Rheumatoid arthritis (RA) can be evaluated with ultrasound using both gray scale and Doppler mode. Gray scale provides cross-sectional images of joints, whereas Doppler shows the vascularity of the proliferated synovium. In RA, ultrasound can detect sub-clinical or early synovitis, assess arthritis more accurately than through clinical examination, and predict recurrence. In particular, a Doppler signal detected inside the joint cavity correlates with disease activity. Imaging remission can reflect the true remission status more accurately than with clinical remission. In this review, we focus on the use of ultrasonographic findings for the diagnosis, assessment, and prediction of RA.
Arthritis ; Arthritis, Rheumatoid* ; Diagnosis ; Joints ; Recurrence ; Synovial Membrane ; Synovitis ; Ultrasonography

Transient synovitis of the hip is non-specific inflammation and self limited condition, which is most common cause of painful limping in children under 10 years of age. Ultrasonography presents some merits, simple, rapid, non-invasive, low cost, repetitive to assess soft structures in and around the hip joint compared to other diagnostic methods. We prospectively studied 32 cases of unilateral transient synovitis at OPD from Jan. 1988 to Oct. 1989 using 5-7.5 MH, probe ultrasonography. 2-times serial check up in symptomatic and asymptomatic stage about capsule thickness and bone-capsule distance in 3 different positions of the both hips were performed for comparision. The following results were obtained; 1. Boys were 25 cases (78%) and 26 cases (83%) were between 3 and 7 years old of age. 2. Bone-capsule distance in ultrasonography revealed abnormal increase in 72%. 3. External rotation position showed wider bone-capsule distance than other position. 4. Capsule thickness was 3.3mm in diseased and 3.0mm in sound, 0.3mm decrease after treatment. 5. Bone-capsule distance was 4.5mm in symptomatic stage, 2.7mm in asymptomatic stage, 1.8mm decrease after treatment in averge.
Child ; Hip Joint ; Hip ; Humans ; Inflammation ; Prospective Studies ; Synovitis ; Ultrasonography

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

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 occurrence of PVNS in the TMJ is very rare. We report a case of PVNS which was misdiagnosed as a parotid tumor at first. CT and conventional radiograph revealed a well difined mass demonstrating higher attenuation than adjacent soft tissue. Erosion, expansion of the cortical plate of the mandibular condyle and sclerotic change beneath the margin of the lesion were also shown. MRI demonstrated well defined mass of very low signal intensity on both T1 and T2 image due to ferromagnetic effect and more clearly delineated the extent of the lesion. Ultrasonogram showed homogenous hypoechoic lesion growing toward both condyle and adjacent soft tissue. Histopathologic findings and characteristic appearance of the various imaging method were discribed and the usefulness of these image for diagnosis and pretreatment evaluation of the PVNS were also discussed on this paper.
Diagnosis ; Diagnostic Imaging* ; Magnetic Resonance Imaging ; Magnets ; Mandibular Condyle ; Synovitis, Pigmented Villonodular* ; Temporomandibular Joint* ; Ultrasonography

Ultrasonography (US) is a cost effective diagnostic imaging tool suitable for routine clinical use. High frequency US is a well-established method for both the diagnosis and monitoring of inflammatory arthritis, capable of detecting a wide range of joint pathologies, including effusion, synovitis, and extra-articular abnormalities. However, to ensure an accurate diagnosis, it is also important to consider periarticular disorders that could clinically mimic joint pathology. Such a diagnosis requires special attention to be paid to the periarticular structures, include the tendon, ligament, muscle, and bursa. Due to the close proximity of these structures to potentially affected joints, periarticular inflammation is often clinically misdiagnosed as articular in origin. In these cases, the processes driving pathology are the result of localized inflammation that is secondary to inflammatory arthritis, such as excessive friction or direct trauma. Therefore, when using US to diagnose inflammatory arthritis, it is important to understand the causative pathology of the periarticular disorders, as well as their clinical presentation.
Arthritis ; Diagnosis ; Diagnostic Imaging ; Friction ; Inflammation ; Joints ; Ligaments ; Pathology ; Synovitis ; Tendons ; Ultrasonography

Ultrasonography (US) is a valuable imaging modality used to assess joint and periarticular abnormalities in patients with osteoarthritis (OA). US can detect articular cartilage damage, bony changes, joint effusion, synovitis, and adjacent soft tissue lesions. In addition, US facilitates the monitoring of disease progression and effects of treatments. US is a safe and accessible bedside procedure that can improve diagnosis and management of patients. The objective of this article was to describe the clinical applications of US for patients with OA.
Cartilage ; Cartilage, Articular ; Diagnosis ; Disease Progression ; Humans ; Joints ; Osteoarthritis* ; Synovitis ; Ultrasonography*

OBJECTIVETo observe the differential effect of joint ultrasound on the syndrome differentiation of rheumatoid arthritis (RA) by observing the high frequency ultrasound performances among inactive stage and different syndromes in active stage.

METHODSTotally 83 RA patients in the active stage were assigned to the dampness heat syndrome group (DHS, 59 cases)and the cold dampness syndrome group (CDS, 24 cases) according to Chinese medicine (CM) syndrome typing. Besides, 20 RA patients in the remission stage were recruited as the control group (abbreviated as the remission group). By using high frequency ultrasound and power Doppler ultrasound technology, a comparative observation of synovitis, tenosynovitis, synovial blood flow, and bone erosion in the 2nd-5th metacarpophalangeal (MCP) joints, proximal interphalangeal (PIP) joints, wrist joints, knee joints, the second and the fifth metatarsophalangeal (MTP) joints (a total of 24 joints) was performed in all patients. Correlation analyses were performed between the ultrasound performance, laboratory indices, and the disease activity. Ultrasound data of each RA patient were analyzed by their total scores. Χ2 test was used for enumeration data. The measurement data was expressed as x ± s. One-way ANOVA was used for data of normal distribution, while non- parametric test was used for data of non-normal distribution. Correlation analysis of two variables was performed for clinical indicators and ultrasound indicators. Its significance was detected using Pearson correlation.

RESULTSCompared with the remission group, the severity degree of synovitis, tenosynovitis, synovial blood flow, and bone erosion significantly increased in the DHS group (P < 0.01). There was statistical difference in ESR, CRP, anti-CCP, DAS28 score, and the positive rate of RF (P < 0.05, P < 0.01). There was statistical difference in the severity degree of synovitis and synovial blood flow, and DAS28 score in the CDS group (P < 0.05). Compared with the CDS group, there was statistical difference in the four ultrasound indices (P < 0.05, P < 0.01), ESR, CRP, anti-CCP, DAS28 score, and the positive rate of RF in the DHS group (P < 0.05, P < 0.01). There was no statistical difference in G, IgG, IgA, or IgM among the three groups (P > 0.05). There existed positive correlation between ESR and the synovitis degree, synovial blood flow, and bone erosion in the DHS group (r = 0.444, 0.397, 0.486, P < 0.05).There existed positive correlation between ESR and the synovitis degree, bone erosion, and synovial blood flow in the DHS group (r = 0.378, 0.270, P < 0.05). There existed positive correlation between the DAS28 score and the synovitis degree and synovial blood flow in the DHS group (r = 0.304, 0.351, P < 0.05).

CONCLUSIONSThe inflammation degree was the most severe in RA patients of DHS. High frequency ultrasound could provide better evidence for Chinese medical syndrome differentiation of RA patients.

Arthritis, Rheumatoid ; diagnostic imaging ; Humans ; Medicine, Chinese Traditional ; Metacarpophalangeal Joint ; ultrastructure ; Syndrome ; Synovitis ; diagnostic imaging ; Ultrasonography

The diagnosis of painful hips of the children are very difficult in their early stage of diseases. Transient synovitis, Legg-Calve-Perthes' diseas juvenile rheumatoid arthritis and pyogenic hip are very similar in clinical manifestation and plane radiology. But the treatment methods and prognoses are very different, so it is very important to make an accurate diagnosis and differential diagnosis as early as possible. In the above mentioned diseases hip joint effusion is one of common manifestations, so we studied the hip joint effusion by ultrasonography in 49 children with painful hips and also we studied both hips of healthy children to determine the criteria of the normal hip joint. And the results are summerized as follows: l. Ultrasonography was very good method for detection of hip joint effusion. 2. In healthy children, the average bone-to-capsule distance was 2.95mm. 3. In children patients with unilateral painful hip, the average bone-to-capsule distance was 2.96mm, so it was very similar to that of healthy children. 4. The difference more than 2mm between both hips was abnormal. 5. In 49 children with painful hips, over all positive rate was 63.3%.
Arthritis, Juvenile ; Child ; Diagnosis ; Diagnosis, Differential ; Hip Joint ; Hip ; Humans ; Methods ; Prognosis ; Synovitis ; Ultrasonography

BACKGROUND: Many shoulder diseases are related to glenohumeral joint synovitis and effusion. The purpose of the present study is to detect effusion within the biceps long head tendon sheath as the sign of glenohumeral joint synovitis using ultrasonography, and to evaluate the clinical meaning of effusion within the biceps long head tendon sheath. METHODS: A consecutive series of 569 patients who underwent ultrasonography for shoulder pain were reviewed retrospectively and ultimately, 303 patients were included. The authors evaluated the incidence and amount of the effusion within the biceps long head tendon sheath on the ultrasonographic short axis view. Furthermore, the authors evaluated the correlation between the amount of effusion within the biceps long head tendon sheath and the range of motion and the functional score. RESULTS: The effusion within the biceps long head tendon sheath was detected in 58.42% of the patients studied: 69.23% in adhesive capsulitis, 56.69% in rotator cuff tear, 41.03% in calcific tendinitis, and 33.33% in biceps tendinitis. The average amount of the effusion within the biceps long head tendon sheath was 1.7 +/- 1.6 mm, and it was measured to be the largest in adhesive capsulitis. The amount of effusion within biceps long head tendon sheath showed a moderate to high degree of correlation with the range of motion, and a low degree of correlation with the functional score and visual analogue scale for pain in each type of shoulder disease. CONCLUSIONS: The effusion within the biceps long head tendon sheath is closely related to the range of motion and clinical scores in patients with painful shoulders. Ultrasonographic detection of the effusion within the biceps long head tendon sheath might be a simple and easy method to evaluate shoulder function.
Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Male ; Middle Aged ; Range of Motion, Articular ; Retrospective Studies ; Shoulder Joint/physiopathology/*ultrasonography ; Synovitis/*ultrasonography ; Tendons/*ultrasonography