Impact of systematic ultrasound of the knee on the rheumatologist’s clinical decision in patients consulting for knee pain

Abstract

This clinical practice study aimed to determine whether the results of systematic US in patients with knee pain modified the rheumatologist's choices concerning diagnostic management and therapy. Patients consulting for non-traumatic knee pain, with recent radiography of the knee, were consecutively included over 9 months. After the radio-clinical assessment, the rheumatologist made a principal diagnosis concerning the knee pain and defined the therapeutic management and a complementary imaging strategy if necessary. US of the painful knee was then done in accordance with the reference protocol with the operators blinded to the clinical results. After reading the US report, the rheumatologist re-evaluated his/her diagnostic and therapeutic approach and the complementary exploration strategy. In the 100 patients included (mean age = 62.9 ± 18.5 years, duration of knee pain = 14.4 ± 8.1 months) with a majority of knee osteoarthritis (61 %), the diagnosis was clarified or modified after the US in 31 % of cases (calcium pyrophosphate deposition arthropathy and tendinitis principally), which led to an intensification of therapy in 15 % of cases and a de-escalation in 5 % of cases. These changes mainly concerned injectable treatments. The US of the painful knee resulted in few changes in imaging prescriptions (6 %), and this was not significant for the number of MRIs requested. In real-life practice in rheumatology, systematic US of the knee clarified the initial clinical diagnosis in almost one-third of cases, but did not significantly modify the therapeutic management, which remained symptomatic, and did not reduce the number of other imaging examinations after the initial radio-clinical assessment.

Musculoskeletal ultrasound imaging - An exploration of physiotherapists' interests and use in practice

“…Couturier et al, (2016) discussed the impact of ultrasound on the decision making of rheumatologists for patients with knee pain, Ozcakar et al (2016) outlined the influence of imaging on the decision to inject and Dale et al (2014) evaluated the ultrasound's impact on treatment decisions for patients with early rheumatoid arthritis. A growing body of literature exists that relates non-musculoskeletal ultrasound imaging to clinical decision making (Novak et al 2015, Norlen et al 2014, Bulsiewicz et al 2014) but there is an absence of literature discussing MSKUSI and its role in treatment decisions and evaluation.…”