The 2017 EULAR standardised procedures for ultrasound imaging in rheumatology

Möller, Ingrid; Janţă, Iustina; Backhaus, Marina; Ohrndorf, Sarah; Bong, David; Martinoli, Carlo; Filippucci, Emilio; Sconfienza, Luca Maria; Terslev, Lene; Damjanov, Nemanja; Hammer, Hilde Berner; Sudoł‐Szopińska, Iwona; Grassi, Walter; Balint, Peter J.; Bruyn, G. A. W.; D’Agostino, Maria; Hollander, Diana; Siddle, Heidi J.; Supp, Gabriela; Schmidt, Wolfgang A.; Iagnocco, Annamaria; Koski, Juhani M.; Kane, David; Fodor, Daniela; Bruns, Alessandra; Mandl, Péter; Kaeley, Gurjit S.; Micu, Mihaela; Ho, Carmen P; Vlad, Violeta; Chávez-López, Mario Alfredo; Filippou, Georgios; Cerón, Carmen; Nestorova, Rodina; Quintero, Maritza; Wakefield, Richard J.; Carmona, Loreto; Naredo, Esperanza

doi:10.1136/annrheumdis-2017-211585

Cited by 219 publications

(168 citation statements)

References 65 publications

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“…During the second reliability exercise, a long briefing was held the day before the patient-based exercise in order to better define the scanning protocol and to test again the definitions on static images. The new EULAR standardised procedures for US15 were followed and considered sufficient for most of the joints plus the specific scanning of the triangular fibrocartilage (including dynamic scanning) as explained in the methods.…”

Section: Discussionmentioning

confidence: 99%

“…The achievement of good kappa values between experts in CPPD and expert sonographers without particular interest before this study on CPPD suggests that the results could be reproducible also in the real world between expert sonographers. Furthermore, at the briefing session, the group decided to adopt the EULAR recommended scanning procedures15 that are freely available for every sonographer. Finally, in the US atlas of CPPD images included in this paper, the reader may find a comprehensive review of the US aspect of CPPD deposition in the different sites investigated during the two workshops even if they did not reach high reliability values.…”

Section: Discussionmentioning

confidence: 99%

“…The US exam was performed according to a standardised sequence that was decided for each site, the day before the exercise during a briefing following the most recent guidelines of the EULAR 15. Briefly, the MCP joints’ hyaline cartilage (HC) was examined on the dorsal aspect of the hands with the fingers in maximum flexion to reveal a large portion of HC.…”

Section: Methodsmentioning

confidence: 99%

See 2 more Smart Citations

Identification of calcium pyrophosphate deposition disease (CPPD) by ultrasound: reliability of the OMERACT definitions in an extended set of joints—an international multiobserver study by the OMERACT Calcium Pyrophosphate Deposition Disease Ultrasound Subtask Force

et al. 2018

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Identification of calcium pyrophosphate deposition disease (CPPD) by ultrasound: reliability of the OMERACT definitions in an extended set of joints—an international multiobserver study by the OMERACT Calcium Pyrophosphate Deposition Disease Ultrasound Subtask Force

et al. 2018

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“…Background: Musculoskeletal ultrasound (MSUS) has assumed a prominent role in rheumatological practice as both a diagnostic and monitoring tool. 1 It has utility in excluding and quantifying active synovitis and can be used to guide adjustments of therapies. 2,3 Objectives: We aimed to observe impacts on clinical practice of utilising ultrasound (US) scanners in outpatient clinics in a district general rheumatology service.…”

Section: Referencesmentioning

confidence: 99%

Ab1187 impact of in-Clinic Ultrasound on Age and Gender of Patients Scanned and Detection of Synovitis – Results From a Quality Improvement Project

Asran

Wig

Vasireddy

2019

Abstracts Accepted for Publication

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BackgroundInflammatory arthritis is more common in women, and the majority of patients have onset before the 6th decade. Synovitis can be difficult to diagnose clinically in the early stages, and can be especially easy to miss where the index of suspicion is low, such as men and the elderly. Ultrasound (US) can confirm synovitis and other conditions in Rheumatology, particularly where examination features are not very obvious. US has traditionally been offered via Radiology services in our hospital as a separate appointment following referral from the Rheumatology clinic, with variable waiting times causing potential delay in starting treatment such as DMARDs. There is also a cost implication with respect to commissioning of the Radiology scan appointments. In Bolton, an US system was installed in Rheumatology from 2016 to perform in-clinic US, for improving access and reducing referrals to Radiology.ObjectivesWe aimed to assess the US usage pattern before and after the new Rheumatology US was installed, with respect to access based on age and gender, the pattern of scanning in-clinic, and rate of synovitis diagnsosis, using a quality improvement framework.MethodsUS referral data from the Radiology department from October 2015 to March 2016 were collated as baseline on a MS Access database. Two Consultant Rheumatologists performed US in-clinic. From May to October 2016 Rheumatology in-clinic data, and also Radiology referral data were collated on the database for comparison. Patient demographics and diagnoses were collated from clinic letters. Descriptive statistics were processed in MS Excel 2010.ResultsBetween October 2015 and March 2016, 68 patients (median age 52 yrs; 28% male) had scans in Radiology. Between May and October 2016, 59 patients (median age 60 yrs; 21% male) had scans in Radiology, and 78 patients (median age 59yrs; 35% male) had scans in Rheumatology clinic. There was no significant difference in scanned areas amongst the three cohorts with the most common overall being hand/wrist area (n=57, 54 and 61 respectively; total 84%), followed by foot/ankle (n=6, 4 and 4 respectively; total 7%). Between the two time periods, there was an increased trend in final working diagnoses of inflammatory arthritis (28 [41%] vs 36 [61%] and 39 [50%] in the 3 cohorts respectively); and a decreasing trend in the final working diagnoses of non-inflammatory conditions (OA, FM, other non-inflammatory pain: 36 [53%] vs 22 [37.3%] and 28 [35.9%] in the 3 cohorts respectively).ConclusionThe availability of Rheumatology US was associated with increased propensity for scanning older patients and a greater proportion of men compared to previously, a qualitative improvement as synovitis diagnosis could be delayed in these groups. The introduction of Rheumatology US was also associated with a trend towards higher proportion of inflammatory diagnoses, suggesting potentially increased appropriate clinical use due to availabiltiy in-clinic. This is supported by the majority being hand/wrist scans, suggesting Rheumatology use is...

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“…1 It has utility in excluding and quantifying active synovitis and can be used to guide adjustments of therapies. 2,3 Objectives: We aimed to observe impacts on clinical practice of utilising ultrasound (US) scanners in outpatient clinics in a district general rheumatology service.…”

mentioning

confidence: 99%

Ab1188 audit: Impact of Musculoskeletal Ultrasound Use in Rheumatology Clinics

Wilkinson

Reed

Else

2019

Abstracts Accepted for Publication

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BackgroundMusculoskeletal ultrasound (MSUS) has assumed a prominent role in rheumatological practice as both a diagnostic and monitoring tool.1 It has utility in excluding and quantifying active synovitis and can be used to guide adjustments of therapies.2,3ObjectivesWe aimed to observe impacts on clinical practice of utilising ultrasound (US) scanners in outpatient clinics in a district general rheumatology service. We were particularly interested to see if this affected treatment choices, follow-up plans and referrals for radiological investigations.MethodsUS scanners were obtained and used by 2 rheumatology consultants with previous ultrasound training. Scanning was performed during standard 20 minute appointments within general rheumatology outpatient clinics. No extra time was allocated. Over 8 weeks, we completed questionnaires for each scan and assessed the impact on management decisions.ResultsOver 8 weeks, data was collected for 36 consecutive patients scanned. Commonly imaged joints were hands (81%,n=29), wrists (75%, n=27), feet (19%, n=7), and ankles (14%, n=5).Most common patient diagnoses were osteoarthritis (n=13, 36%), rheumatoid arthritis (n=10, 28%) and psoriatic arthropathy (n=6, 17%). The remaining patients had diagnostic labels including undifferentiated inflammatory arthritis or no formal diagnosis. Abnormalities suggesting active inflammation were seen in 42%. In 33% osteoarthritic changes were observed, erosions were seen in 5%. 20% scans were normal.US altered the management in 58% (n=21/36) of cases. These alterations to management included: drug added(n=5), drug stopped(n=3), dose increase (n=1), joint injection (n=3), intramuscular injection (n=2). Of the medications added, 3 were DMARDs, 1 was a biologic therapy and one case was not specified. The medications stopped were all DMARDS.US use in clinic prevented radiological investigation in 72% (26/36) of cases. These were radiology ultrasound (n=23) and MRI (n=3). Hands and wrists scans accounted for 86% of these.US altered the follow up in 56% (20/36) of cases. Of these, 40% (8/20) were reviewed earlier, and 40% (8/20) of patients were discharged based on ultrasound information.In 16/36 patients, US did not alter management. The average time taken to scan in clinic was 7 minutes per patient. The median time was 5 minutes, with the average skewed due to a few prolonged scans of multiple anatomical areas.ConclusionThis audit has demonstrated that US use has impacted on our clinical practice. We identified patients to be seen earlier and altered management based on US findings.US use also prevented radiological investigations in 72% of cases. This has positive impacts on staffing, finances, radiology department capacity and patient convenience. Furthermore, we were able to discharge 40% of patients who otherwise would have been recalled.Overall, we believe this audit shows positive impacts of MSUS on patient care. Challenges include time pressures of scanning in clinic, time and cost implications of ultrasound training and the need to sta...

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The 2017 EULAR standardised procedures for ultrasound imaging in rheumatology

Abstract: This task force has produced a consensus-based comprehensive and practical framework on standardised procedures for MSUS imaging in rheumatology.

Cited by 219 publications

References 65 publications

Identification of calcium pyrophosphate deposition disease (CPPD) by ultrasound: reliability of the OMERACT definitions in an extended set of joints—an international multiobserver study by the OMERACT Calcium Pyrophosphate Deposition Disease Ultrasound Subtask Force

Identification of calcium pyrophosphate deposition disease (CPPD) by ultrasound: reliability of the OMERACT definitions in an extended set of joints—an international multiobserver study by the OMERACT Calcium Pyrophosphate Deposition Disease Ultrasound Subtask Force

Ab1187 impact of in-Clinic Ultrasound on Age and Gender of Patients Scanned and Detection of Synovitis – Results From a Quality Improvement Project

Ab1188 audit: Impact of Musculoskeletal Ultrasound Use in Rheumatology Clinics

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