J Korean Rheum Assoc.  2009 Jun;16(2):74-86. 10.4078/jkra.2009.16.2.74.

Ultrasonographic Assessment in Rheumatoid Arthritis

• Kim HR
• Yoon CH

• KMID: 2202122
• DOI: http://doi.org/10.4078/jkra.2009.16.2.74

Abstract

The administration of disease-modifying antirheumatic drugs (DMARDs) in the early period of rheumatoid arthritis (RA) is critical for protecting against joint damage and inducing remission. Physicians need to identify patients at risk of progression to RA at the early stages of arthritis. Musculoskeletal ultrasonography (MSUS) allows the direct visualization of synovitis and bone erosion in the early phase, and may be useful for differentiating early rheumatoid arthritis from other inflammatory arthritis. Power Doppler sonography is a promising tool for assessing the disease activity and monitoring the effects of DMARDs. This article reviews the current status and recent advances in MSUS imaging in RA.

Keyword

Rheumatoid arthritis; Ultrasonography; Power doppler; Synovitis; Bone erosion

MeSH Terms

Antirheumatic Agents
Arthritis
Arthritis, Rheumatoid
Humans
Joints
Synovitis
Antirheumatic Agents

Figure

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  Fig. 1. Ultrasonographic findings of joint effusion. (A) Metacarpophalangeal joint, (B) metatarsophalangeal joint, (C) suprapatellar recess of the knee and (D) anterior talotibial joint.

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  Fig. 2. Ultrasonographic findings of joint effusion can be graded according to the amount. (A) Grade 0 (no effusion), (B) grade 1 (minimal amount of fluid), (C) grade 2 (moderate amount of fluid without distension of the joint capsule), and (D) grade 3: extensive amount of fluid with distension of the joint capsule.

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  Fig. 3. Ultrasonographic findings of synovial proliferation. (A) Olecrenon fossa of the elbow, (B) lateral recess of the knee, (C) metacarpophalangeal joint, and (D) dorsal carpal joint.

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  Fig. 4. Ultrasonographic findings of bone erosion. (A) Small erosion in the talus, (B) irregular and moderate-sized erosions of the metacarpal head, (C) large and deep erosion of the metacarpal head, and (D) inflammatory pannus with increased vascularity on power Doppler ultrasound in the metatarsal joint.

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  Fig. 5. Ultrasonographic findings of tenosynovitis. (A, B) Anechoic fluid accumulation in the sheath of posterior tibial tendon (longitudinal and transverse scans). (C, D) Hyperechoic synovial proliferation in the sheath of the extensor digitorum tendons (longitudinal and transverse scans).

Reference

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