The role of ultrasonography in the diagnostic criteria for rheumatoid arthritis and monitoring its therapeutic efficacy

Abstract

Rheumatoid arthritis (RA) is a chronic systemic disease of connective tissue. It is characterized by symmetrical multiple joint involvement and extra-articular symptoms. Modern RA treatment methods place a particular emphasis on the earliest possible diagnosis and initiation of appropriate treatment. Currently, ultrasonography (US) is the key imaging test performed in RA patients. However, despite the general acknowledgement of its role in the assessment of disease activity, US was not included in the applicable ACR/EULAR criteria. This is due to the lack of strictly defined criteria for US evaluation and the interpretation of test results. In addition, the absence of a correlation between the common DAS/DAS28 disease activity score and ultrasound assessment of joints makes developing new diagnostic criteria difficult. The objective of this article is to review recent scientific reports on the use of ultrasonography in the diagnosis and monitoring of RA and to indicate current problems associated with the interpretation of test results and the comparison with applicable scores of disease activity.

The changing role of ultrasonography examination in patients with rheumatoid arthritis in light of recent studies

“…Unfortunately, in retrospect, one can see that this is a highly difficult task, as evidenced by the work done by the EULAR-OMERACT Ultrasound Task Force established in 2004 [6,7]. Despite the progress that has been made in recent years, there remains a need for further research in this area [8,9].…”

“…Over the last two decades, in addition to the evolution of therapies, there have been major advances in the knowledge of RA. One could hazard to say that the essence of the condition is synovitis [ 6 ]. As a natural consequence of such understanding of the disease, the importance of diagnostic imaging which allows for a thorough assessment of the synovial membrane and joints, inter alia, increases.…”

The rheumatoid hand in the light of fluorescence: a diagnostic technique of the future?

“…Currently, it is difficult to imagine the modern diagnostic process for rheumatoid arthritis (RA) without the evaluation of synovitis. Synovitis is considered to be the core component of RA and at the same time it has a significant influence on therapeutic decisions [1–3]. Precise evaluation of synovitis allows one to avoid unnecessary use of biologicals, which may cause adverse events such as circulatory insufficiency exacerbation or onset of neuropathy [4, 5].…”

“…Despite the lack of diagnostic imaging in the current American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) 2010 classification criteria, there is a general consensus regarding its high diagnostic utility [1]. However, before diagnostic imaging is included in new diagnostic criteria, the results of the current research need to be subjected to systematic review and appropriate interpretation with regard to the currently used disease activity scales such as the Disease Activity Score (DAS, DAS28), Clinical Disease Activity Index (CDAI) or Simplified Disease Activity Index (SDAI).…”

The importance of ultrasound examination in early arthritis

“…Our diagnostic options are expanded with imaging diagnostics, which should be used as a supplementary measure to the physical examination. Ultrasound (US) diagnostics is important, as it may supply some additional data regarding development of RA at its early stage, and activity of the disease [6, 7]. The method allows visualisation of inflammation of the synovial membrane and erosions at the very early stage of the disease (discovery of synovial membrane hypertrophy [GS] is much more common with US, compared to the clinical examination).…”