“The MUSICAL pediatric ultrasound examination – a comprehensive, reliable, time efficient assessment of synovitis”

• Type of Material: Article
• Authors: Patricia Vega-Fernandez, Cincinnati Children’s Hospital; Tracy V. Ting, Cincinnati Children’s Hospital; Edward J. Oberle, Ohio State University; Courtney McCracken, Emory University; Janet Figueroa, Emory University; Mekibib Altaye, Cincinnati Children’s Hospital; Amy Cassedy, Cincinnati Children’s Hospital; Gurjit S. Kaeley, University of Florida; Johannes Roth, Hebrew SeniorLife, IFAR
• Language: English
• Date: 2022-09-13
• Publisher: Wiley
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2022 John Wiley & Sons, Inc
• Final Published Version (URL): https://doi.org/10.1002/acr.24759
• Title of Journal or Parent Work: Arthritis Care & Research
• Volume: 75
• Issue: 2
• Start Page: 401
• End Page: 409
• Grant/Funding Information: Project funded by a Childhood Arthritis and Rheumatology Research Alliance - Arthritis Foundation Small Grant; Center for Clinical & Translational Science & Training (CCTST) at the University of Cincinnati funded by the National Institutes of Health (NIH) Clinical and Translational Science Award (CTSA) program, grant 2UL1TR001425-05A1; and the National Institutes of Arthritis and Musculoskeletal Skin Diseases under Award - Number P30AR076316. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.
• Keywords: autoimmune arthritis; Juvenile Idiopathic Arthritis (JIA); disease burden; systemic treatment; early treatment initiation; Musculoskeletal Ultrasonography (MSUS)
• Research Categories: Health Sciences, Human Development

Abstract

Objective. To develop and initially validate a comprehensive pediatric musculoskeletal ultrasound (MSUS) joint-specific scoring system. To determine the minimum number of joints needed to identify active disease. Methods. A semiquantitative scoring system was developed by consensus and initially validated by inter-rater reliability using intraclass correlation coefficients (ICC). Subsequently, newly diagnosed Juvenile Idiopathic Arthritis (JIA) patients with an active joint count >4 had a 42 joint MSUS performed at baseline and 3 months using this protocol. A minimum set of joints needed to identify all patients with synovitis on MSUS was obtained through a data reduction process. Spearman’s correlation (rs) was calculated to determine the association between MSUS findings and clinical Juvenile Arthritis Disease Activity Score-10 (cJADAS-10). Standardized response means (SMR) were used to assess change over time. Results. The final joint-specific scoring system revealed an excellent inter-rater reliability (ICC = 0.81–0.96) for all joints. Thirty patients were enrolled. Scanning 5 joints bilaterally: wrists, 2nd and 3rd MCPs, knees and ankles captured 100% of children with B-mode synovitis and had moderate correlation with cJADAS-10 at baseline (rs=0.45). Mean ultrasound scores at baseline and follow-up were 28.3 and 22.3 with SRM of 0.69 (p=0.002) for 42 joints and 36 and 27.7 with SRM of 0.76 (p=0.003) for the reduced joints, respectively. Conclusion. A limited MSUS examination called MUSICAL (Musculoskeletal UltraSound In Childhood Arthritis Limited-examination) captures all patients with active synovitis and our new joint specific scoring system is highly reliable and sensitive to change.