J Rheum Dis.  2016 Feb;23(1):11-18. 10.4078/jrd.2016.23.1.11.

Recent Trends of Ultrasound in Rheumatology

• Kang T
• Wakefield
• Emery P

• KMID: 2222795
• DOI: http://doi.org/10.4078/jrd.2016.23.1.11

Abstract

Owing to the ability of musculoskeletal ultrasound (US) to depict cross sectional images of synovial joint and related structures, US has become the most reliable tool for evaluation of arthritic activity of rheumatoid arthritis (RA). US can detect early synovitis, assess disease activity, and determine true remission in patients with RA. US also can detect early enthesitis in patients with spondyloarthropathies. In addition, US can provide a reliable tool for measuring skin thickness in patients with systemic sclerosis. With guidance of injection or aspiration, US can result in a better clinical outcome. Thus, educational needs and research networks are increasing. We present a review of rheumatology US, focusing on recent trends and advances.

Keyword

Doppler ultrasonography; Rheumatoid arthritis; Scleroderma systemic; Spondylitis ankylosing

MeSH Terms

Arthritis, Rheumatoid
Humans
Joints
Rheumatology*
Scleroderma, Systemic
Skin
Spondylarthropathies
Synovitis
Ultrasonography*
Ultrasonography, Doppler

Figure

• 

  Figure 1. Gray scale and power Doppler ultrasound (US) mode. (A) Gray scale US of the right 3rd metacarpophalangeal joint shows anatomical abnormalities of joint effusion and synovial proliferation. (B) In contrast, power Doppler shows the presence of Doppler signal. The positive Doppler signal detected inside the joint cavity always represents active ongoing inflammation. Active synovitis is seen in the right wrist joint.

• 

  Figure 2. Tenosynovitis in a patient with rheumatoid arthritis. (A) Proliferation of synovium (arrow) of tendon sheath with effusion is observed in transverse scan of left 2nd finger flexor tendon. (B) In longitudinal scan of the same lesion, thickened tendon (arrow) with surrounding proliferated synovium is also seen. (C) Confluent power Doppler signals (arrow) are observed near the insertion site of tibialis posterior tendon in left ankle joint, which represents active tenosynovitis at the corresponding site. (D) In transverse view of the same lesion, power Doppler hyperemia (arrow) is also seen within the proliferated tenosynovium.

• 

  Figure 3. Achilles tendon enthesitis in a patient with ankylosing spondylitis. (A) Longitudinal scan shows Doppler signals detected around the insertion site of left Achilles tendon (arrows), which means that there is active enthesitis. (B) Transverse scan of the same lesion also shows power Doppler signals (arrows) at the entheseal site.

• 

  Figure 4. Measurement of skin thickness (the distance between the upper and lower arrow in each image) in (A) a patient with systemic sclerosis (SSc) patient and (B) normal subject. High resolution ultrasound (US) machine can visualize the interface between skin and subcutaneous tissue (lower arrow), as well as the interface between US gel and epidermis (upper arrow). Using measurement function of US system, the thickness of skin can be assessed. The thickness of skin in a patient with SSc was measured higher than the normal subjects as shown in this image.

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