The use of musculoskeletal ultrasonography (US) in the management of rheumatoid arthritis (RA) has drawn attention to paediatric rheumatologists, and this has become an important part of the clinical care of patients with juvenile idiopathic arthritis (JIA) as well. However, several points have to be addressed before drawing conclusions on the usefulness in the everyday clinical management of JIA. First, even in RA a similar viewpoint1 argued against the use of US for directing treatment decisions. In fact, many pitfalls have been highlighted by the authors, including the meaning of grey scale and/or power Doppler signal as sign of active inflammation versus past synovitis, the presence of abnormal US findings in a sizeable percentage of healthy subjects, the technical differences between different machines and the lack of standardisation. Indeed, the authors pointed out that in prospective therapeutic clinical trials with a Treat to Target (T2T) strategy following patients with US was not needed. If we go to square one, it needs to be emphasised that in a growing skeleton the imaging results can be quite different than in adults. In fact, in children physiological US findings might be misinterpreted as pathologic. Skeletal maturation has a profound effect on imaging results, since bone, cartilage and adjacent structures undergo continuous modifications with growth. Normal US appearance of paediatric joints should be the starting point for any subsequent definition of pathology, and in particular for studies in JIA. In order to standardise the use of US in paediatric rheumatology, definitions for US findings in the different parts of the normal paediatric joint have been developed and validated through Delphi process in different publications.2 3 A systematic standardised examination method was proposed, and an atlas of images of normal joint appearance at different ages has accordingly been created. Subsequently, the Outcome Measures …

中文翻译：

---

超声在幼年特发性关节炎治疗中的真正作用是什么？

肌肉骨骼超声（US）在类风湿关节炎（RA）治疗中的应用引起了儿科风湿病学家的关注，这也成为幼年特发性关节炎（JIA）患者临床护理的重要组成部分。然而，在得出 JIA 在日常临床管理中的有用性之前，必须解决几个问题。首先，即使在 RA 中，也有类似的观点 1 反对使用 US 来指导治疗决策。事实上，作者强调了许多陷阱，包括灰度和/或能量多普勒信号作为活动性炎症与既往滑膜炎的标志的意义，在相当大比例的健康受试者中存在异常的美国发现，技术差异不同机器之间以及缺乏标准化。确实，作者指出，在前瞻性治疗性临床试验中，不需要对 US 患者进行靶向治疗 (T2T) 策略。如果我们转到第一个，需要强调的是，在不断增长的骨骼中，成像结果可能与成人大不相同。事实上，在儿童中，生理性超声检查结果可能会被误解为病理性的。骨骼成熟对成像结果有深远的影响，因为骨骼、软骨和相邻结构会随着生长不断发生变化。儿科关节的正常 US 外观应该是任何后续病理学定义的起点，特别是对于 JIA 研究。为了规范超声在儿科风湿病学中的使用，不同出版物中通过德尔菲法对正常儿童关节不同部位的超声检查结果进行了定义和验证。 2 3 提出了一种系统的标准化检查方法，并据此建立了不同年龄正常关节外观图像图谱。创建。随后，结果措施……