US-guided interventional joint procedures in patients with rheumatic diseases—When and how we do it?

Abstract

a b s t r a c tObjective: To describe the main indications and the technical steps to perform ultrasound guided procedures in patients with rheumatic diseases. To access procedures accuracy, safety and effectiveness. Materials and methods: 27 patients with pain related to articular complications of rheumatic diseases and according to previous radiographic or US exam were submitted to several US-guided procedures. 42% of patients (n = 11) had rheumatoid arthritis, 11% (n = 3) spondyloarthropathies, 18% (n = 5) psoriatic arthritis, 15% (n = 4) undifferentiated arthritis, 3% (n = 1) Sjögren syndrome and 11% (n = 3) had gout.Described procedures are synovial biopsies, intra-articular injections of corticosteroids, radiation synovectomy and synovial cysts drainage procedures. When a therapeutical procedure was made, patients were evaluated by 2 rheumatologists.Corticosteroids used were Prednisolone and Triamcinolone. Yttrium-90 was used for synovectomy. Results: In all cases success was achieved with correct needle placement inside the joint. After injection/aspiration symptoms successfully solved with all patients improving their health status. No complications were recorded during follow-up period. Conclusions: US-guidance is very reliable to afford a safety procedure always checking the injection, biopsy or aspiration. Guided-biopsy has high success rates obtaining several samples. Thus is also possible to use more powerful/long acting therapeutic drugs aggressive to extra-articular structures avoiding complications.

Success Rate and Utility of Ultrasound-guided Synovial Biopsies in Clinical Practice

“…The success rates in retrieving synovial tissue described by other authors vary from 89% to 100% (23,25,(27)(28)(29). Although, the rate of success in our cohort was slightly lower, for which there are several potential reasons.…”

American Medical Society for Sports Medicine (AMSSM) position statement: interventional musculoskeletal ultrasound in sports medicine

“…A majority of the studies (49/57 (86%))6 7 9 11–13 15 17–25 27–30 32–51 53–61 evaluated injections in a single joint, whereas 14% (8/57)5 8 10 16 26 31 52 55 assessed injections in more than one joint. Thirty-five per cent (20/57) of the studies evaluated knee injections,8–10 13 15 16 19–23 26 31 32 36 37 48 52 56 57 46% (26/57) evaluated glenohumeral (GH) joint injections,5 7 8 10 11 15–17 24–26 28 29 31 38–40 42 43 46 47 49 52 54 60 61 21% (12/57) evaluated hip injections8 12 27 30 33 35 41 44 45 50 52 59 62 and 4% (2/57) evaluated sacroiliac (SI) joint injections 18 34. Four studies (7%) assessed injections in the ‘shoulder’, but did not specify which shoulder structure or joint they were injecting 6 53 55 58…”

“…The level of evidence for a majority of the studies evaluating major joint USGI accuracy (15/23 (65%))5 8 9 15 16 18 20 21 23 27 30 32 34 36–39 41 42 44–46 49 or LMGI accuracy (28/28 (100%))5 7 9–13 17 19 21–26 28 31 32 36–38 40 43 47 48 50 60 61 were level 1 or 2. The mean accuracy of GH, hip and knee joint USGIs in studies with level 1 or 2 evidence ranged from 91% to 100%,5 8 9 15 18 21 23 32 36–39 42 46 49 whereas the mean accuracy of LMGIs were between 64% and 81% 5 7 9–13 17 19 21–26 28 31 32 36–38 40 43 47 48 50 60 61.…”

“…Twenty-three studies assessing injections into intermediate sized joints were identified (see online supplementary appendix 2) 8 16 26 31 52 63–80. Seventy-four per cent (17/23) of the studies evaluated injections into a single joint8 63–65 67–70 72–80 and 26% (6/23) assessed injections into multiple joints 16 26 31 52 66 71.…”

Imaging in gout

“…These techniques have the potential to assess various manifestations of disease (Table 1). Imaging may play a role in gout diagnosis, assessment of disease complications, guiding joint aspiration [5], monitoring of disease progression, and understanding the mechanisms of disease. This review discusses the role of imaging in assessing the manifestations of gout, with emphasis on publications in the last year.…”