5 Imaging Ultrasound imaging for the rheumatologist VII. Ultrasound imaging in rheumatoid arthritis E. Filippucci 1 , A. Iagnocco 2 , G. Meenagh 3 , L. Riente 4 , A. Delle Sedie 4 , S. Bombardieri 4 , G. Valesini 2 , W. Grassi 1 1 Cattedra di Reumatologia, Università Politecnica delle Marche, Jesi, Italy; 2 Cattedra di Reumatologia, Università di Roma “La Sapienza”, Roma, Italy; 3 Department of Rheumatology, Weston General Hospital, Weston-super-Mare, Bristol, UK; 4 Unità Operativa di Reumatologia, Università di Pisa, Pisa, Italy. Emilio Filippucci, MD; Annamaria Iagnocco, MD; Gary Meenagh, MD; Lucrezia Riente, MD; Andrea Delle Sedie, MD; Guido Valesini, MD, Professor of Rheumatology; Stefano Bombardieri, MD, Professor of Rheumatology; Walter Grassi, MD, Professor of Rheumatology. Please address correspondence to: Prof. Walter Grassi, Cattedra di Reumatologia, Università Politecnica delle Marche, Ospedale “A. Murri”,Via dei Colli 52, 60035 Jesi (AN), Italy. E-mail: walter.grassi@univpm.it Received on February 1; accepted on February 3, 2007. Clin Exp Rheumatol 2007; 25: 5-10. © Copyright CLINICAL AND EXPERIMENTAL RHEUMATOLOGY 2007. Key words: Ultrasonography, rheumatoid arthritis, synovitis, bone erosion, therapy monitoring. ABSTRACT The present review provides an update of the available data and discusses re- search issues of ultrasound (US) imag- ing in rheumatoid arthritis (RA). Currently the principal indications for using US in the assessment of patients with RA include: detection of sub-clini- cal synovitis, demonstration of bone erosion undetected by conventional radiography, detailed assessment of tendon pathology and guided injection and aspiration of joints and soft tis- sues. Future potential applications are likely to include short and long term therapy monitoring and early detection of cartilaginous changes in RA. The main priorities requiring the atten- tion of investigators include: address- ing validity issues, especially those related to criterion and discriminator validity, development of international consensus on scoring systems, evalua- tion of the role of power Doppler in the assessment of disease activity, develop- ment of a specific training programme for rheumatologists performing US and investigation of the potential of 3D US using a volumetric probe. Introduction Over the last decade, there has been an explosion of research in the field of the management of patients with rheuma- toid arthritis (RA). Refining diagnos- tic accuracy in early disease, intensive monitoring of disease activity and the search for the ideal therapy leading to remission have been the key targets of these investigations (1-3). Ultrasound (US) is rapidly becoming one of the standard tools within the rheumatologistʼs armamentarium in the assessment of patients with RA. Despite the enormous advances of the last decade, US imaging continues to evolve both in terms of technological advancement and the ever increasing number of applications in rheumatolo- gy (4-7). Over the last five years, there has been exponential growth within the literature, centring upon the US assess- ment of patients with RA (8-18). This review provides an update of the available data and discusses research issues of US imaging in RA. Clinical applications Currently the principal indications for using US in the assessment of patients with RA include: detection of sub-clin- ical synovitis, demonstration of bone erosion undetected by conventional radiography, detailed assessment of tendon pathology and guided injection and aspiration of joints and soft tissues (19-23). These applications have been collated by an international panel of experts in US, both rheumatologists and radiologists, and represent part of the core knowledge and skills required for competency in musculoskeletal US (20). Future potential applications are likely to include short and long term therapy monitoring and early detection of carti- laginous changes in RA. Greyscale US with high quality equip- ment permits quick and accurate dif- ferentiation between synovial effusion and synovial proliferation (19, 24). Power Doppler provides information on the perfusional status of the syno- vial tissue which reflects the activity of the inflammatory process (25-27). Moreover, US is helpful in identifying pathologic changes responsible for re- gional pain syndromes in patients with RA e.g., shoulder pain, carpal tunnel syndrome, knee pain (28-31). The use of high frequency US to guide needle positioning within inflamed small joints of the hand, has been shown to provide greater accuracy than brought to you by CORE View metadata, citation and similar papers at core.ac.uk provided by Institutional Research Information System University of Turin