Ultrasound and its clinical use in rheumatoid arthritis: where do we stand?

Abstract

High-resolution musculoskeletal ultrasound (MSUS) has been increasingly employed in daily rheumatological practice and in clinical research. In rheumatoid arthritis (RA), MSUS can be now considered a complement to physical examination. This method evaluates synovitis through gray-scale and power Doppler and it is also able to identify bone erosions. The utilization of MSUS as a marker of RA activity has received attention in recent literature. Current data account for good correlation of MSUS with classical measures of clinical activity; in some instances, MSUS appears to perform even better. Diagnosis of subclinical synovitis by MSUS might help the physician in RA management. With some variation, interobserver MSUS agreement seems excellent for erosion and good for synovitis. However, lack of MSUS score standardization is still an unmet need. In this review, we describe several MSUS scores, as well as their correlation with clinical RA activity and response to therapy. Finally, we look at the relationship of MSUS with synovial tissue inflammation and discuss future perspectives for a better interpretation and integration of this imaging method into clinical practice.

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

“…Ultrasound offers a clear advantage in assessing subclinical synovitis, which is important for the evaluation of radiographic progression risk and for the identification of patients who can maintain remission despite dose reduction [ 1 , 41 , 42 ]. Moreover, in ERA diagnosis, US allows for early detection of the disease and should be included in future classification criteria [ 43 – 45 ].…”

“…Rheumatoid arthritis (RA) is a chronic disease that leads to joint damage through inflammation of the synovial membrane [1,2], though symptoms outside the joints may also occur in the course of RA. In the first weeks of the disease, the inflammatory process usually involves small joints of the hands and feet [3].…”

Update on the Pathomechanism, Diagnosis, and Treatment Options for Rheumatoid Arthritis

“…Both ultrasound and MRI have been recommended for diagnosing and monitoring disease activity in RA patients [130]. Ultrasound analysis (e.g., as high-resolution musculoskeletal ultrasound) of inflamed joints allows imaging of synovial proliferation by grayscale as well as both active inflammation and neoangiogenesis by power Doppler [131]. In addition, ultrasound is able to identify bone erosions [132], as well as subclinical synovitis that may result in radiographic disease progression even if the patient is in apparent clinical remission [133,134].…”

Proliferative Synovitis, an Ultrasound Pattern Associated with ACPA positive Patients, Erosive Disease and Enhanced Need to Change Therapy in Rheumatoid Arthritis

“…Ultrasound (US) is a non-invasive imaging technique playing an important role for the assessment of patients with rheumatoid arthritis (RA). The use of US is relevant along the different stages of the disease, more sensitive and reliable than physical examination and has a potential role to guide therapeutic interventions [1].…”