The use of musculoskeletal ultrasound in a Rheumatology Outpatient Clinic

Iagnocco, Annamaria; Ceccarelli, Fulvia; Perricone, Carlo; Gattamelata, Angelica; Finucci, Annacarla; Ricci, Eleonora; Scirocco, Chiara; Rutigliano, Iolanda Maria; Iorgoveanu, Vasilia; Cravotto, E; Valesini, Guido

doi:10.11152/mu.201.3.2066.164.fcc2

Cited by 5 publications

(1 citation statement)

References 8 publications

(7 reference statements)

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“…In recent years, musculoskeletal US has frequently been used for early diagnosis of RA, assessment of disease activity and treatment response, and prediction of prognosis [20][21][22]. The goal of US use is to accurately determine disease activity and thus provide tight control of RA [23].…”

Section: Discussionmentioning

confidence: 99%

Assessment of disease activity with simplified joint ultrasonography method in rheumatoid arthritis patients

2022

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Background/Aim: Ultrasound (US) is a highly useful tool for assessing the disease activity of rheumatoid arthritis (RA). On the other hand, examining all joints could be time-consuming and unfeasible. Defining the number of joints and which joints should be tested is essential to accurately measuring RA activity. Several simplified US methods are undergoing development for this purpose. The aim of this study was to assess the correlation between simplified 12-joint US findings and physical examination findings/disease activity in RA patients. Methods: This cohort study included 62 RA patients who had been undergoing treatment for at least three months. Multiplanar grayscale images and power Doppler (PD) of the 12 joints (bilateral elbow, wrist, second and third metacarpophalangeal [MCP] joints, knee, and ankle) were acquired and compared with clinical assessments. Disease activity was assessed using the clinical disease activity and simplified disease activity indices and disease activity score-28 (CDAI, SDAI, and DAS28, respectively). Synovial effusion, synovial proliferation, and PD US scores were calculated for 12 joints. Correlations between US scores and disease activity, clinical examination, and acute phase reactants were assessed. Results: The number of joints with PD activity and US total and US synovial proliferation scores showed weak correlations with clinical activity scores (r = 0.25, r = 0.26, and r = 0.28 for SDAI and r = 0.23, r = 0.26, and r = 0.28 for DAS28, respectively). The CDAI did not present any statistically significant correlations. The agreement between US findings and clinical joint examination was generally weak. PD activities of the second MCP joints (r = 0.84, P < 0.01) and knees (r = 0.42, P < 0.01) mostly correlated with clinical examination although it was weakly correlated at the third MCP (r = 0.152) and wrist (r = 0.148), and not correlated at the elbow (r = 0.125). Conclusion: The weak correlation between US findings and clinical examination/disease activity suggests that clinical examination alone may not be sufficient to determine joint inflammation and disease activity. US could provide a more accurate assessment of RA patients and aid in medication selection.

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Section: Discussionmentioning

confidence: 99%

Assessment of disease activity with simplified joint ultrasonography method in rheumatoid arthritis patients

2022

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Clinical usefulness and patient satisfaction with a musculoskeletal ultrasound clinic: results of a 6-month pilot service in a Rheumatology Unit

et al. 2016

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There is no agreement among the rheumatology community in how to implement the musculoskeletal ultrasound (MSUS) technique in the Rheumatology Divisions. To test the perceived usefulness of the MSUS, under consensus indications, for referring colleagues for the clinical management of their patients with inflammatory arthritis (IA) and to score the satisfaction level of the patients with different aspects of the ultrasound (US) examination, after attend to the MSUS clinic. A written questionnaire-based survey regarding the usefulness and satisfaction with the implementation of a pilot MSUS clinic in a Rheumatology Unit. Over a 6-month period, 43 patients attended 10 MSUS clinics. Referral agreed indications were: US assisting in early/subclinical diagnosis (35 %), decision making with patient treatment (44 %), monitoring of disease activity/treatment response (39 %) and US-guided injection (11 %). Average scores of the referrers regarding usefulness of the information provided for the US for these indications were 8.0, 8.3, 8.7 and 8.6, respectively, with a high score of 9.0 regarding the valuable support of the US for the management of their patients with IA. Patient satisfaction scores in responders (44 %) were averaged 9.5 and higher for receiving an adequate explanation of the US procedure, indications, US findings and their significance, lack of discomfort and length of the appointment. The average score was slightly lower (8.5) for the waiting time frame for the appointment for the MSUS examination. The referrers expressed a perception of usefulness of our pilot US clinic, under previous consensus indications, for the clinical management of their patients with IA. In addition, this MSUS clinic seemed to show a good acceptability and a high satisfaction scores for the patients.

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Ultrasound of knee osteoarthritis: interobserver agreement and correlation with Western Ontario and McMaster Universities Osteoarthritis

Razek

El-Basyouni

2015

Clin Rheumatol

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The aim of this work was to assess the reproducibility of ultrasound findings of knee osteoarthritis and to correlate ultrasound findings with Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Prospective study was conducted upon 80 patients (56 F, 24 M; mean age 57 years) with primary osteoarthritis of knee joint. All patients underwent clinical assessment with calculation of WOMAC and high-resolution ultrasound of the knee joint. The ultrasound images were analyzed for cartilage thinning, osteophytes, synovial effusion, synovial proliferation, popliteal cyst, and meniscal protrusion. Image analysis was performed by two readers and linear regression analysis was used to determine association of ultrasound findings with WOMAC. There was excellent inter-observer agreement of both readers for cartilage thinning (k = 0.99, P = 0.001), osteophytes (k = 0.94, P = 0.001), synovial effusion (k = 0.98, P = 0.001), synovial thickening (k = 0.96, P = 0.001), popliteal cyst (k = 1.00, P = 0.001), and meniscal protrusion (k = 0.86, P = 0.001). There was significant association of WOMAC with cartilage changes (t = 3.406, 3.302, P = 0.001), osteophytes (t = 3.841, 3.006, P = 0.001), and synovial effusion (t = 4.140 and 2.787, P = 0.05) of both readers. We concluded that ultrasound is a reproducible method for assessment of knee osteoarthritis and well correlated with WOMAC.

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The use of musculoskeletal ultrasound in a Rheumatology Outpatient Clinic

Cited by 5 publications

References 8 publications

Assessment of disease activity with simplified joint ultrasonography method in rheumatoid arthritis patients

Assessment of disease activity with simplified joint ultrasonography method in rheumatoid arthritis patients

Clinical usefulness and patient satisfaction with a musculoskeletal ultrasound clinic: results of a 6-month pilot service in a Rheumatology Unit

Ultrasound of knee osteoarthritis: interobserver agreement and correlation with Western Ontario and McMaster Universities Osteoarthritis

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