Author: Nothing to Disclose

Surjit Singh, Abstract Co-Author: Nothing to Disclose

Sudha Suri, Abstract Co-Author: Nothing to Disclose

To study the role of power doppler sonography(PDS) in assessment of therapeutic response in JRA of the knee joint.

A total of 30 patients (16 girls, 14 boys, aged 1-16 years) of JRA with knee joint involvement were selected . Clinical assessment and ultrasound was done on the same day (baseline) and repeated at the end of 2nd and 6th month of therapy.Therapy used was intra-articular administration of steroids.Clinical examination of the knee was performed. Patients with a mean score of > 1 were classified as active knee involvement (group A) while patients with a mean score 0-1 were considered to be in clinical remission (group B). Ultrasound (USG) was done using HDI ATL 5000 Scanner , with a 5-12 MHz linear array transducer.Initially gray scale USG was performed followed by (PDS). On gray scale USG , synovial effusion, synovial thickness, and cartilage thickness was quantitatively assessed for each knee.PDS was then performed in the suprapatellar region and degree of vascularity (on both pre and post therapy images) was assessed and graded as grade 1-normal(0-2 pixels), grade 2 –mild hyperemia (2-4 pixels);grade 3- moderate ( 4-6 pixels); grade 4- marked hyperemia(>6 pixels).Total USG score was obtained by adding the sum of scores of synovial effusion,synovial thickening and PDS.

Results were compared between the total clinical score and total ultrasound score and between the group A and group B at baseline , end of 2nd month and end of 6th month . There were statistically significant differences between the clinical and ultrasound indices and confirmed that USG ( with PDS) is more sensitive in detection and follow up of clinically silent cases of JRA. PDS showed hyperemic changes in knees that were clinically normal.Post therapy PDS revealed a decrease in vascularity by atleast 1-2 scores on 6th month follow up but only by 1 score on 2nd month follow up and there was a statistically significant difference between the 2nd month and 6th month follow up .

PDS holds promise for the detection of active synovial inflammatory disease in sub-clinical cases of JRA and is useful in objective assessment of therapeutic response.

Shanmugavel, C, Sodhi, K, Katariya, S, Sidhu, R, Singh, S, Suri, S, Role of Power Doppler Sonography in Evaluation of Therapeutic Response of the Knee in Juvenile Rheumatoid Arithritis(JRA).  Radiological Society of North America 2004 Scientific Assembly and Annual Meeting, November 28 - December 3, 2004 ,Chicago IL. http://archive.rsna.org/2004/4411577.html