Ultrasonography and color Doppler of proximal gluteal enthesitis in juvenile idiopathic arthritis: a descriptive study

Background: The presence of enthesitis (insertional inflammation) in patients with juvenile idiopathic arthritis (JIA) is difficult to establish clinically and may influence classification and treatment of the disease. We used ultrasonography (US) and color Doppler (CD) imaging to detect enthesitis at the small and deep-seated proximal insertion of the gluteus medius fascia on the posterior iliac crest where clinical diagnosis is difficult. The findings in JIA patients were compared with those obtained in healthy controls and with the patients' MRI results. Methods: Seventy-six proximal gluteus medius insertions were studied clinically (tenderness to palpation of the posterior iliac crest) and by US and CD (echogenicity, thickness, hyperemia) in 38 patients with JIA and in 38 healthy controls, respectively (median age 13 years, range 7-18 years). In addition, an additional MRI examination of the sacroiliac joints and iliac crests was performed in all patients. Results: In patients with focal, palpable tenderness, US detected decreased echogenicity of the entheses in 53% of the iliac crests (bilateral in 37% and unilateral in 32%). US also revealed significantly thicker entheses in JIA patients compared to healthy controls (p < 0.003 left side, p < 0.001 right side). There was no significant difference in thickness between the left and right sides in individual subjects. Hyperemia was detected by CD in 37% (28/76) of the iliac crests and by contrast-enhanced MRI in 12% (6/50). Conclusions: According to US, the gluteus medius insertion was thicker in JIA patients than in controls, and it was hypoechoic (enthesitis) in about half of the patients. These findings may represent chronic, inactive disease in some of the patients, because there was only limited Doppler flow and MRI contrast enhancement. The present study indicates that US can be useful as an adjunct to clinical examination for improved assessment of enthesitis in JIA. This may influence disease classification, ambition to treat, and choice of treatment regimen

Futures of Fixing : Exploring the life of product users in circular economy repair society scenarios

A Circular Economy (CE) constitutes one pathway towards realising sustainable productionand consumption. Here, the repair of broken products (compared to replacement) consti-tutes an important strategy to keep products in the economy for longer, thereby reducingwaste, as well as the need to extract resources and emit pollution in the manufacture of areplacement product. In today’s world, repair does not necessarily constitute the naturalresponse to product breakage. However, increasing legislative efforts and grassroots move-ments are attempting to change that and make repair accessible, affordable and culturallyacceptable. The question is what such a society – where repair is normalised – would be like

Ultrasonography and color Doppler in juvenile idiopathic arthritis: diagnosis and follow-up of ultrasound-guided steroid injection in the wrist region. A descriptive interventional study

<p>Abstract</p> <p>Background</p> <p>The wrist region is one of the most complex joints of the human body. It is prone to deformity and functional impairment in juvenile idiopathic arthritis (JIA), and is difficult to examine clinically. The aim of this study was to evaluate the role of ultrasonography (US) with Doppler in diagnosis of synovitis, guidance of steroid injections, and follow-up examinations of the wrist in JIA.</p> <p>Methods</p> <p>In 11 patients (median age 12.5 years, range 2-16), 15 wrists with clinically active arthritis were assessed clinically by US and color Doppler (Logiq 9, GE, 16-4 MHz linear transducer) prior to and 1 and 4 weeks after US-guided steroid injection.</p> <p>Results</p> <p>US detected synovitis in the radio-carpal joints, the midcarpal joints, and the tendon sheaths in 87%, 53% and 33% of the wrists, respectively. Multiple compartments were involved in 67%. US-guidance allowed accurate placement of steroid in all 21 injected compartments, with a low rate of subcutaneous atrophy. Synovial hypertrophy was normalized in 86% of the wrists, hyperemia in 91%, and clinically active arthritis in 80%.</p> <p>Conclusions</p> <p>US enabled detection of synovial inflammation in compartments that are difficult to evaluate clinically and exact guidance of injections, and it was valuable for follow-up examinations. Normalization of synovitis was achieved in most cases, which supports the notion that US is an important tool in management of wrist involvement in JIA.</p

Ultrasonography and color Doppler in juvenile idiopathic arthritis: diagnosis and follow-up of ultrasound-guided steroid injection in the ankle region. A descriptive interventional study

BACKGROUND: The ankle region is frequently involved in juvenile idiopathic arthritis (JIA) but difficult to examine clinically due to its anatomical complexity. The aim of the study was to evaluate the role of ultrasonography (US) of the ankle and midfoot (ankle region) in JIA. Doppler-US detected synovial hypertrophy, effusion and hyperemia and US was used for guidance of steroid injection and to assess treatment efficacy. METHODS: Forty swollen ankles regions were studied in 30 patients (median age 6.5 years, range 1-16 years) with JIA. All patients were assessed clinically, by US (synovial hypertrophy, effusion) and by color Doppler (synovial hyperemia) before and 4 weeks after US-guided steroid injection. RESULTS: US detected 121 compartments with active disease (joints, tendon sheaths and 1 ganglion cyst). Multiple compartments were involved in 80% of the ankle regions. The talo-crural joint, posterior subtalar joint, midfoot joints and tendon sheaths were affected in 78%, 65%, 30% and 55% respectively. Fifty active tendon sheaths were detected, and multiple tendons were involved in 12 of the ankles. US-guidance allowed accurate placement of the corticosteroid in all 85 injected compartments, with a low rate of subcutaneous atrophy (4,7%). Normalization or regression of synovial hypertrophy was obtained in 89%, and normalization of synovial hyperemia in 89%. Clinical resolution of active arthritis was noted in 72% of the ankles. CONCLUSIONS: US enabled exact anatomical location of synovial inflammation in the ankle region of JIA patients. The talo-crural joint was not always involved. Disease was frequently found in compartments difficult to evaluate clinically. US enabled exact guidance of steroid injections, gave a low rate of subcutaneous atrophy and was proved valuable for follow-up examinations. Normalization or regression of synovial hypertrophy and hyperemia was achieved in most cases, which supports the notion that US is an important tool in the management of ankle involvement in JIA

Ultrasonography for Diagnosis, Intervention and Follow-up in Juvenile Idiopathic Arthritis

Early therapeutic intervention and the use of novel, highly effective treatments in juvenile idiopathic arthritis (JIA) have improved the outcome in many diseased children, but have also increased the need for more precise methods for evaluating disease activity. In this context, both ultrasonography (US) and magnetic resonance imaging (MRI) play an important role in adult rheumatology, although these methods have yet not been fully evaluated in JIA. The objective of the present research was to evaluate Doppler-US in the clinical setting of pediatric rheumatology. This was achieved by investigating the following: • Doppler-US for identification of the exact anatomical locations of inflamed structures in clinically affected ankle and wrist regions • US for guidance of steroid injections in the ankle and wrist regions • Doppler-US for follow-up of treatment efficacy after steroid injections • Doppler-US and MRI for diagnosis of deep-seated gluteal enthesitis, including a comparison of the results with those obtained in healthy age- and sex-matched controls • Doppler-US and MRI for evaluation of symptomatic joints in JIA patients, including a comparison of the results with those found in healthy age- and sex-matched controls The findings of the current studies indicate that use of Doppler-US/US in pediatric rheumatology: • enables identification of the exact anatomical location of inflammation in the ankle and wrist regions; • improves assessment of synovitis and enthesitis; • allows precise guidance of steroid injections in the ankle and wrist regions; • is valuable for repetitive monitoring of treatment efficacy; • is readily available at point of care and, in anatomically accessible areas, is complementary to MRI for investigation of disease activity and damage

Transformation and realization of the Curriculum for the Preschool 2018 : A qualitative study on preschool teachers’ adaptation of the curriculum for the youngest children

Transformering och realisering av Läroplan för förskolan 2018, syftar till att återge en trovärdig bild över hur förskollärare tolkar och tillämpar läroplanen i förskolan för de yngsta barnen. I föreliggande studie lyfter vi omständigheter som begränsar och möjliggör förskollärarens undervisningsuppdrag. Studien bygger på teoretiska utgångspunkter som Läroplansteorin och Harts samt Shiers delaktighetsstege. Vi har valt att använda oss av en kvalitativ studie genom att intervjua och observera förskollärare. Vidare identifierar resultatdelen faktorer som personaltäthet, gruppstorlek, åldersspridning på barnen och språkliga hinder som de strukturella omständigheterna som undervisningen står i relation till. Förskollärares egna erfarenheter, kommunikativa kompetens och stoff är de aspekter som påverkar undervisningens innehåll och förmedlingsform. Vidare sammanför studien dessa moment som det primära när det kommer till hur läroplanen realiseras. Vilket lärande som möjliggörs för barnen bygger på kriterier som består därmed av stoffet som väljs ut tillsammans med de behov som förskollärare bedömer att det enskilda barnet har. Barnens aktuella kunskapsnivå, det vill säga de förmågor de besitter ligger till grund för hur undervisningen organiseras och på vilken svårighetsnivå den hamnar på. Studien intresserar sig särskilt för de tillämpningar förskolläraren gör i arbetet med de yngsta barnen och hur detta står i relation till de strävansmål som omfattas i Läroplanen för förskolan 2018 (Lpfö 18 2018). Läroplanen lämnar både ett tolknings- och handlingsutrymme som begränsar eller möjliggör förskollärares uppdrag och föreliggande studie koncentreras till hur detta utrymme hanteras

Transformation and realization of the Curriculum for the Preschool 2018 : A qualitative study on preschool teachers’ adaptation of the curriculum for the youngest children

Transformering och realisering av Läroplan för förskolan 2018, syftar till att återge en trovärdig bild över hur förskollärare tolkar och tillämpar läroplanen i förskolan för de yngsta barnen. I föreliggande studie lyfter vi omständigheter som begränsar och möjliggör förskollärarens undervisningsuppdrag. Studien bygger på teoretiska utgångspunkter som Läroplansteorin och Harts samt Shiers delaktighetsstege. Vi har valt att använda oss av en kvalitativ studie genom att intervjua och observera förskollärare. Vidare identifierar resultatdelen faktorer som personaltäthet, gruppstorlek, åldersspridning på barnen och språkliga hinder som de strukturella omständigheterna som undervisningen står i relation till. Förskollärares egna erfarenheter, kommunikativa kompetens och stoff är de aspekter som påverkar undervisningens innehåll och förmedlingsform. Vidare sammanför studien dessa moment som det primära när det kommer till hur läroplanen realiseras. Vilket lärande som möjliggörs för barnen bygger på kriterier som består därmed av stoffet som väljs ut tillsammans med de behov som förskollärare bedömer att det enskilda barnet har. Barnens aktuella kunskapsnivå, det vill säga de förmågor de besitter ligger till grund för hur undervisningen organiseras och på vilken svårighetsnivå den hamnar på. Studien intresserar sig särskilt för de tillämpningar förskolläraren gör i arbetet med de yngsta barnen och hur detta står i relation till de strävansmål som omfattas i Läroplanen för förskolan 2018 (Lpfö 18 2018). Läroplanen lämnar både ett tolknings- och handlingsutrymme som begränsar eller möjliggör förskollärares uppdrag och föreliggande studie koncentreras till hur detta utrymme hanteras

Comparison of ultrasonography with Doppler and MRI for assessment of disease activity in juvenile idiopathic arthritis: a pilot study

Background: In juvenile idiopathic arthritis (JIA), the trend towards early therapeutic intervention and the development of new highly effective treatments have increased the need for sensitive and specific imaging. Numerous studies have demonstrated the important role of MRI and US in adult rheumatology. However, investigations of imaging in JIA are rare, and no previous study has been comparing MRI with Doppler ultrasonography (US) for assessment of arthritis. The aim of the present study was to compare the two imaging methods regarding their usefulness for evaluating disease activity in JIA, and to compare the results with those obtained in healthy controls. Methods: In 10 JIA patients (median age 14 years, range 11-18), 11 joints (six wrists, three knees, two ankles) with arthritis were assessed by color Doppler US and MRI. The same imaging modalities were used to evaluate eight joints (three wrists, three knees, two ankles) in six healthy age- and sex-matched controls. The US examinations of both the patients and controls were compared with the MRI findings. Results: In 10 JIA patients, US detected synovial hypertrophy in 22 areas of 11 joints, 86% of which had synovial hyperemia, and MRI revealed synovitis in 36 areas of the same 11 joints. Erosions were identified by US in two areas of two joints and by MRI in six areas of four joints. Effusion was shown by US in nine areas of six joints and by MRI in 17 areas of five joints. MRI detected juxta-articular bone marrow edema in 16 areas of eight joints. Conclusions: The results of this pilot study indicate that both MRI and US provide valuable imaging information on disease activity in JIA. Importantly, the two techniques seem to complement each other and give partly different information. Although MRI is considered to be the reference standard for advanced imaging in adult rheumatology, US seems to provide useful imaging information that could make it an option in daily clinical practice, in JIA as well as in adult rheumatology. However, the current work represents a pilot study, and thus our results need to be confirmed in a larger prospective clinical investigation