Role of ultrasonography in the diagnosis of rheumatic diseases in light of ACR/EULAR guidelines

Abstract

In the past years, ultrasound imaging has become an integral element of the diagnostic process in rheumatic diseases. It enables the identification of a range of inflammatory changes in joint cavities, sheaths and bursae, and allows their activity to be assessed. In 2012, experts of the European Society of Musculoskeletal Radiology prepared recommendations concerning the role of ultrasonography in the diagnosis of musculoskeletal diseases. Ultrasound was considered the method of choice in imaging peripheral synovitis. Moreover, ultrasound imaging has been popularized thanks to the new classification criteria for rheumatoid arthritis issued by the American College of Rheumatology and European League Against Rheumatism in 2010. They underline the role of ultrasound imaging in the detection of articular inflammatory changes that are difficult to assess unambiguously in the clinical examination. These criteria have become the basis for recommendations prepared by experts from the European League Against Rheumatism concerning medical imaging in rheumatoid arthritis. Nine of ten recommendations concern ultrasonography which is relevant in detecting diseases, predicting their progression and treatment response, monitoring disease activity and identifying remission. In the new criteria concerning polymyalgia rheumatica from 2012, an ultrasound scan of the shoulder and pelvic girdle was considered an alternative to clinical assessment. Moreover, the relevance of ultrasonography in the diagnosis and monitoring of peripheral spondyloarthropathies was widely discussed in 2014 during the meeting of the European League Against Rheumatism in Paris.

Keywords: polymyalgia rheumatica; rheumatic diseases; rheumatoid arthritis; spondyloarthropathies; ultrasonography.

Fig. 1

Grey-scale US (A) and color Doppler (B) of the wrist: effusion, synovial hypertrophy in the radiocarpal joint (synovitis) and tenosynovitis of the extensor carpi ulnaris

Fig. 2

US of the wrist: synovial hypertrophy with poorly enhanced synovial vascularity in the distal radioulnar joint (synovitis)

Fig. 3

MRI of the sacroiliac joints, TIRM sequence (turbo inversion recovery magnitude) (A) and T1FS sequence (T1 fat-suppressed sequence) after contrast agent administration (B): bilateral bone marrow edema in the subchondral layer of the iliac and sacral bone with changes prevailing on the left side undergoes contrast enhancement; and (B) bilateral inflammation of the anterior joint capsule and synovitis