Objective: To compare high-resolution ultrasound (HRUS) with conventional radiography in the detection of erosions in the first metatarsophalangeal joints (1st MTPJs) of patients with gout and to identify the characteristic sonographic features of gout. Methods: HRUS examination of the 1st MTPJs of both feet was performed by two independent sonographers. The presence of joint and soft-tissue pathology was recorded. x Ray examination of the feet was performed on the same day and reported by the same radiologist. Results: 39 male patients with gout and 22 age-matched control subjects (14 with an inflammatory arthropathy and 8 disease free) were studied. The agreement on erosion between HRUS and x ray was poor, k = 0.229 (non-weighted), with McNemar's test being significant (p,0.001) indicating a large number of false negative x rays. 22 MTPJs in patients with gout had never been subjected to a clinical attack of acute gout. In these MTPJs, there were 10 erosions detected by HRUS and 3 erosions on x ray. HRUS features significantly more prevalent in the patients with gout were hard and soft tophus-like lesions (p,0.01) and the double contour sign (p,0.01). Conclusions: These data show that HRUS may assist in the management of gout in two ways: first, by aiding in the diagnosis by identifying the sonographic features that may be representative of the disease, and, second, by allowing the early detection of erosive joint damage and/or tophaceous deposits even in clinically silent joints.

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In this study, steroid injection showed a clear benefit over placebo at 6 weeks and this difference was maintained at 12 weeks. Trial Registration No ISRCTN79628180 (www.controlled-trials.com).

Both the addition of ETN to MTX and the substitution of ETN for MTX in patients with rheumatoid arthritis who had an inadequate response to MTX resulted in substantial improvements in clinical signs and symptoms and were generally well-tolerated treatment strategies for improving clinical signs and symptoms of rheumatoid arthritis.

Objective: To propose e-learning methods that address the fundamental problems related to sonographic training in rheumatology. Methods: The project was designed for rheumatologists with strong motivation to learn ultrasound. A modular approach was constructed, consisting of a basic 3-day residential course, followed by a 6-month period of web-based tutoring, and culminating in a final 2-day residential course with a formal assessment of competency. Results: The website (http://www.e-sonography.com) was accessed by all 60 participants. A mean of 20 (range 10-80) log-on sessions were registered for each participant, and a mean of 250 min (range 60-600 min) of web access was recorded. A total of 163 sonographic images were submitted by 18 (30%) participants. The majority of the images focused on the following anatomical areas: shoulder 49 (30%), hand 34 (21%) and knee 20 (12%). A total time investment of approximately 14 h was made by the US tutors over the 6-month period for interaction with the participants. Conclusions: The e-learning methods described in this report represent the first attempt to adopt a novel technique to circumvent several of the inherent barriers to the many facets of teaching musculoskeletal ultrasound to a wide audience. S onographic training in rheumatology is considered by many to be a virtually endless process, and currently there is no agreement between recognised experts on the best approach to adopt. [1][2][3][4][5][6] In recent years, several proposals have been put forward with the aim of addressing the specific difficulties encountered by rheumatologists training in ultrasonography (US). [7][8][9] Direct supervision by an expert is universally recognised as a core element for appropriate training in US. Unfortunately, this approach is beset with logistical difficulties in terms of the relative lack of recognised tutors together with constraints on time for both tutor and student.The primary aim of this report is to propose methods that directly address these fundamental problems in a web-based approach. As a secondary aim, we endeavoured to provide an overall assessment of clinical US competency. METHODSThe project was designed for rheumatologists with strong motivation to learn US and was advertised in all Italian rheumatology departments. A modular approach to training was constructed, consisting of a basic 3-day residential course, according to the standard provided by The European League Against Rheumatism (EULAR) sonography courses, followed by a 6-month period of web-based tutoring and culminating in a final 2-day residential course with a formal assessment of competency. The basic courseThe introductory basic US course was organised for a total of 60 rheumatologists from all over Italy. The main aim of the introductory course was to convey basic knowledge in clinical US. The programme included lectures and practical sessions with healthy subjects and patients with rheumatic disease. Dedicated presentations were given related to the eight anatomical sites indicated in the p...