Guidelines for musculoskeletal ultrasound in rheumatology

Backhaus, Marina

doi:10.1136/ard.60.7.641

Cited by 917 publications

(652 citation statements)

References 13 publications

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“…The most affected large joint (shoulder, elbow, hip, and knee) was sonographically examined in a standardized modified manner according to the German (13)(14)(15)(16) and EULAR (17) guidelines at the baseline and the followup visits. The determined joint regions were assessed by GSUS and PDUS.…”

Section: Us Examinationmentioning

confidence: 99%

Development and evaluation of a novel ultrasound score for large joints in rheumatoid arthritis: One year of experience in daily clinical practice

Hartung¹,

Kellner²,

Strunk³

et al. 2012

Arthritis Care & Research

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Objective. To introduce and evaluate a new standardized ultrasound (US) score developed for large joints in patients with rheumatoid arthritis (RA). Methods. A US score was designed to determine the degree of inflammation in the shoulder, the elbow, the hip, and the knee joint in patients with RA (Sonography of Large Joints in Rheumatology [SOLAR] score). Synovitis and synovial vascularity were scored semiquantitatively (grade 0 -3) by gray-scale US (GSUS) and power Doppler US (PDUS). Patients with RA were examined at baseline and 3, 6, and 12 months after initiation of local or systemic therapy (diseasemodifying antirheumatic drugs [DMARDs]/biologic agents). Erythrocyte sedimentation rate, anti-cyclic citrullinated peptide antibodies, and the clinical Disease Activity Score in 28 joints (DAS28) were determined. Results. A cohort of 199 patients were analyzed and followed up over 12 months. At baseline, before modification of the therapy, patients received either DMARDs (n ‫؍‬ 131), DMARDs plus biologic agents (n ‫؍‬ 46), biologic monotherapy (n ‫؍‬ 8), or no DMARD therapy (n ‫؍‬ 14). At baseline, the mean DAS28 score was 4.6 and decreased to 3.2 after 1 year of therapy (P < 0.001). All US scores demonstrated a statistically significant improvement except for the PDUS scores for the shoulder and the hip. In detail, the mean synovitis GSUS score for the knee decreased from 5.2 at baseline to 2.2 after 12 months of followup. The mean GSUS score for the shoulder fell from 2.6 to 1.6, for the elbow fell from 5.2 to 2.6, and for the hip fell from 2.2 to 0.4 (P < 0.05 for each). Conclusion. The SOLAR score is a feasible tool for the qualitative and quantitative evaluation of large joint involvement in patients with RA using US.

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Section: Us Examinationmentioning

confidence: 99%

Development and evaluation of a novel ultrasound score for large joints in rheumatoid arthritis: One year of experience in daily clinical practice

Hartung¹,

Kellner²,

Strunk³

et al. 2012

Arthritis Care & Research

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“…The US study was performed by an experienced rheumatologist sonographer (AI) who was blinded to the clinical and laboratory findings in each patient. In every joint, a multiplanar scanning technique [17,18] was used and the presence of inflammation documented in joints and or peri-articular tissues (joint effusion, synovial proliferation, hyperaemia in the synovial tissue, tenosynovitis and bursitis) together with the presence of permanent damage (bone erosions and cartilaginous abnormalities). The changes within each articular and peri-articular structure were recorded as being present in accordance with the reported definitions in the literature [22,23].…”

Section: Us Examinationmentioning

confidence: 99%

“…US is of particular benefit when searching for bone erosion and cartilaginous change in early phases of the disease process, thereby allowing a diagnosis to be confirmed and the progression of the disease to be followed [16]. Furthermore, multiplanar scanning permits examination of superficial areas which cannot be studied satisfactorily with conventional X-ray [17,18].…”

Section: Introductionmentioning

confidence: 99%

Etanercept in the treatment of rheumatoid arthritis: clinical follow-up over one year by ultrasonography

et al. 2007

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We evaluated clinically and sonographically the effects of etanercept therapy in patients with rheumatoid arthritis (RA) over 12 months of treatment. Eighteen patients affected by RAwho were non-responders or partial responders to disease modifying therapy were commenced on Etanercept treatment. Before starting therapy (T0) and at 12 months (T1), the following parameters were evaluated: erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), visual analogue scale (VAS) for pain, number of painful and swollen joints, health assessment questionnaire (HAQ) and disease activity score in 28 joints (DAS 28). Musculoskeletal ultrasound (US) was performed in the following joints: second and fifth metacarpophalangeal, third interphalangeal, wrist and knee joints and a semiquantitative score (0-3) calculated and used to indicate the presence of a localised inflammatory process (synovitis, tenosynovitis, bursitis) and/or structural damage (bone erosion and cartilaginous change). An overall score was calculated based on the sum of the single scores to obtain a comprehensive score indicative of the global pathological change. The US global scores significantly reduced between T0 and T1 (p<0.0001). The following laboratory and clinical parameters also significantly reduced: ESR (p<0.0001), CRP (p<0.02), VAS (p<0.001), number of total swollen joints (p<0.001), number of total painful joints (p<0.01), HAQ scores (p<0.05) and DAS 28 (p< 0.0001). A positive response to treatment with Etanercept was demonstrated both by US examination of several joints and by clinical evaluation of several parameters. US is a useful tool in the monitoring of biologic therapy in RA, assessing both inflammatory and destructive changes.

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“…Courses in MUS are popular, but these aim to introduce concepts and aid understanding rather than provide formal training. Guidelines are available on image acquisition, equipment, and practice standards (18,19) but there is little information and no published agreement on any other fundamental issue with regard to education in this area. For example, there are no guidelines in place to direct a rheumatologist as to the appropriate knowledge and skills that they require to perform an adequate MUS assessment, or even for what indications or in which anatomic areas it is appropriate to perform such an examination.…”

Section: Introductionmentioning

confidence: 99%

Recommendations for musculoskeletal ultrasonography by rheumatologists: Setting global standards for best practice by expert consensus

Brown

O’Connor

Roberts

et al. 2005

Arthritis & Rheumatism

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Objective. To establish an expert consensus of best practice for rheumatologists performing musculoskeletal ultrasonography (MUS).Methods. A panel of worldwide experts in MUS was identified by literature review, membership of teaching faculty, and peer recommendation. They were invited to take part in a 4-stage Delphi process employing 2 iterative rounds to establish a consensus of specific indications, anatomic areas, and knowledge and skills required by rheumatologists performing MUS. Results. Experts in MUS were identified (n ‫؍‬ 57; 37 radiologists, 20 rheumatologists). Successive rounds of this rigorousDelphi exercise enabled group consensus to be achieved in 30 of the proposed 37 categories comprising 8 of 13 indications (inflammatory arthritis, tendon pathology, effusion, bursitis, monitoring disease activity, monitoring disease progression, guided aspiration, and injection), 8 of 10 anatomic areas (hand, wrist, elbow, shoulder, hip, knee, ankle and heel, and forefoot), and 14 categories of knowledge and skills (physics, anatomy, pathology, equipment, clinical application and relevance, indications and limitations, artifact, machine function and operation, patient and probe position, planes and system of examination, image optimization, dynamic assessment, color Doppler, and power Doppler). Conclusion. We have produced the first expert-derived, interdisciplinary consensus of recommendations for rheumatologists performing MUS. This represents a significant advance that will not only direct future rheumatology MUS practice, but will facilitate informed educational development. This is an important step towards the introduction of a specific training curriculum and assessment process to ensure competent rheumatologist ultrasonographers.

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Guidelines for musculoskeletal ultrasound in rheumatology

Cited by 917 publications

References 13 publications

Development and evaluation of a novel ultrasound score for large joints in rheumatoid arthritis: One year of experience in daily clinical practice

Development and evaluation of a novel ultrasound score for large joints in rheumatoid arthritis: One year of experience in daily clinical practice

Etanercept in the treatment of rheumatoid arthritis: clinical follow-up over one year by ultrasonography

Recommendations for musculoskeletal ultrasonography by rheumatologists: Setting global standards for best practice by expert consensus

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