A Novel Ultrasound Score to Improve the Assessment of Joint Inflammation in Children with Chronic Musculoskeletal Pain

PROJECT SUMMARY/ABSTRACT Candidate: Patricia Vega-Fernandez, MD MSc RhMSUS is a pediatric rheumatologist whose overarching career goal is to improve the outcomes of children affected by autoimmune rheumatologic diseases through a career as an independent translational scientist focused on biology-based imaging and clinical research to support the development of personalized treatment approaches. Dr. Vega-Fernandez, an Associate Professor of Pediatrics at Cincinnati Children’s Hospital Medical Center (CCHMC), has conducted multiple studies focused on addressing the feasibility, reliability and validity of musculoskeletal ultrasound (MSUS) in Juvenile Idiopathic Arthritis (JIA). The proposed R03 project builds on the skills and knowledge gained by Dr. Vega-Fernandez through the KL2 award. Moreover, this R03 will provide her the research and professional skills needed to conduct fundamental research, secure funding, and advance her career as an independent investigator. Mentors/Environment: Dr. Vega-Fernandez and her mentors, Hermine Brunner MD MSc MBA, Tracy V Ting MD MSc RhMSUS, Mekibib Altaye PhD, and Arthur Meyers MD, have assembled a strong team of advisors from CCHMC. The candidate will leverage several of the Center for Clinical & Translational Science and Training (CCTST) cores at the University of Cincinnati to support the proposed research activities. Research: Chronic musculoskeletal pain (CMSKP) is a common problem in childhood. Children with CMSKP are at increased risk for mood disorders, school absences, social isolation, and poor health-related quality of life. Frequently associated with CMSKP are childhood conditions such as juvenile fibromyalgia (JFM) and JIA. While both conditions frequently present with similar symptoms such as joint pain and swelling, there are important differences in the pathophysiology of these diseases: JIA is an autoimmune condition characterized by joint inflammation, while JFM is a non-inflammatory disorder where neurobiologic disruptions results in chronic pain and transient soft tissue and joint swelling. Diagnosis of arthritis in children is based on the presence of joint swelling and limited range of motion and/or tenderness on palpation. Clinical assessment of active arthritis in children is subjective and has low inter-rater reliability. MSUS can objectively inform the presence of joint inflammation. There is a knowledge gap on the clinical significance of MSUS findings in children with CMSKP. The central hypothesis is that the MSUS of ten joints (MSUS-10) score will serve as a diagnostic imaging tool to differentiate inflammatory from non-inflammatory components of joint pain in pediatric CMSKP with focus on JIA and JFM. This hypothesis will be tested with two specific aims: 1) Determine the accuracy of MSUS-10 in identifying the presence of joint inflammation in children with JFM and JIA in the setting of CMSKP; 2) Establish the clinical impact of the MSUS-10 on immediate diagnosis and treatment strategies in JIA children with CMSKP. Expected outcomes are significant in establishing MSUS as an accurate diagnostic imaging tool that complements medical decision-making processes regarding treatment plans in children experiencing CMSKP.