Interessamento entesitico in bambini e adolescenti con malattia infiammatoria cronica intestinale: uno studio ecografico

Background: joint involvement is the most common extraintestinal manifestation in paediatric IBD patients. Several studies in adult population have shown that enthesis ultrasound (US) has a high sensitivity in the diagnosis of enthesitis. Objectives: The objective is to evaluate, using a high frequency ultrasound probe, the prevalence of subclinical entheseal involvement in paediatric IBD patients. Methods: 27 paediatric IBD patients [12 Crohn's disease, 13 ulcerative colitis and 2 IBD type unclassified; 15 females and 12 males, mean age of 13,7 years (ranging 7,2-21,0 years)] without clinical signs or symptoms of musculo-skeletal involvement were consecutively investigated with US (ESAOTE MyLAB 70 6-18 MHz linear array transducer) and compared with 24 healthy controls matched for age and sex. Twelve enthesis were scored according to the Madrid Sonographic Enthesis Index (MASEI) in both groups. Results: no patients reached the MASEI score value suggestive for an early spondyloarthritis involvement but the average MASEI score was significantly higher in IBD patients compared to controls (3.15\ub12.84 vs 0.96\ub11.12, p=0.0006).There was also a significantly higher percentage of patients with at least one enthesis with power Doppler (PD) score 652 (37% vs 16%; p= 0.037) and at least one enthesis with dishomogeneous echostructure (59% vs 0%; p= 0.000). No differences were found in terms of erosions, calcifications and structural thickness. In IBD patients, no correlation was found between MASEI total score and sex, age, disease duration and clinical activity scores. Conclusions: US detectable enthesopathy is frequent even in paediatric IBD patients

Standard and pocket-size lung ultrasound devices can detect interstitial lung disease in rheumatoid arthritis patients

Objectives. Interstitial lung disease (ILD) is a frequent extra-articular manifestation of RA associated with increased mortality. High-resolution CT (HRCT) is used for diagnosis and follow-up, but its accuracy is counterbalanced by high costs and radiological risk. In the presence of ILD, lung US (LUS) detects vertical artefacts called B-lines. The aims of the present study were to evaluate the accuracy of LUS in the diagnosis of ILD in RA and to validate the use of a pocket-size US device (PS-USD) as a screening tool.Methods. LUS was performed with standard equipment by a trained physician through longitudinal scans following anatomical lines: 72 segments were considered (28 anteriorly and 44 posteriorly) and B-lines were counted in each segment. A B-lines score >10 identified a positive examination (presence of ILD). A second LUS session for positive/negative judgment was performed by a short-trained physician using a PS-USD.Results. Thirty-nine patients were studied. The sensitivity and specificity of standard LUS vs HRCT were 92% and 56%, respectively. The B-line score was significantly correlated with HRCT score (r = 0.806). A total of 29 patients were studied with a PS-USD. Sensitivity and specificity for PS-USD vs HRCT were 89% and 50%.Conclusion. The sensitivity of LUS in the detection of ILD supports its use as a screening test for ILD in RA patients, even in the ambulatory setting with a PS-USD. The strong correlation between echographic and HRCT scores indicates LUS is a valid tool for grading and follow-up of ILD