Concepts in diagnosing, scoring, and monitoring tenosynovitis and other tendon abnormalities in patients with rheumatoid arthritis- the role of musculoskeletal ultrasound.

Abstract

In the last years, important advancements have been made in implementing high resolution imaging related information inside the global management algorithm in RA patients. Musculoskeletal ultrasound has already proven its utility in visualizing directly the joint synovial tissue, the synovial vascularization and in monitoring the response to therapy. Recently, much attention has been given to the presence of tenosynovitis, as a constant, complementary but different facet of the inflammatory involvement in RA. Tenosynovitis identification in early RA stages may allow adequate treatment adjustment in early and established disease in order to prevent and/ or slow down the development of structural damage at tendon and joint level.

Musculoskeletal ultrasound versus MRI of the hands in healthy subjects – a pilot study

“…A truly inflamed tendon will show gliding abnormalities together with a variable spectrum of morphologic modifications in the tendon sheath/tendon belly. MSUS evaluation has this advantage over MRI where only morphologic information can be depicted [39,50]. At this point we could hypothesize that tenosynovitis could be a very feasible discriminative imaging parameter between healthy subjects and groups with subclinical disease.…”

Multidisciplinary approach in the treatment of tendinous foot involvement in rheumatoid arthritis

“…As reported by several authors [13,15,17,18,40], ultrasound-guided infiltrations improve the symptoms of tenosynovitis, irrespective of the site. However, the maximun efficacy occurs only during short term (1-3 months) [14].…”

“…Ultrasound-guided infiltrations have proven to be more successful than the conventional blind injections. Ultrasound has provided valuable information for the physical examination and has been proven to be highly sensitive for the detection of joint inflammation, tendon involvement, and follow-up [13][14][15]. Approximately 75% of all infiltrations into a tendon are made in the foot or ankle [16], with short-term relief of pain and of inflammatory symptoms (4-12 weeks) [14,17].…”

Tenosinovitis en artritis reumatoidea, evaluación por ultrasonido y resonancia magnética

“…Clínicamente la tenosinovitis se manifiesta por dolor e impotencia funcional en el sitio de la inflamación y puede producir tumefacción local que, en varias ocasiones, no se hace evidente a la inspección. De hecho, la tenosinovitis con frecuencia se pasa por alto en la práctica clínica debido a que el examen físico puede ser muy desafiante en pacientes con múltiples articulaciones inflamadas, cambios estructurales y patología periarticular, que ocurren en áreas anatómicas complejas como la mano o el pie 17 . Por ejemplo, a nivel de las correderas extensoras del carpo, con frecuencia, la tenosinovitis es indistinguible de la sinovitis al examen semiológico lo que da lugar a errores diagnósticos y, consecuentemente, a tratamientos desacertados.…”