Rheumatology Advance Access originally published online on May 25, 2004
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Rheumatology 2004; 43: 829-838
Rheumatology Vol. 43 No. 7 © British Society for Rheumatology 2004; all rights reserved
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Musculoskeletal ultrasound—a state of the art review in rheumatology. Part 2: Clinical indications for musculoskeletal ultrasound in rheumatology
School of Clinical and Medical Sciences (Rheumatology), University of Newcastle-upon-Tyne, Newcastle-upon-Tyne, UK, 1 Department of Rheumatology, University of Ancona, Ancona, Italy, 2 Centre for Rheumatic Diseases, Glasgow Royal Infirmary, Glasgow, UK, 3 3rd General and Paediatric Rheumatology Department, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary.
Correspondence to: D. Kane, School of Clinical and Medical Sciences (Rheumatology), Cookson Building, Framlington Place, University of Newcastle-upon-Tyne, Newcastle-upon-Tyne NE2 4HH, UK. E-mail: d.j.kane{at}ncl.ac.uk
Rheumatologists remain divided on whether they should introduce musculoskeletal ultrasound (MSUS) into their clinical practice. A central issue in the application of MSUS in clinical rheumatology is the need for proof of clinical relevance and improved patient care. There is now accumulating evidence that MSUS improves clinical diagnosis and intervention skills. High-resolution ultrasound is superior to clinical examination in the diagnosis and localization of joint and bursal effusion and synovitis. MSUS is the imaging modality of choice for the diagnosis of tendon pathology. MSUS is seven times more sensitive than plain radiography in the detection of rheumatoid erosions, allowing earlier diagnosis of progressive rheumatoid arthritis. Ligament, muscle, peripheral nerve and cartilage pathology can also be readily demonstrated by MSUS. There is exciting evidence that MSUS may potentially be used by rheumatologists to non-invasively diagnose and monitor not just joint and muscle disease but also nerve compression syndromes, scleroderma, vasculitis and Sjögren's syndrome. Joint aspiration and injection accuracy can be improved by MSUS, with initial evidence confirming improved efficacy. As the number of rheumatologists performing MSUS increases and the technical capabilities of MSUS improve, there is likely to be a growing number of proven clinical indications for the application of MSUS in rheumatology practice. This paper reviews the evidence for the application of MSUS in rheumatology.
KEY WORDS: Musculoskeletal ultrasound, Synovitis, Erosion, Enthesitis
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