Pediatric Rheumatology

Pediatric Rheumatology Outcomes

2021

Ultrasound is a very useful tool in detecting sign of active arthritis in pediatric patients. It is safe and can be done in clinic at the bedside to provide an immediate information to the family. It is as sensitive as MRI in identifying arthritis when performed by experts, is less expensive, and does not require sedation.

Our Cleveland Clinic department of pediatric rheumatology goal is to safely and effectively treat patient with chronic arthritis, including those with the diagnosis of juvenile idiopathic arthritis.

Over the last year our pediatric rheumatology team performed musculoskeletal ultrasound on 82 patients and a total of 102 joints were imaged (44% knee, 20% ankle, and 15% fingers).  Close to half of patients had an existing JIA diagnosis. 

Reasons to obtain MSK ultrasound included the following: equivocal physical examination (58%), need to localize pathology (31%), need to assess disease activity (35.8%) and need to follow treatment response (8.6%)

Usefulness of Musculoskeletal Ultrasound in Pediatric Rheumatology Clinic

MSK ultrasound was found to be useful as shown below:

Among patients who needed ultrasound to clarify arthritis activity, the majority of them (84%) were found to have signs of active arthritis on ultrasound.

Improved Outcome of Arthritis Care as a Result of MSK Ultrasound

As a result of implementing a bedside MSK ultrasound into our routine care, the findings from these images led to changes in management for over 60% of our patients. These changes included treatment recommendations such as: starting arthritic type medications (45%), performing steroid joint injections (18%), and adjusting arthritis medication dosages/other change in medication(s) (12%). Clinical follow up approximately 3 months after changes in management, identified that patient’s arthritis disease went from a state of active to inactive in 47% of patients and 28% of patients noted signs of improvement in their arthritis.

In summary, our ability to perform state-of-the-art musculoskeletal ultrasound examinations in our pediatric rheumatology clinics has improved our arthritis disease outcome and the quality of care given to our pediatric arthritis patients.