Ultrasound in Rheumatology: two decades of rapid development and evolving implementation

Esperanza Naredo
2015 Medical ultrasonography  
Over the last two decades, an increasing number of rheumatologists have progressively incorporated musculoskeletal ultrasound (MSUS) as a valuable diagnostic and monitoring tool in their clinical practice and research [1, 2] . This imaging modality has become an established aid incorporated into the clinical management for evaluating the periarticular and the intra-articular structures involved in rheumatic and musculoskeletal disorders. MSUS is routinely available, multiplanar, dynamic,
more » ... sive, relatively inexpensive, and patient-friendly. Above all, for rheumatologists, MSUS facilitates the scanning of all peripheral joints as many times as required at the time of consultation. It also, allows an immediate correlation between imaging findings and clinical data which improves the management of patients with a wide range of rheumatic diseases from chronic inflammatory arthritis, microcrystalline arthropathies, osteoarthritis, or vasculitis to soft tissue syndromes. In addition, ultrasound is a bedside tool for performing accurate and safe musculoskeletal injections and biopsies [3, 4] . In rheumatoid arthritis and other inflammatory arthritis, we have come from roughly detecting joint effusions and Baker´s cysts, then finely scoring synovitis and subradiographic structural damage [5,6] to a challenging ultrasound-targeted treatment [7] . MSUS B-mode and particularly Doppler mode have demonstrated a consistent and relevant role in optimizing the diagnosis, assessment of the inflammatory activity, monitoring of the therapy response, and prediction of the outcomes in rheumatoid arthritis and spondylarthritis [8] . MSUS is now also being used in pediatric rheumatologic diseases where its capabilities and advantages can be even greater than in adults [9] . Also MSUS is expanding its applications to new anatomic regions of importance in rheumatologic practice that are readily accessible to US evaluation such as large vessels, salivary glands, ligaments, and peripheral nerves. In recent years, we have witnessed the first timid attempts to incorporate MSUS findings in rheumatologic disease classification or diagnostic criteria such as rheumatoid arthritis, polymyalgia rheumatica, gout, calcium pyrophosphate deposition disease and Sjögren syndrome [10] [11] [12] [13] [14] . Codreanu et al [15] described the rationale and the long process which was required to include MSUS in the classification criteria of polymyalgia rheumatic and gout in an elegant article published in this journal. Furthermore, Scientific Rheumatology societies such as the European League Against Rheumatism (EULAR) and the American College of Rheumatology (ACR) have produced evidence and expert opinion-based recommendations on the use of MSUS in the clinical management of rheumatoid arthritis [8, 16] In the first decade of the 21st century, the above described increasing utility of MSUS in rheumatology has lead to a great demand for appropriate education in this technique among rheumatologists worldwide. As MSUS is the most operator-dependent imaging modality, mainly because of the intrinsic real time nature of image acquisition, appropriate training is highly important to ensure skilled and safe use of this technique by rheumatologists. A thorough knowledge of sectional anatomy, US physics and technology, joint scanning method, pattern of normal and pathological MS tissues, artifacts, and definitions and diagnostic criteria for abnormalities are all necessary to perform MSUS correctly. Many countries have promoted MSUS education among rheumatologists. Scientific soci-
doi:10.11152/mu.2013.2066.171.ezn pmid:25745649 fatcat:zvpnspbynzb2ji5timyrw2vqjm