Ab1163 can a Musculoskeletal Ultrasound Report Change a Rheumatologist’s Opinion?

Abstract

BackgroundThe era of musculoskeletal ultrasound (MSUS) is becoming enormous, but the extent to which MSUS has influenced management plans for patients with different musculoskeletal symptomsremains questionable.ObjectivesTo assess the changes in the provisional diagnosis and treatment decisions made by rheumatologistsafter receiving MSUS reportsfor their patients.MethodsThis study has been carried out at Rheumatology & Rehabilitation outpatient clinicsin Zagazig University Hospitals in Egypt. This is anobservational study on 101 patients with musculoskeletal complaints who have been referredby rheumatologists for a MSUS scan atZagazig University MSUS Unit in the same department.The patients’ mean age was 41.5 ± 15.67, including 70 females (69.3%) and 31 males (30.7%). Patients included 29 patients with hand/wrist complaints (28.7%), 2 patients with elbow pain (2%), 36 patients with shoulder pain (35.6%), 7 patients with ankle/foot pain (6.9%), 10 patients with knee pain (9.9%), and 17 patients with polyarticular pain (16.8%). The rheumatologists were asked to set a provisional diagnosis and treatment planbefore the MSUS scan and toreconsider their own plan for any adjustments afterwards.ResultsRegarding all 101 patients, the diagnosis & treatment decisions were changed in 37%and 65% respectively after the MSUS scan as shown in figure (1). Fifty percent of the changes in treatment were classified as minor in the form of adding/changing the type of NSAIDs, adding/changing the dose of steroids, changing the dose of DMARDS and adding/modifying physiotherapy while the other 50%were major in the form of initiating/adding DMARDs, interventional treatmentor referral to surgery.Ten patients out of 29 with hand/wristcomplaints encountered change in diagnosis (34.5%), 1 patient out of 2 with elbow pain (50%) and 11 patients out of 36 with shoulder pain (30.6%). In patients with knee pain and ankle/foot pain, changes occurred with 4 patients for each representing 40% and 42.9% respectively. Regarding patients with polyarticular complaints 8 patients representing 47.1% were categorized to different disease entities.Treatment decisions were much more frequently changedas more pathological details were clarified by MSUS. Treatment decision changes occurred in 83.3% of patients with shoulder pain 70% of which were minor mainly due to better evaluation of rotator cuff syndromes grading tears and detecting bursitis. While for knee pain 50% of treatment decisions were changed of which 60% were major as in knee osteoarthritis detection of significant synovitis&Baker’s cysts lead to interventionaltreatment.Regarding patients with hand/wrist &polyarticularcomplaints, 44.8% and 68.8% of treatment decisions were changed respectively of which 75% and 90.8% were major owing mainly to changes in diagnosis &detectingsubclinical activity. Finally regarding ankle/foot pain, treatment changes happened in 71.4%of which 80% were minor.Figure 1ConclusionMSUS scanshave a great impact on rheumatologists’ decisions in clinical practice. Remarkable ch...