Owing to the ability of musculoskeletal ultrasound (US) to depict cross sectional images of synovial joint and related structures, US has become the most reliable tool for evaluation of arthritic activity of rheumatoid arthritis (RA). US can detect early synovitis, assess disease activity, and determine true remission in patients with RA. US also can detect early enthesitis in patients with spondyloarthropathies. In addition, US can provide a reliable tool for measuring skin thickness in patients with systemic sclerosis. With guidance of injection or aspiration, US can result in a better clinical outcome. Thus, educational needs and research networks are increasing. We present a review of rheumatology US, focusing on recent trends and advances.
Arthritis, Rheumatoid ; Humans ; Joints ; Rheumatology* ; Scleroderma, Systemic ; Skin ; Spondylarthropathies ; Synovitis ; Ultrasonography* ; Ultrasonography, Doppler

The use of musculoskeletal ultrasound in rheumatology clinical practice has rapidly increased over the past decade. Ultrasound has enabled rheumatologists to diagnose, prognosticate and monitor disease outcome. Although international standardization remains a concern still, the use of ultrasound in rheumatology is expected to grow further as costs fall and the opportunity to train in the technique improves. We present a review of value of ultrasound, focusing on major applications of ultrasound in rheumatologic diseases.
Humans ; Magnetic Resonance Imaging ; Musculoskeletal System/ultrasonography ; Osteoarthritis/ultrasonography ; Rheumatic Diseases/*ultrasonography ; Sjogren's Syndrome/ultrasonography ; Spondylarthropathies/ultrasonography ; Synovitis/ultrasonography ; Tendinopathy/ultrasonography ; Vasculitis/ultrasonography

OBJECTIVE: To determine the diagnostic value of ultrasonography (US) in detection of calcaneal enthesopathies and compare US findings with clinical examination and laboratory data in patients with seronegative spondyloarthropathy (SpA). METHODS: We studied fifty six patients with SpA (ankylosing spondylitis 51; psoriatic arthritis 2; reactive arthritis 3). Gray scale US and power Doppler sonography (PDS) was performed in Achilles tendons and plantar fascia using a 40 mm, 12 MHz linear probe to detect tendon thickness, loss of normal fibrillar echogenecity, blurred tendon margin, calcification, fluid collection around tendon, bony erosion, enthesopathic spur, retrocalcaneal bursitis and increased vascularity. Clinical examination including Mander enthesis index (MEI) score, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were examined at the same time. RESULTS: In 112 Achilles tendons, 72.3% showed abnormal US findings, as followings, increased tendon thickness 50.9%; loss of normal fibrillar echogenecity 32.1%; blurred tendon margin 24.1%; calcification 5.4%; fluid collection around tendon 17.7%; bony erosion 16%; enthesopathic spur 8.9%; retrocalcaneal bursitis 13.4%; and increased vascularity in power Doppler sonography (PDS) 14.2%. In 112 plantar aponeurosis, 59.8% showed abnormal US enthesopathic spur 8.9%; retrocalcaneal bursitis 13.4%; and increased vascularity in power Doppler sonography (PDS) 14.2%. In 112 plantar aponeurosis, 59.8% showed abnormal US findings, as followings, increased tendon thickness 12.5%; loss of normal fibrillar echogenecity 50%; blurred tendon margin 30.3%; bony spur 2.7%; and increased vascularity in PDS 4.5%. PDS findings well correlated with findings of gray scale US. While 46% of symptomatic patients and 41.2% of patients with tenderness have abnormal X-ray findings, 69.4% of symptomatic patients and 73.8% of patients with tenderness have abnormal US findings. Patients with clinical symptoms, elevated CRP level and >1 MEI score showed increased vascularity in PDS. CONCLUSION: US is a simple and useful method in the detection of enthesopathies of SpA, even in patients without clinical symptom nor abnormal radiographic finding, and PDS combined with gray scale US is more sensitive tool which reflects the clinical examination.
Achilles Tendon ; Arthritis, Psoriatic ; Arthritis, Reactive ; Blood Sedimentation ; Bursitis ; C-Reactive Protein ; Fascia ; Humans ; Rheumatic Diseases* ; Spondylarthropathies* ; Spondylitis ; Tendons ; Ultrasonography