Title:Ultrasound Hand and Wrist Findings in Children with Systemic Lupus
Erythematosus
Volume: 19
Issue: 2
Author(s): Heba Taher Osman, Noha Mostafa, Huda Marzouk, Nahla Sabry, Marise Abdou and Iman Khalifa*
Affiliation:
- Pediatric Department, Helwan University, Cairo, Egypt
Keywords:
Musculoskeletal, juvenile systemic lupus erythematosus (JSLE), hand and wrist, ultrasound, power doppler, synovitis.
Abstract:
Background: Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disease
that can involve any organ system. SLE typically affects the musculoskeletal system to varying
degrees, and patients are frequently most prone to have pain in the hand joints.
Objectives: The study aims to assess by ultrasound the presence of joint inflammation in patients
with juvenile Systemic Lupus Erythematosus (JSLE) not complaining of painful joints of the hand
and wrist (asymptomatic) and compare the findings with those in JSLE patients complaining of
painful hand and wrist joints (symptomatic) and in healthy controls.
Methods: This was a cross-sectional case control study on 37 JSLE patients. Thirty were asymptomatic
for joint complaints. Ultrasound examined wrists and joints of both hands, 11 joints in each
hand, to assess synovial hypertrophy, effusion and pathological vascularization (using power Doppler)
(PD), and were given a score of 0-3. Patients were compared with 8 healthy controls.
Results: Ultrasound abnormalities (synovial hypertrophy and increased vascularity) were detected
in 22/30 of the asymptomatic patients (73.3%) and in all 7 symptomatic patients (100%). In asymptomatic
children, 29 joints were affected (4.4% of all joints), compared to 13 joints in the symptomatic
patients (8.4% of all joints). Synovitis score was mild or moderate (1 or 2) in both symptomatic
and asymptomatic patients, with all showing increased vascularity. In the control group, 5
joints (2.8% of all joints) showed synovial hypertrophy but no increased vascularity.
Conclusion: Increased vascularity (PD more than 0) is a more reliable indicator of inflammation
than synovial hypertrophy, which may be detected in healthy individuals.
