Musculoskeletal Ultrasound in Osteoarthritis and Rheumatoid Arthritis

Giorgio Tamborrini, Adrian Ciurea, Stefano Bianchi
US Musculoskeletal Review, 2011;6(1):32-4
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Abstract

Ultrasonography (US) is a validated and established imaging tool in the diagnosis and assessment of inflammatory and non-inflammatory joint diseases and plays an important role in monitoring therapy. US can visualise several soft-tissue structures and is able to detect a variety of pathologic changes. Alterations of cartilages, bone surfaces, and synovial tissue changes in osteoarthritis or rheumatoid arthritis are often detected earlier by US compared with conventional radiographs. US is particularly useful in the early detection of inflammatory signs in patients with undifferentiated arthritis or normal X-ray by using Doppler and power-Doppler. In this article we present the basic US appearance of joint changes in osteoarthritis and rheumatoid arthritis.
Keywords
Musculoskeletal, ultrasound, osteoarthritis, rheumatoid arthritis, power Doppler
Disclosure The authors have no conflicts of interest to declare.
Received: May 02, 2011 Accepted July 07, 2011
Correspondence: Giorgio Tamborrini, University Hospital Zürich, Departement of Rheumatology, Gloriastrasse 25, 8091 Zürich, Switzerland. E: giorgio.tamborrini@usz.ch

Ultrasonography (US) is a dynamic, safe, and non-invasive modality without contraindications for assessing osteoarthritic patients. High-resolution US can demonstrate structural changes of cartilage, menisci, bone surface, synovial membrane, tendons, ligaments, joint capsule, and bursas in early and late stages in osteoarthritis (OA). Table 1 shows the typical US findings in OA compared with rheumathoid arthritis (RA).1–3 Osteophytes (see Figure 1) and cartilage changes (see Figure 2) are typical diagnostic markers.

Synovial membrane thickening and joint effusions reflect an inflammation. In active inflammatory processes color or power Doppler US can demonstrate hyperemia due to active synovial inflammation.4,5 US is a valuable tool in the monitoring of disease progression and in the assessment of response to local and systemic treatment, helping rheumatologists in the clinical management of osteoarthritic patients.3

Future standardisation of the image acquisitions may improve the validity of the technique in clinical practice. Some progress has already been made with the demonstration of a good reproducibility of US measurements of articular cartilage thickness in finger joints or knees.6 Today, the sensitivity of detectable structural changes in early OA is improving and will be increased using enhanced future techniques. Particularly in finger joints, US can show small osteophytes and synovitis before they can be detected in the clinical examination or using conventional radiography. Realtime US is very useful in guiding the correct position of the needle and in facilitating atraumatic joint aspiration and therapeutic injection, particularly in small joints. These procedures are performed safely and are well tolerated when executed under US guidance.7,8

Ultrasonography in Rheumatoid Arthritis

In assessing, managing, and monitoring patients with RA, an accurate quantification of inflammation and structural damage is essential.9 Without appropriate and early treatment with disease-modifying drugs, inflammation can progress and result in severe joint destruction and dysfunction. Conventional radiography is still the gold standard technology, but its predominant role is in the assessment of later stages of RA where radiographs can show periarticular osteopenia, joint space reduction, and erosions.

References:
  1. Meenagh G, Filippucci E, Iagnocco A, et al., Ultrasound imaging for the rheumatologist VIII. Ultrasound imaging in osteoarthritis, Clin Exp Rheumatol, 2007;25(2):172–5.
  2. Grassi W, Filippucci E, Farina A, Ultrasonography in osteoarthritis, Semin Arthritis Rheum, 2005;34(6 Suppl. 2):19–23.
  3. Moller I, Bong D, Naredo E, et al., Ultrasound in the study and monitoring of osteoarthritis, Osteoarthritis Cartilage, 2008;16(Suppl. 3):4–7.
  4. De Miguel Mendieta E, Cobo Ibáñez T, Usón Jaeger J, et al., Clinical and ultrasonographic findings related to knee pain in osteoarthritis, Osteoarthritis Cartilage, 2006;14(6):540–4.
  5. Mancarella L, Magnani M, Addimanda O, et al., Ultrasounddetected synovitis with power Doppler signal is associated with severe radiographic damage and reduced cartilage thickness in hand osteoarthritis, Osteoarthritis Cartilage, 2010;18(10):1263–8.
  6. Naredo E, Acebes C, Möller I, et al., Ultrasound validity in the measurement of knee cartilage thickness, Ann Rheum Dis, 2009;68(8):1322–7.
  7. Epis O, Iagnocco A, Meenagh G, et al., Ultrasound imaging for the rheumatologist XVI, Ultrasound-guided procedures, Clin Exp Rheumatol, 2008;26(4):515–8.
  8. Tamborrini G, Backhaus M, Schmidt W, Ziswiler HR, et al., Ultrasound and Arthritis, Z Rheumatol, 2010;69:889–902.
  9. Raza K, Filer A, Predicting the development of RA in patients with early undifferentiated arthritis, Best Pract Res Clin Rheumatol, 2009;23:25–30.
  10. Szkudlarek M, Narvestad E, Court-Payen M, et al., Ultrasonography of the RA finger joints is more sensitive than conventional radiography for detection of erosions without loss of specificity, with MRI as a reference method, Ann Rheum Dis, 2004;63:82–3.
  11. Wakefield RJ, Gibbon WW, Conaghan PG, et al., The value of sonography in the detection of bone erosions in patients with rheumatoid arthritis, Arthritis Rheum, 2000;43:2762–770.
  12. Karim Z, Wakefield RJ, Conaghan PG, et al., The impact of ultrasonography on diagnosis and management of patients with musculoskeletal conditions, Arthritis Rheum, 2001;44:2932–3.
  13. Backhaus M, Kamradt T, Sandrock D, et al., Arthritis of the finger joints: A comprehensive approach comparing conventional radiography, scintigraphy, ultrasound, and contrast-enhanced magnetic resonance imaging,Arthritis Rheum, 1999;42:1232–45.
  14. Backhaus M, Burmester GR, Sandrock D, et al., Prospective two-year follow-up study comparing novel and conventional imaging procedures in patients with arthritic finger joints, Ann Rheum Dis, 2002;61:895–904.
  15. Scheel AK, Hermann KG, et al., Prospective long term follow-up imaging study comparing radiography, ultrasonography and magnetic resonance imaging in rheumatoid arthritis finger joints, Ann Rheum Dis, 2006;65:595–600.
  16. Scheel AK, Hermann KG, Ohrndorf S, et al., Ultrasonography of the metatarsophalangeal joints in rheumatoid arthritis: Comparison with magnetic resonance imaging, conventional radiography, and clinical examination. Arthritis Rheum, 2004;50:2103–12.
  17. Scheel AK, Hermann KG, et al., A novel ultrasonographic synovitis scoring system suitable for analyzing finger joint inflammation in rheumatoid arthritis, Arthritis Rheum, 2005;52:681–6.
  18. Scheel AK, Hermann KG, Kahler E, et al., Power Doppler ultrasonography for assessment of synovitis in the metacarpophalangealjoints of patients with rheumatoid arthritis: A comparison with dynamic magnetic resonance imaging, Arthritis Rheum, 2001;44:2018–23.
  19. Backhaus M, Ohrndorf S, Kellner H, et al., Evaluation of a Novel 7-Joint Ultrasound Score in Daily Rheumatologic Practice: A Pilot Project, Arthritis Rheum, 2009;61(9):1194–1201.
  20. Goldberg BB, Liu JB, Forsberg F, Ultrasound contrast agents: A review, Ultrasound Med Biol, 1994;20:319–33.
  21. Blomley MJ, Cooke JC, et al., Microbubble contrast agents: A new era in ultrasound, BMJ, 2001;322:1222–5.
  22. Klauser A, Demharter J, De Marchi A, et al., Contrastenhanced gray-scale sonography in assessment of joint vascularity in rheumatoid arthritis: Results from the IACUS Study Group, Eur Radiol, 2005;15:2404–10.
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