Ultrasound applications for the practicing rheumatologist

Musculoskeletal ultrasound is an increasingly used tool for the evaluation and management of rheumatologic diseases. Its utilisation by rheumatologists is varied around the world and is dependent upon training and local expertise. Its applications can be broadly categorised into three main areas; for the education of patients, to aid the rheumatologist in the diagnosis and monitoring of disease, and therapeutically for joint aspiration and injection.Ultrasound is a safe, portable, easily repeatable, dynamic images in multiple planes and cheap form of imaging. Ultrasound however, is operator dependent and has a number of artefacts that can result in misinterpretation. Musculoskeletal Ultrasound uses a number of modes to characterise joint pathology, including grey scale, colour and power Doppler, spectral Doppler, 3D imaging, elastography.Musculoskeletal ultrasound can detect and monitor multiple joint pathologies including synovitis, tenosynovitis, and tendon pathologies, entheseal processes, bone erosions and osteophytes, cartilage changes and bursal pathologies.

► Ultrasound is a relatively cheap, non ionsing, dynamic form of imaging that can provide both structural, functional and vascular information.
► Ultrasound is being studied across the breadth of rheumatology, including rheumatoid arthritis, spondyloarthritis, crystal diseases, osteoarthritis, vasculitis, sjogren's syndrome and soft tissue rheumatism using grey scale and Doppler ultrasound.
► Ultrasound detection of disease is now incorporated into ACR/EULAR classification criteria for rheumatoid arthritis and polymylagia rheumatica.
► The knowledge base that is required for using ultrasound has been established whilst training and supervision to learn ultrasound are improving concurrently with the increase in interest from rheumatologists for using the technology.
► Ultrasound guidance has been shown to improve accuracy and is an area of considerable interest to rheumatologists.