Controversies in rheumatology: ultrasound for monitoring of RA—do we need it?

Abstract

Clinical joint examination is the cornerstone for evaluation of patients with rheumatoid arthritis (RA). However, since large discrepancies have been shown even between experienced rheumatologists in evaluation of joint inflammation, and tender joints may have limited value in reflecting inflammation, ultrasound has in the last decennials been introduced in the clinical assessments of RA patients. Ultrasound has high accordance with other imaging modalities and enables detection of clinically difficult pathologies and contributes to assessments of joints difficult to evaluate clinically. However, there is no general agreement on the optimal use of ultrasound in rheumatology and the prevalence of machines as well as the level of experience is highly different across the countries. In addition, standardized use of ultrasound in treat-to-target follow-up of RA patients was found not to have any added value. Thus, how to use ultrasound in monitoring of RA patients is open for debate. The present article will discuss the pros and cons for using ultrasound in the clinical setting.

Harnessing the Potential of Exosomal miRNAs: A Breakthrough in Rheumatoid Arthritis Diagnosis and Monitoring

“…Early symptoms of RA, such as joint pain, swelling, and stiffness, often lack speci city, resembling manifestations of other disorders, posing a potential challenge in the timely diagnosis and management of RA in its initial stages. Although imaging techniques like radiography, MRI and ultrasound technology are capable of assessing joint structure and pathology, their sensitivity in detecting early RA without evident bone damage is comparatively inadequate [22][23][24][25]. The most robust blood-based assays for RA currently heavily rely on serum protein biomarkers, with ACPA and RF being pivotal components of the standard RA classi cation criteria set forth by the American College of Rheumatology and the European League Against Rheumatism [26].…”

What Bedside Skills Could the Modern Rheumatologist Possess? Part II. “Certain Technical Procedures”

“…9,10 Synovial features, without biopsy, utilizing power Doppler detecting red blood cell movement that can serve as a surrogate marker for the presence and intensity of synovitis, have been extensively studied 11 and proposed as an outcome measure for treatments of inflammatory arthropathies, although the utility of such techniques remains unsettled. 12 Media comprised tiny gas-filled microbubbles, injected intravenously before US examination, and enhanced the signal reflected by vascularized structures such as inflamed synovium. Such contrast-enhanced MSKUS examination detects synovitis with greater sensitivity and accuracy 13 but has not yet been adapted to the bedside.…”