Muscuskeletal Ultrasound in Rheumatoid Arthritis
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Musculoskeletal ultrasound (MSUS) has been around for quite sometime and has turned into an established imaging technique for the diagnosis and follow up of patients with rheumatic diseases — such as rheumatoid arthritis. MSUS generates pictures/imaging of muscles, tendons, ligaments, joints and soft tissue throughout the body.
From Radiology Info, MSUS helps diagnose the following:
- tendon tears, such as tears of the rotator cuff in the shoulder or Achilles tendon in the ankle
- abnormalities of the muscles, such as tears and soft-tissue masses
- bleeding or other fluid collections within the muscles, bursae and joints
One limitation however of this imagine procedure is that it has difficulty penetrating to the bones and so can only see the outer surface of bony structures. For imaging of the internals of the bones and joints, MRI comes in.
According to UK’s National Rheumatoid Arthritis Society:
Ultrasound is relatively inexpensive and safe, avoiding the exposure to radiation that is necessary for conventional x-rays, CT and MRI scans.
Traditionally, rheumatologists have referred patients to radiologists for all ultrasound examinations but recent developments have enabled them to conduct some scans themselves. The advent of portable ultrasound machines (figure 2) means that scans can be carried out at the bedside or in the outpatient clinic without the need for a second appointment in the x-ray department.
This speeds up the process of investigation and allows the rheumatologist to plan treatment without delay. Radiologists are expert at conducting detailed scans that often assist with a structural diagnosis. Rheumatologists tend to use ultrasound in a slightly different way. They may use it to guide them in carrying out difficult joint injections.
They also use it to detect subtle inflammation around tendons and small knuckle joints. This is important because clinical examination may not always identify inflammation, particularly in early arthritis. The earlier the diagnosis of rheumatoid arthritis, the better the chance of dampening down inflammation and preventing joint damage.
Well I guess it is always better to see a rheumatologist for this procedure…though the combined ‘reading’ or interpretation of both rheumatologist and radiologist alike would be a lot of help. Has anybody reading this underwent MSUS, let us know about it. Was the procedure helpful in the diagnosis?
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thanks a lot for the info. they’re much appreciated.
As a Rheumatologist I have been using Ultrasound as a diagnostic and therapeutic (for guided injections so I can actually see where I’m putting the needle) purposes for 6 years. Ultrasound exams for patients with Rheumatoid arthritis can be very helpful in making the diagnosis certain, following the effectiveness or lack of effectiveness of therapy and guiding new therapy. The procedure is painless, takes about 30 minutes and when combined with other clinical, laboratory and imaging data, Ultrasound can be helpful in staging where /how the RA is being managed. The procedure is 1/10th the cost of a typical MRI. Since so few Rheumatologists do this at the present time I have been seeing their patients and sending them a report after so they can combine the Ultrasound information into a complete picture for the patient.
Patients enjoy the procedure since they see firsthand the source of the problem in their joints, ie the synovial tissue. Inflammation is shown by use of the power doppler setting on the Ultrasound machine. If inflammation is present then the small blood vessels will light up red on the scan indicating the need for more or different treatment. Also damage to the bones called erosions can be seen. Repeat scans done months after instituting therapy can be used to judge any change in size or nuimber of erosions as a measure of effectiveness.
Taken as a whole the use of ultrasound in managing patients with Rheumatoid Arthritis can provide a new and informative part of the picture that both the patient and the Rheumatologist can use to improve the outcome of treatment for this chronic, painful and often debilitating disease.
Mrs. Mordecai: thanks for sharing your experience. one more question: is the procedure expensive?
I had one a few weeks ago! I didn’t think it was anything earth-shattering, especially since it seemed to give less info than the MRI I had just had a few weeks earlier, but it was kind of gratifying to see the technologist exclaiming over the amount of fluid in my knee. It’s also nice that it’s safer, and you don’t have to hold still for so long. But on the downside, it tickles!