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  • Review Article
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Musculoskeletal ultrasonography in patients with rheumatoid arthritis

Nature Reviews Rheumatology volume 9, pages 433–437 (2013)Cite this article

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Abstract

In the current paradigm for management of patients with rheumatoid arthritis (RA), obtaining clinical remission of symptoms remains the most important aim, but achieving radiographic remission is another key goal of treatment. Several parameters detectable by musculoskeletal ultrasonography can predict the development of severe RA, as well as monitor patients' responses to treatment; thus, musculoskeletal ultrasonography is widely used for evaluating patients with RA, both in clinical trials and in clinical practice. This Review describes the applications of musculoskeletal ultrasonography in patients with RA, focusing on the identification of ultrasonographic features that predict the development of erosions. Such predictive markers include high vascularity of synovitis, persistent synovitis, tenosynovitis of the extensor carpi ulnaris tendon, and erosive changes in the distal ulna. This article also describes ultrasonographic scores that could feasibly be integrated into daily rheumatology practice for the evaluation of patients with RA.

Key Points

  • The use of musculoskeletal ultrasonography is widely established in the field of rheumatology, both in clinical studies and in clinical practice

  • Grayscale and power or color Doppler ultrasonography are used to assess patients with rheumatoid arthritis (RA) in clinical practice and research; contrast-enhanced ultrasonography is currently only used in research

  • Several ultrasonographic parameters can predict the development of severe erosive RA and, therefore, have a potential role as imaging biomarkers

  • Ultrasonography sum scores involve assessment of a reduced number of joints compared with radiographic scores, which could speed up clinical examination time

  • Although ultrasonography sum scores accurately reflect overall RA disease activity, consensus on an international musculoskeletal ultrasonography score has not been reached yet

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Figure 1: Ultrasonographic appearance of synovitis in the dorsomedian wrist region of a patient with RA.
Figure 2: Ultrasonographic appearance of erosion in metatarsophalangeal joint 5 in a patient with RA by greyscale ultrasonography.
Figure 3: Ultrasonographic appearance of tenosynovitis of the extensor carpi ulnaris in a patient with RA.

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Acknowledgements

The scientific work of S. Ohrndorf is financially sponsored by the third-party funds of the Bundesministerium für Bildung und Forschung (BMBF) project 'ArthroMark' (subproject no. 7 'Clinical study on Biomarkers and Imaging'), Germany.

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Authors and Affiliations

  1. Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin, Charitéplatz 1, 10117, Berlin, Germany

    Sarah Ohrndorf & Marina Backhaus

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M. Backhaus and S. Ohrndorf contributed equally to all aspects of the manuscript, including researching data for the article, writing the manuscript and review or editing of the manuscript before submission.

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Correspondence to Marina Backhaus.

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The authors declare no competing financial interests.

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Ohrndorf, S., Backhaus, M. Musculoskeletal ultrasonography in patients with rheumatoid arthritis. Nat Rev Rheumatol 9, 433–437 (2013). https://doi.org/10.1038/nrrheum.2013.73

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