More doctors use ultrasound to diagnose, manage rheumatic diseases

October 29, 2012

More rheumatologists are embracing musculoskeletal ultrasound (MSUS) to diagnose and manage rheumatic diseases. In response, the American College of Rheumatology (ACR) assembled a task force to investigate and determine best practices for use of MSUS in rheumatology practice. The resulting scenario-based recommendations, which aim to help clinicians understand when it is reasonable to integrate MSUS into their rheumatology practices, now appear online in Arthritis Care & Research.

In Europe, more than 100 million individuals are affected by , according to the European League Against Rheumatism (EULAR). The ACR estimates that nearly 50 million Americans are burdened by and more than 7 million individuals suffer from inflammatory rheumatic diseases such as systemic lupus erythematosus, rheumatoid arthritis and gout.

"With so many people affected by rheumatic diseases, including arthritis, a diagnostic tool such as MSUS that is minimally invasive and with little risk to patients is an important tool for rheumatologists," explains lead researcher Dr. Tim McAlindon from Tufts Medical Center in Boston, Mass. "Our task force goal was to establish when use of MSUS was 'reasonable' in a number of medical situations."

The task force reviewed medical literature to come up with scenario-based recommendations for how MSUS could be used in rheumatology practice. These recommendations include a rating by type of evidence, with Level A supported by at least two randomized clinical trials or one or more meta-analyses of randomized trials; Level B backed by one randomized trial, non-randomized studies or meta-analyses of non-randomized studies; and Level C confirmed by consensus expert opinion, case studies, or standard clinical care.

The complete list of 14 recommendations of the reasonable use of MSUS in rheumatology, along with level of evidence, is published in the article. Partial list of recommendations includes:

  • For a patient with articular pain, swelling or mechanical symptoms, without on clinical exam, it is reasonable to use MSUS to further elucidate the diagnosis at the following joints: glenohumeral, acromioclavicular, sternoclavicular, elbow, wrist, metacarpophalangeal, interphalangeal, hip, knee, ankle, midfoot and metatarsophalangeal. Level of evidence: B.
  • For a patient with diagnosed inflammatory arthritis and new or ongoing symptoms without definitive diagnosis on clinical exam, it is reasonable to use MSUS to evaluate for inflammatory disease activity, structural damage or emergence of an alternate cause at the following sites: glenohumeral, acromioclavicular, elbow, wrist, metacarpophalangeal, interphalangeal, hip, knee, ankle, midfoot and metatarsophalangeal, and entheseal. Level B.
  • For a patient with shoulder pain or mechanical symptoms, without definitive diagnosis on clinical exam, it is reasonable to use MSUS to evaluate underlying structural disorders; but not for adhesive capsulitis or as preparation for surgical intervention. Level B.
  • It is reasonable to use MSUS to evaluate the parotid and submandibular glands in a patient being evaluated for Sjögren's disease to determine whether they have typical changes as further evidence of the disorder. Level B.
  • For a patient with symptoms in the region of a joint whose evaluation is obfuscated by adipose or other local derangements of soft tissue, it is reasonable to use MSUS to facilitate clinical assessment at the glenohumeral, acromioclavicular, elbow, wrist, hand, metacarpophalangeal, interphalangeal, hip, knee, ankle/foot, and metatarsophalangeal joints. Level C.
  • For a patient with regional neuropathic pain without definitive diagnosis on clinical exam, it is reasonable to use MSUS to diagnose entrapment of the median nerve at the carpal tunnel; ulnar nerve at the cubital tunnel; and posterior tibial nerve at the tarsal tunnel. Level B.
  • It is reasonable to use MSUS to guide articular and peri-articular aspiration or injection at sites that include the synovial, tenosynovial, bursal, peritendinous and perientheseal areas. Level A.

The benefits of MSUS use include a faster, more accurate diagnosis, better measurement of treatment success, reduced procedural pain, and improved patient satisfaction. However, the authors highlight that economic impact was not part of this study. Dr. McAlindon concludes, "Further study of the cost-effectiveness and long-term outcomes of MSUS is necessary to determine its value compared to other interventions."

Explore further: ACR endorses standardized measures to determine rheumatoid arthritis disease activity

More information: Arthritis Care and Research, October 29, 2012. DOI: 10.1002/acr.21836

Related Stories

ACR endorses standardized measures to determine rheumatoid arthritis disease activity

April 2, 2012
A working group convened by the American College of Rheumatology (ACR) has evaluated more than 60 disease activity measures for rheumatoid arthritis (RA). The group narrowed the number of RA disease activity measures and ...

American College of Rheumatology releases first classification criteria for polymyalagia rheumatica

March 2, 2012
The American College of Rheumatology has released the first classification criteria for polymyalgia rheumatica – aimed at helping physicians identify patients with this condition, which occurs in persons aged 50 years ...

Rheumatologists update assessments for adult pain

November 16, 2011
Assessment of patient outcomes allows physicians and researchers to measure the success or failure of diagnostics and treatments that patients receive. One set of measurement tools focuses on assessing adult pain and is included ...

Doctors and rheumatoid arthritis patients differ on perception of disease activity

July 18, 2012
Researchers from Austria have determined that patients with rheumatoid arthritis (RA) and their doctors differ on perception of RA disease activity. The study now available in Arthritis & Rheumatism, a journal of the American ...

More African-Americans burdened by osteoarthritis in multiple large joints

October 21, 2011
New research suggests African Americans have a higher burden of multiple, large-joint osteoarthritis (OA), and may not be recognized based on the current definition of "generalized OA." African Americans were also more likely ...

Recommended for you

Faulty gene linked to obesity in adults

August 18, 2017
Groundbreaking new research linking obesity and metabolic dysfunction to a problem in the energy generators in cells has been published by researchers from the Harry Perkins Institute of Medical Research and The University ...

Two lung diseases killed 3.6 million in 2015: study

August 17, 2017
The two most common chronic lung diseases claimed 3.6 million lives worldwide in 2015, according to a tally published Thursday in The Lancet Respiratory Medicine.

New test differentiates between Lyme disease, similar illness

August 16, 2017
Lyme disease is the most commonly reported vector-borne illness in the United States. But it can be confused with similar conditions, including Southern Tick-Associated Rash Illness. A team of researchers led by Colorado ...

Addressing superbug resistance with phage therapy

August 16, 2017
International research involving a Monash biologist shows that bacteriophage therapy – a process whereby bacterial viruses attack and destroy specific strains of bacteria - can be used successfully to treat systemic, multidrug ...

Can previous exposure to west Nile alter the course of Zika?

August 15, 2017
West Nile virus is no stranger to the U.S.-Mexico border; thousands of people in the region have contracted the mosquito-borne virus in the past. But could this previous exposure affect how intensely Zika sickens someone ...

Compounds in desert creosote bush could treat giardia and 'brain-eating' amoeba infections

August 15, 2017
Researchers at Skaggs School of Pharmacy and Pharmaceutical Sciences at University of California San Diego and the University of Colorado Anschutz Medical Campus have found that compounds produced by the creosote bush, a ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.