Abstract
Modern ultrasonography enables clinicians to sensitively assess the progression of inflammatory joint and tendon disease, and to investigate vasculitides, connective tissue diseases and nerve lesions. Despite the advantages of musculoskeletal ultrasonography for diagnostic, prognostic and monitoring purposes, fewer than 10% of European rheumatologists use this technique in routine clinical practice. The reliability and limitations of rheumatic ultrasonography remain a concern, although good interobserver and intraobserver agreement in results from ultrasonography have been demonstrated among experienced sonographers. International recommendations for assessments and ultrasonography training courses are available, and will improve the standardization of the use of these techniques. In clinical practice, ultrasonography can complement the diagnostic evaluation of patients with rheumatic disease and might have value in confirming and extending clinical findings. Musculoskeletal ultrasonography can also be a valuable follow-up tool to monitor disease activity and support treatment decisions for specific patients. Furthermore, ultrasonography-guided articular injections provide better precision and a higher success rate for synovial fluid aspiration than clinically-guided injections. In the future, three-dimensional ultrasonography techniques, the fusion of ultrasonography and other imaging methods, and real time sonoelastography will be interesting new fields of investigation.
Key Points
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The advantages of ultrasonography include its safe and non-invasive nature, the lack of contraindications, and the relatively low costs compared with other imaging tools such as MRI
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The interobserver reliability of musculoskeletal ultrasonography is good overall, but varies depending on the disease, the disease manifestation, and the region examined
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Characteristic ultrasonographic findings can support the diagnostic evaluation of patients with suspected inflammatory rheumatic diseases
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Follow-up ultrasonographic examinations are helpful to monitor the course of inflammation; active inflammation as determined by ultrasonography—even in the absence of clinical symptoms—is associated with worse prognosis in rheumatoid arthritis
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Ultrasound-guided joint and soft tissue injections are more precise than those guided by palpation
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Ultrasonography is not suited to evaluation of certain anatomic sites or intraosseal changes, is operator-dependant, and recommendations regarding the anatomic sites for, and frequency of, follow-up ultrasonographic investigations are lacking
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M. Schirmer is supported by a project grant from the Austrian Society of Rheumatology and Rehabilitation.
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Supplementary Table 1
Selected indications and diagnostic value of ultrasonography in the management of rheumatic diseases. (DOC 72 kb)
Supplementary Table 2
Indications and evidence for ultrasonography as a tool to guide injections, aspiration and biopsy. (DOC 92 kb)
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Schirmer, M., Duftner, C., Schmidt, W. et al. Ultrasonography in inflammatory rheumatic disease: an overview. Nat Rev Rheumatol 7, 479–488 (2011). https://doi.org/10.1038/nrrheum.2011.95
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DOI: https://doi.org/10.1038/nrrheum.2011.95
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