Preliminary definitions for the sonographic features of synovitis in children

Johannes Roth, Viviana Ravagnani, Marina Backhaus, Peter V. Balint, Alessandra Bruns, George A. Bruyn, Paz Collado, Lorenia De la Cruz, Severine Guillaume-Czitrom, Troels Herlin, Cristina Hernandez, Annamaria Iagnocco, Sandrine Jousse-Joulin, Stefano Lanni, Vibke Lilleby, Clara Malattia, Silvia Magni-Manzoni, Consuelo Modesto, Ana Narrodi, Juan Carlos NietoSarah Ohrndorf, Linda Rossi, Anne-Marit Selvaag, Nanno Swen, Tracy Ting, Nikolay Tzaribachev, Patricia Vega-Fernandez, Jelena Vojinovic, Daniel Windschall, Maria Antonietta D'Agostino, Esperanza Naredo, OMERACT Ultrasound Group

Research output: Contribution to journalArticlepeer-review


Objectives Musculoskeletal ultrasonography (US) has the potential to be an important tool in the assessment of disease activity in childhood arthritides. To assess pathology, clear definitions for synovitis need to be developed first. The aim of this study was to develop and validate these definitions through an international consensus process. Methods The decision on which US techniques to use, the components to be included in the definitions as well as the final wording were developed by 31 ultrasound experts in a consensus process. A Likert scale of 1-5 with 1 indicating complete disagreement and 5 complete agreement was used. A minimum of 80% of the experts scoring 4 or 5 was required for final approval. The definitions were then validated on 120 standardized US images of the wrist, MCP and tibiotalar joints displaying various degrees of synovitis at various ages. Results B-Mode and Doppler should be used for assessing synovitis in children. A US definition of the various components (i.e. synovial hypertrophy, effusion and Doppler signal within the synovium) was developed. The definition was validated on still images with a median of 89% (range 80-100) of participants scoring it as 4 or 5 on a Likert scale. Conclusions US definitions of synovitis and its elementary components covering the entire pediatric age range were successfully developed through a Delphi process and validated in a web-based still images exercise. These results provide the basis for the standardized US assessment of synovitis in clinical practice and research. This article is protected by copyright. All rights reserved.

Original languageEnglish
JournalArthritis Care and Research
Publication statusE-pub ahead of print - Oct 16 2016


  • Journal Article


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