SP0116 Value of ultrasound in clinical decision making
Authors: L. Terslev
Journal: Annals of the Rheumatic Diseases (2018)

<h3></h3> The use of ultrasound (US) has increased over the past 20 years for clinical decision making and for optimised patient care. The utility of US for correctly diagnosing the cause of musculoskeletal symptoms is known by many clinicians but little published data exist in this area. However, the value of US for diagnosing and handling treatment decisions especially in patients with rheumatoid arthritis (RA) has been well documented. US has been proven to be more sensitive than clinical joint evaluation.<sup>1 2</sup> This has resulted in the acknowledgement of US as an addition to the clinical joint evaluation in suspected RA patients for assessing a more elaborate joint involvement helping the clinician to correctly classify the patients according to the new RA classification criteria.<sup><sup>3</sup></sup> Likewise, in early undifferentiated inflammatory arthritis the use of US may assist in pinpointing those patients who will develop persistent inflammatory arthritis over time.<sup><sup>4</sup></sup> US may also impact diagnosis and treatment decisions. This has been shown both in situations with regional pain such as the painful foot in chronic inflammatory diseases and the possible need for corticosteroid injections but also in global disease activity assessment in RA patients where US provides additional disease activity information leading to altered treatment decisions as compared to regularly DAS28 assessment.<sup><sup>5,6</sup></sup> Also, in remission US may – by assessing subclinical inflammation – detect those patients with the highest risk of flare.<sup><sup>7</sup></sup> US is a valuable part of future decision making in rheumatology. <h3>References</h3> [1] Wakefield RJ, Green MJ, Marzo-Ortega H, Conaghan PG, Gibbon WW, McGonagle D, et al. Should oligoarthritis be reclassified? Ultrasound reveals a high prevalence of subclinical disease. Ann Rheum Dis2004;63:382–5. [2] Salaffi F, Filippucci E, Carotti M. Naredo E, Meenagh G, Ciapetti A, et al. Inter-observer agreement of standard joint counts in early rheumatoid arthritis: A comparison with grey scale ultrasonography–a preliminary study. Rheumatology (Oxford)2008;47:54–8. [3] Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT, Bingham CO 3rd, Birnbaum NS, Burmester GR, Bykerk VP, Cohen MD, Combe B, Costenbader KH, Dougados M, Emery P, Ferraccioli G, Hazes JM, Hobbs K, Huizinga TW, Kavanaugh A, Kay J, Kvien TK, Laing T, Mease P, Ménard HA, Moreland LW, Naden RL, Pincus T, Smolen JS, Stanislawska-Biernat E, Symmons D, Tak PP, Upchurch KS, Vencovský J, Wolfe F, Hawker G. Rheumatoid arthritis classification criteria: An American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rheum2010Sep;62(9):2569–81. [4] Freeston JE, Wakefield RJ, Conaghan PG, Hensor EM, Stewart SP, Emery P. A diagnostic algorithm for persistence of very early inflammatory arthritis: The utility of power Doppler ultrasound when added to conventional assessment tools. Ann Rheum Dis2010Feb;69(2):417–9. [5] d'Agostino MA, Ayral X, Baron G, Ravaud P, Breban M, Dougados M. Impact of ultrasound imaging on local corticosteroid injections of symptomatic ankle, hind-, and mid-foot in chronic inflammatory diseases. Arthritis Rheum2005Apr 15;53(2):284–92. [6] Dale J, Purves D, McConnachie A, McInnes I, Porter D. Tightening up? Impact of musculoskeletal ultrasound disease activity assessment on early rheumatoid arthritis patients treated using a treat to target strategy. Arthritis Care Res (Hoboken)2014Jan;66(1):19–26. [7] Saleem B, Brown AK, Quinn M, Karim Z, Hensor EM, Conaghan P, Peterfy C, Wakefield RJ, Emery P. Can flare be predicted in DMARD treated RA patients in remission, and is it important? A cohort study. Ann Rheum Dis2012Aug;71(8):1316–21. <h3>Disclosure of Interest</h3> None declared