{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,6]],"date-time":"2025-11-06T12:29:22Z","timestamp":1762432162112,"version":"build-2065373602"},"reference-count":17,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2022,4,3]],"date-time":"2022-04-03T00:00:00Z","timestamp":1648944000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background: The role of musculoskeletal ultrasound in JIA is still controversial, although there is growing evidence on its utility, especially in the diagnosis of tenosynovitis. Methods: We presented a retrospective cross-sectional study of a group of patients with JIA with ankle swelling followed in a Pediatric Rheumatology Service of a tertiary-level pediatric hospital in Northern Italy during the follow-up period between January 1st 2003 and December 31st 2019. Preliminary results have been presented at the EULAR Congress 2021. We enrolled only patients who underwent msk-US, and we identified those with a clinical and sonographic diagnosis of tenosynovitis. For each patient, we collected data on demographics, clinical characteristics, and therapeutic strategies during the follow-up. Results: On December 31st 2019, 56 swollen ankles of 48 patients were assessed with msk-US. Twenty-two ankles showed sonographic signs of joint synovitis, sixteen ankles presented signs of both joint synovitis and tenosynovitis, and fourteen ankles presented sonographic signs of tenosynovitis only. Overall, tenosynovitis was detected on 27 (56%) out of 48 children with at least a swollen ankle. In 13 patients out of 27 with tenosynovitis (48%), there was no joint synovitis of ankle or foot. Twenty-five patients with tenosynovitis (92%) achieved clinical and radiological remission: seven patients achieved remission of tenosynovitis with methotrexate only, and fifteen patients with biological drugs alone or in combination therapy. Conclusions: We observed that more than half of the patients with ankle swelling presented a tenosynovitis, and about 50% of them did not show sonographic signs of an active joint synovitis. Among patients with tenosynovitis, biological therapy alone or in association with DMARDs showed effectiveness in inducing disease remission.<\/jats:p>","DOI":"10.3390\/children9040509","type":"journal-article","created":{"date-parts":[[2022,4,3]],"date-time":"2022-04-03T06:04:01Z","timestamp":1648965841000},"page":"509","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Ultrasonographic Assessment for Tenosynovitis in Juvenile Idiopathic Arthritis with Ankle Involvement: Diagnostic and Therapeutic Significance"],"prefix":"10.3390","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4240-9624","authenticated-orcid":false,"given":"Sara","family":"Della Paolera","sequence":"first","affiliation":[{"name":"Institute of Maternal and Child Health IRCCS \u201cBurlo Garofolo\u201d, Via dell\u2019Istria <i>n<\/i>\u00b0 65\/1, 34137 Trieste, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Serena","family":"Pastore","sequence":"additional","affiliation":[{"name":"Institute of Maternal and Child Health IRCCS \u201cBurlo Garofolo\u201d, Via dell\u2019Istria <i>n<\/i>\u00b0 65\/1, 34137 Trieste, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0573-464X","authenticated-orcid":false,"given":"Alen","family":"Zabotti","sequence":"additional","affiliation":[{"name":"Department of Medical and Biological Sciences, Rheumatology Clinic, University of Udine, Piazzale Santa Maria della Misericordia <i>n<\/i>\u00b015, 33100 Udine, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6943-7927","authenticated-orcid":false,"given":"Alberto","family":"Tommasini","sequence":"additional","affiliation":[{"name":"Institute of Maternal and Child Health IRCCS \u201cBurlo Garofolo\u201d, Via dell\u2019Istria <i>n<\/i>\u00b0 65\/1, 34137 Trieste, Italy"},{"name":"Department of Medicine, Surgery and Science Health, University of Trieste, Piazzale Europa <i>n<\/i>\u00b01, 34127 Trieste, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6817-4953","authenticated-orcid":false,"given":"Andrea","family":"Taddio","sequence":"additional","affiliation":[{"name":"Institute of Maternal and Child Health IRCCS \u201cBurlo Garofolo\u201d, Via dell\u2019Istria <i>n<\/i>\u00b0 65\/1, 34137 Trieste, Italy"},{"name":"Department of Medicine, Surgery and Science Health, University of Trieste, Piazzale Europa <i>n<\/i>\u00b01, 34127 Trieste, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,4,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1186\/s12969-017-0155-3","article-title":"Ultrasound-guided steroid tendon sheath injections in juvenile idiopathic arthritis: A 10-year single-center retrospective study","volume":"15","author":"Peters","year":"2017","journal-title":"Pediatric Rheumatol. Online J."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1346","DOI":"10.1002\/acr.22846","article-title":"Delineating the Application of Ultrasound in Detecting Synovial Abnormalities of the Subtalar Joint in Juvenile Idiopathic Arthritis","volume":"68","author":"Lanni","year":"2016","journal-title":"Arthritis Care Res."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"437","DOI":"10.1136\/annrheumdis-2019-216358","article-title":"What is the real role of ultrasound in the management of juvenile idiopathic arthritis?","volume":"79","author":"Cimaz","year":"2020","journal-title":"Ann. Rheum. Dis."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1180","DOI":"10.1002\/acr.24241","article-title":"Comparison Between Clinical and Ultrasound Assessment of the Ankle Region in Children With Juvenile Idiopathic Arthritis","volume":"73","author":"Lanni","year":"2021","journal-title":"Arthritis Care Res."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1186\/1546-0096-9-4","article-title":"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","volume":"9","author":"Laurell","year":"2011","journal-title":"Pediatric Rheumatol. Online J."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"948.3","DOI":"10.1136\/annrheumdis-2021-eular.4272","article-title":"ANKLE ARTHRITIS IN JUVENILE IDIOPATHIC ARTHRITIS: DON\u2019T MISS TENOSYNOVITIS. CLINICAL AND SONOGRAPHIC FEATURES OF ANKLE TENOSYNOVITIS IN JIA","volume":"80","author":"Pastore","year":"2021","journal-title":"Ann. Rheum. Dis."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1966","DOI":"10.1002\/art.41879","article-title":"Definition and Validation of the American College of Rheumatology 2021 Juvenile Arthritis Disease Activity Score Cutoffs for Disease Activity States in Juvenile Idiopathic Arthritis","volume":"73","author":"Trincianti","year":"2021","journal-title":"Arthritis Rheumatol."},{"key":"ref_8","first-page":"2485","article-title":"Musculoskeletal ultrasound including definitions for ultrasonographic pathology","volume":"32","author":"Wakefield","year":"2005","journal-title":"J. Rheumatol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"641","DOI":"10.1136\/ard.60.7.641","article-title":"Guidelines for musculoskeletal ultrasound in rheumatology","volume":"60","author":"Backhaus","year":"2001","journal-title":"Ann. Rheum. Dis."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1328","DOI":"10.1136\/annrheumdis-2012-202092","article-title":"Reliability of a consensus-based ultrasound score for tenosynovitis in rheumatoid arthritis","volume":"72","author":"Naredo","year":"2013","journal-title":"Ann. Rheum. Dis."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"441","DOI":"10.1002\/acr.20655","article-title":"Frequent discordance between clinical and musculoskeletal ultrasound examinations of foot disease in juvenile idiopathic arthritis","volume":"64","author":"Hendry","year":"2012","journal-title":"Arthritis Care Res."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2409","DOI":"10.3899\/jrheum.091262","article-title":"Prospective evaluation of clinical and ultrasound findings in ankle disease in juvenile idiopathic arthritis: Importance of ankle ultrasound","volume":"37","author":"Pascoli","year":"2010","journal-title":"J. Rheumatol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1186\/s12969-016-0096-2","article-title":"Ultrasound in juvenile idiopathic arthritis","volume":"14","year":"2016","journal-title":"Pediatric Rheumatol. Online J."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1038\/nrrheum.2012.30","article-title":"Advances and challenges in imaging in juvenile idiopathic arthritis","volume":"8","author":"Malattia","year":"2012","journal-title":"Nat. Rev. Rheumatol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"666","DOI":"10.1136\/annrheumdis-2016-209840","article-title":"Intramuscular versus ultrasound-guided intratenosynovial glucocorticoid injection for tenosynovitis in patients with rheumatoid arthritis: A randomised, double-blind, controlled study","volume":"76","author":"Fana","year":"2017","journal-title":"Ann. Rheum. Dis."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1299","DOI":"10.1093\/rheumatology\/kes027","article-title":"CS injection of tenosynovitis in patients with chronic inflammatory arthritis: The role of US","volume":"51","author":"Filippucci","year":"2012","journal-title":"Rheumatology"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"108396","DOI":"10.1016\/j.clim.2020.108396","article-title":"Psoriatic arthritis in childhood: A commentary on the controversy","volume":"214","author":"Stoll","year":"2020","journal-title":"Clin. Immunol."}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/9\/4\/509\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T22:49:25Z","timestamp":1760136565000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/9\/4\/509"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,4,3]]},"references-count":17,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2022,4]]}},"alternative-id":["children9040509"],"URL":"https:\/\/doi.org\/10.3390\/children9040509","relation":{},"ISSN":["2227-9067"],"issn-type":[{"type":"electronic","value":"2227-9067"}],"subject":[],"published":{"date-parts":[[2022,4,3]]}}}