Musculoskeletal ultrasound for treating rheumatoid arthritis to target—a systematic literature review

Abstract

Objective We aimed to systematically review the literature to retrieve evidence on the diagnostic and prognostic value of musculoskeletal ultrasound for a treat to target (T2T) approach in rheumatoid arthritis (RA). Methods Eight research questions were developed addressing the role of ultrasound (including different ultrasound scores and elementary lesions) for diagnosis, monitoring and prognosis of RA. PubMed and Embase were searched (2005–2020). Articles on RA and reporting data on musculoskeletal ultrasound were included and extracted according to the underlying questions, and risk of bias assessed according to the study design. Results Out of 4,632 records, 60 articles were included. Due to clinical heterogeneity, meta-analysis was not possible. Ultrasound better predicted disease relapses with respect to clinical examination in patients in remission, while both methods performed similarly in predicting response to therapy, achievement of remission and radiographic progression. Ultrasound was superior to clinical examination in diagnosing joint involvement using another imaging modality, such as magnetic resonance imaging, as reference. Limited ultrasound scores performed like more extensive evaluations for the detection of joint inflammation and for outcome prediction. Higher ultrasound scores of synovitis were linked to poor outcomes at all disease stages, however, a specific cut-off distinguishing between low- and high-risk groups did not emerge. Conclusions These data confirm the pivotal role of ultrasound when evaluating synovial inflammation and when identifying RA patients at higher risk of relapse. Further research is needed to better define the role of ultrasound in a T2T management strategy in moderately-to-highly active RA.

Assessment of joint inflammation at the wrist of patients with rheumatoid arthritis: thermography findings closely mirror those from ultrasonography

“…A recent systematic review on the use of musculoskeletal ultrasound for treating RA to target revealed that ultrasonography is superior to clinical assessment in diagnosing joint involvement using MRI as a reference imaging modality (32). With this present study demonstrating that thermography at the wrist of RA patients closely mirror those from ultrasonography, two interesting questions that arise are as follows: (1) whether thermal imaging may similarly have some advantage(s) over clinical assessment and (2) whether thermography could have a place as an adjunctive tool in the routine assessment of joint inflammation in RA patients.…”

What Bedside Skills Could the Modern Rheumatologist Possess? Part II. “Certain Technical Procedures”

“…Ultrasound-guided synovial biopsy has become popular among those examining the synovium for research 8 and may become important to the practicing clinician as rheumatologic treatment moves to becoming "precision based." 9,10 Synovial features, without biopsy, utilizing power Doppler detecting red blood cell movement that can serve as a surrogate marker for the presence and intensity of synovitis, have been extensively studied 11 and proposed as an outcome measure for treatments of inflammatory arthropathies, although the utility of such techniques remains unsettled. 12 Media comprised tiny gas-filled microbubbles, injected intravenously before US examination, and enhanced the signal reflected by vascularized structures such as inflamed synovium.…”

Harmonizing Medicine and Surgery in the Pursuit of Boolean Remission: A Rheumatological Magnum Opus

“…The future of Boolean remission in rheumatic diseases holds promise with the integration of emerging technologies and biomarkers [ 30 ]. Advanced imaging techniques, such as musculoskeletal ultrasound and magnetic resonance imaging, can provide detailed assessments of joint inflammation and damage [ 31 ]. Biomarkers, including genetic markers and novel serological indicators, may enhance the accuracy and specificity of Boolean remission criteria [ 32 ].…”