Small Joints, Big Clues: Paediatric Rheumatology in Ultrasound.

Abstract

Juvenile Idiopathic Arthritis (JIA) represents the most common chronic rheumatic disease of childhood, encompassing a heterogeneous group of subtypes including oligoarticular, polyarticular, systemic, enthesitis-related, and psoriatic arthritis. Early, accurate assessment of inflammation can help guide treatment and improving long-term outcomes. Ultrasound has become an important tool in paediatric rheumatology, offering real-time, radiation-free visualisation of joints, tendons, and entheses with a sensitivity that often exceeds clinical examination. This talk provides a practical approach to ultrasound evaluation in children with JIA. It will outline key sonographic features associated with active diseases including synovial hypertrophy, effusion, tenosynovitis, enthesitis, and Doppler signal indicating hyperaemia while emphasising how these findings differ from adult presentations. Particular focus will be placed on recognising age-specific normal variants, including physiologically thick articular cartilage, developmental irregularities at growth plates, and the presence of low-grade Doppler vascularity that may be normal in growing joints. Scanning techniques tailored to paediatrics and important differential diagnoses such as joint infection and osteomyelitis will be discussed. By the end of the talk, attendees will be equipped with practical strategies to distinguish pathology from normal development and enhance the accuracy of their ultrasound assessment in paediatric rheumatology.