Ultrasound in Rheumatoid Arthritis

Abstract

Rheumatoid arthritis (RA) is a chronic inflammatory disease characterized by synovial inflammation that can lead to structural damage of cartilage, bone and tendons. Assessing the inflammatory activity and the severity is essential in RA to help rheumatologists in adopting proper therapeutic strategies and in evaluating disease outcome and response to treatment. In the last years musculoskeletal (MS) ultrasonography (US) underwent tremendous technological development of equipment with increased sensitivity in detecting a wide set of joint and soft tissues abnormalities. In RA MSUS with the use of Doppler modalities is a useful imaging tool to depict inflammatory abnormalities (i.e. synovitis, tenosynovitis and bursitis) and structural changes (i.e. bone erosions, cartilage damage and tendon lesions). In addition, MSUS has been demonstrated to be able to monitor the response to different therapies in RA to guide local diagnostic and therapeutic procedures such as biopsy, fluid aspirations and injections. Future applications based on the development of new tools may improve the role of MSUS in RA.

FoxP3+T regulatory cells in Rheumatoid arthritis and the imbalance of the Treg/TH17 cytokine axis

“…The same scoring system was applied to erosions where 0 = absence of erosions, 1 = mild erosions, 2 = moderate erosions, 3 = severe erosions. Total US scoring was done by adding the score of the 12 joints for both hypertrophy and erosions, maximum score was 72 [19,20].…”

The use of musculoskeletal ultrasound in a Rheumatology Outpatient Clinic

“…The results, indicating that RA was the most frequent indication for US assessment, underline the great interest of rheumatologists for this condition: data from the literature indicate the growing interest on the US application in patients affected by RA [9][10][11][12][13]. Thanks to its great sensitivity in detecting abnormalities since early phase of disease and in identifying subclinical synovitis, US assessment is recommended as a complementary tool to the clinical evaluation [14].…”

T Helper 17 Cells and Inducible Nitric Oxide Synthase: Good Index to Predict Renal Tissue Involvement in Systemic Lupus Erythematosus Patients

“…According with the OMERACT indications, synovial fluid is defined as an abnormal hypoechoic or anechoic intra-articular material that is displaceable and compressible, and that does not exhibit Doppler signal 4 . Figure 2 A-B Recurrent episodes of tenosynovitis associated with proliferation of the tenosynovium can lead to tendon structural changes as tendon adhesion and rupture causing severe articular impairment 20 .…”

“…Musculoskeletal (MS) ultrasound (US) has been widely employed in the assessment and monitoring of rheumatic diseases, particularly in patients affected by RA. Thanks to its characteristic of validity, reliability, reproducibility and sensitivity to change, US superseded other commonly used imaging modalities, such as plain radiography (X-ray), and its use has been included in the daily routine clinical practice in rheumatology 4 .…”

“…In 2001 the EULAR guidelines indicated the standard scans to perform at each joint for the evaluation of articular and peri-articular structures (eular), these recommendations were reinforced by the treat-totarget approach with remission set as the primary treatment goal for RA in everyday clinical practice 10 . In 2005, the OMERACT group published consensus US definitions for common pathologic lesions observed in patients affected by RA, each definition will be mentioned with the appropriate sign 4 . Musculoskeletal US scoring systems are used to verify clinically detected RA disease activity and to assess therapeutic response.…”