• National Medical Research Council

• Immune checkpoint inhibition
• Immunotherapy
• Inflammatory arthritis
• Musculoskeletal ultrasound
• irAEs

• Humans
• Immune Checkpoint Inhibitors/adverse effects
• Male
• Female
• Middle Aged
• Aged
• Ultrasonography
• Arthritis/diagnostic imaging
• Arthritis/chemically induced
• Synovitis/diagnostic imaging
• Synovitis/chemically induced
• Adult
• Neoplasms/diagnostic imaging
• Neoplasms/drug therapy
• Point-of-Care Systems
• Musculoskeletal System/diagnostic imaging

• T32 AR007258 NIAMS NIH HHS

• AUC
• Appropriateness Criteria
• appropriate use criteria
• diagnostic imaging
• hand pain
• osteoarthritis
• wrist instability

• Humans
• Chronic Pain/diagnostic imaging
• United States
• Societies, Medical
• Evidence-Based Medicine
• Hand/diagnostic imaging
• Diagnosis, Differential
• Arthralgia/diagnostic imaging

• Early diagnosis
• Medical education, attitudes, practice
• Patient care
• Point-of-care ultrasound
• Rheumatology, ultrasound, musculoskeletal ultrasound
• Surveys and questionnaires

• Humans
• Female
• Male
• Ultrasonography
• Rheumatology/education
• Mexico
• Adult
• Rheumatologists
• Surveys and Questionnaires
• Health Knowledge, Attitudes, Practice
• Attitude of Health Personnel

• Barriers
• Musculoskeletal ultrasound
• POCUS
• Point of care ultrasound
• Training

• Humans
• Arthritis, Psoriatic/diagnostic imaging
• Psoriasis/diagnostic imaging
• Ultrasonography
• Patients

• Aged
• Humans
• Young Adult
• Middle Aged
• Cross-Sectional Studies
• Brazil/epidemiology
• Ultrasonography
• Ultrasonography, Doppler
• Synovitis

• Musculoskeletal ultrasound
• Scanning protocol
• Ultrasound of the elbow
• Ultrasound of the shoulder
• Ultrasound of the wrist and ultrasound of the hand

• Flare
• Predictive
• Rheumatoid arthritis
• Risk factor
• Tenosynovitis
• Ultrasound

In recent years, a novel Doppler ultrasonography (US) modality—superb microvascular imaging (SMI)—has been presented as a reliable method to evaluate small vessel blood flow with minimised motion artefacts. In this review, we present the challenges of incorporating SMI in daily practice with detailed and comparable US images of a fingertip. The main focus of this paper is the discussion of all tested US techniques, artefacts, and practical challenges for evaluating Raynaud’s syndrome in systemic sclerosis. Despite a few reports on SMI use in assessing nailfold capillaries, there is still a need for more evidence of its value and possibilities for its standardisation.

• Doppler
• nailfold capillaroscopy
• superb microvascular imaging
• ultrasound

• cost effectiveness
• magnetic resonance imaging
• musculoskeletal ultrasound
• rheumatology clinic

• Musculoskeletal ultrasound
• Scanning protocol
• Ultrasound of the ankle and foot
• Ultrasound of the hip
• Ultrasound of the knee

• Ankle/diagnostic imaging
• Consensus
• Delphi Technique
• Humans
• North America
• Ultrasonography

• biological agents
• radiology
• rheumatoid arthritis

• clinical guidelines
• imaging
• knee osteoarthritis

• China
• Musculoskeletal ultrasound
• Musculoskeletal ultrasound training
• Musculoskeletal ultrasound use
• Rheumatology
• Survey research

• Asia
• China
• Clinical Competence
• Europe
• Humans
• Musculoskeletal Diseases
• Rheumatologists
• Rheumatology/education
• Ultrasonography

• 2017YFC0907603 National Key Research and Development Program of China
• K01 TW009995 FIC NIH HHS
• 2017YFC0907605 National Key Research and Development Program of China
• 2017YFC0907604 National Key Research and Development Program of China
• 2017YFC0907601 National Key Research and Development Program of China
• 2017YFC0907602 National Key Research and Development Program of China
• T35 HL007649 NHLBI NIH HHS
• 2008BAI59B02 Chinese National Key Technology Research and Development Program, Ministry of Science and Technology
• 2012AA020830 Chinese National High Technology Research and Development Program, Ministry of Science and Technology
• 81601433 National Natural Science Foundation of China

• musculoskeletal ultrasound
• protocol
• rehabilitation
• scleroderma

• 90AR5020 ACL HHS
• K24 AR063120 NIAMS NIH HHS
• R01 AR070470 NIAMS NIH HHS
• R43 AR063129 NIAMS NIH HHS

Musculoskeletal ultrasound (MSUS) and the multi-biomarker disease activity (MBDA) score are outcome measures that may aid in the management of rheumatoid arthritis (RA) patients. This study evaluated tofacitinib response by MSUS/MBDA scores and assessed whether baseline MSUS/MBDA scores or their early changes predict later clinical response.

Twenty-five RA patients treated with tofacitinib were assessed at baseline, 2, 6 and 12-weeks. Power doppler (PDUS) and gray scale (GSUS) ultrasound scores, MBDA score, clinical disease activity index (CDAI), and disease activity score (DAS28) were obtained. Pearson correlations and multiple linear regression models were used to evaluate associations and identify predictors of response to therapy.

MSUS, MBDA scores, CDAI, and DAS28 improved significantly over 12 weeks (p < 0.0001). Baseline MSUS and MBDA score correlated with each other, and with 12-week changes in CDAI/DAS28 (r = 0.45–0.62, p < 0.05), except for GSUS with DAS28. Two-week change in MSUS correlated significantly with 12-week changes in CDAI/DAS28 (r = 0.42–0.57, p < 0.05), except for early change in PDUS with 12-week change in CDAI. Regression analysis demonstrated significant independent associations between baseline PDUS/MBDA score and 6-week change in CDAI/DAS28, with adjustment for baseline CDAI/DAS28 (all p < 0.05); and between baseline MBDA scores and 12-week change in DAS28 (p = 0.03).

RA patients treated with tofacitinib for 12 weeks demonstrated improvement by clinical, imaging, and biomarker end-points. Baseline PDUS and MBDA score were predictive of CDAI and DAS28 responses. This is the first study to evaluate early measurements of MSUS and MBDA score as predictors of clinical response in RA patients treated with tofacitinib.

ClinicalTrials.gov NCT02321930 (registered 12/22/2014).

• Multi-biomarker disease activity score
• Outcome measures
• Rheumatoid arthritis
• Ultrasound

• Cartilage
• Imaging
• Osteoarthritis
• Osteophytes
• Synovitis
• Ultrasound

Joint replacements continue to occur during a rheumatoid arthritis (RA) patient’s lifetime despite significant advances in available treatment options. The purpose of this study was to examine and quantify synovitis in surgically operated joints by ultrasound (US) in RA patients starting a new therapeutic agent.

RA subjects were enrolled in either tocilizumab or tofacitinib open-label, investigator-initiated trials and were assessed by ultrasound. In a subset of RA patients with joint replacements and/or operations of joint areas (OJA; e.g. joint arthroscopies, fusions, and synovectomies), joint-level scores of synovitis were compared between replaced joints, OJAs, and native joints. Joint-level synovitis was measured by grayscale (GSUS (0–3)) and power Doppler (PDUS (0–3)) at baseline and follow-up (3–6 months). McNemar’s test or Wilcoxon signed rank test utilized the mixed effects ordinal logistic regression models.

Twenty RA patients had a total of 25 replaced joints and 24 OJA. All replaced joints had GSUS> 1 and 92% had PDUS> 1 at baseline, while OJA and native joints had lower evidence of GSUS> 1 (37.5, 38% respectively) and PDUS> 1 (45.8, 62% respectively). GSUS and PDUS semiquantitative scores improved significantly with treatment in replaced joints (p = 0.01, p = 0.007), and native joints (p < 0.001 both), but not OJA.

In RA, joint replacement does not eliminate or prevent ultrasound measured synovitis, where all replaced joints have some evidence of US synovitis. US can also act as a potential marker of response to therapy in replaced joints. Scoring US synovitis in replaced joints should be considered in ultrasound RA clinical trials.

ClinicalTrials.gov NCT01717859 (registered 10/31/2012); ClinicalTrials.gov NCT02321930 (registered 12/22/2014).

• Arthritis, rheumatoid
• Joints
• Response
• Surgical procedures operative
• Synovitis
• Ultrasonography

• Diagnostic imaging
• Erosion
• MRI
• Metatarsophalangeal joint
• Rheumatoid arthritis
• Synovial inflammation
• Ultrasonography

Our aim was to evaluate the effectiveness of teaching anatomy through combined musculoskeletal sonoanatomy and human cadaveric dissection for rheumatologists practising musculoskeletal US.

The principal focus was on scanning and then dissecting relevant musculoskeletal structures. Outcomes measured included confidence levels and objective knowledge. A mixed-methods approach of evaluation and descriptive statistical data analysis was performed.

The change in confidence ratings by delegates after the teaching event as represented by the mean difference (s.d.) (s.e.m.) for identification of surface anatomy was 1.846 (1.281) (0.355), with Student’s paired t = 5.196 and P=0.000223. The mean difference (s.d.) (s.e.m) for performing IA injections was 1.538 (1.266) (0.351), with Student’s paired t = 4.382, P=0.001, and for recognizing sonoanatomical structures it was 1.769 (1.235) (0.343), with Student’s paired t  = 5.165 and P= 0.000235. There was a significant increase in correct identification of anatomical and sonoanatomical knowledge in the pre- and post-course assessments. Rotator cuff interval region improved from 13 to 73%, P  = 0.004; knee tendons insertion sites from 47 to 93%, P  = 0.016; and muscles not adjacent to joints from 27 to 93%, P  = 0.002.

Dissection of joints enabled a three-dimensional relational mind map of the relevant regions of the human body, producing clarity in understanding regional relational topographic anatomy and sonoanatomy. The combination of US and cadaveric dissection improved learners’ satisfaction, confidence and knowledge in areas where soft tissue complaints are common, which is likely to lead to accurate early diagnosis and cost-conscious, better overall care.

• Certification
• Competency assessment
• Education
• Musculoskeletal ultrasound
• Ultrasound
• Ultrasound in rheumatology

• Diagnosis
• Early rheumatoid arthritis
• Imaging
• Rheumatic disease
• Ultrasonography
• Ultrasound

• Arthritis, Rheumatoid/diagnostic imaging
• Female
• Humans
• Ultrasonography/methods

• Clinical ultrasonography
• Ecografía clínica
• Enfermedades autoinmunes sistémicas
• Sjögren's syndrome
• Systemic autoimmune diseases
• Síndrome de Sjögren
• Vasculitis

• Consensus
• Humans
• Leadership
• Medicine
• Program Development
• Quality of Health Care
• Ultrasonography/statistics & numerical data
• Workflow

• Antirheumatic Agents/administration & dosage
• Antirheumatic Agents/adverse effects
• Antirheumatic Agents/therapeutic use
• Arthritis, Rheumatoid/drug therapy
• Clinical Decision-Making
• Cost-Benefit Analysis
• Dose-Response Relationship, Drug
• Drug Administration Schedule
• Humans
• Models, Econometric
• Physical Examination
• Quality of Life
• Quality-Adjusted Life Years
• Synovitis/diagnostic imaging
• Synovitis/drug therapy
• Technology Assessment, Biomedical
• Ultrasonography/economics

• procedures
• rheumatic and musculoskeletal diseases
• rheumatology
• scanning
• standardization
• ultrasound

• Consensus
• Delphi Technique
• Europe
• Humans
• Musculoskeletal Diseases/diagnostic imaging
• Rheumatic Diseases/diagnostic imaging
• Rheumatology/standards
• Ultrasonography/methods
• Ultrasonography/standards

• CAT CL-2014-05-006 Department of Health

• Ascites
• Bedside ultrasound
• Education
• Hepatomegaly
• Point-of-care ultrasound (POCUS)
• Rational physical examination

Clinical swollen joint examination of the obese rheumatoid arthritis (RA) patient can be difficult. Musculoskeletal Ultrasound (MSUS) has higher sensitivity than physical examination for swollen joints (SJ). The purpose of this study was to determine the joint-specific association between power Doppler (PDUS) and clinical SJ in RA across body mass index (BMI) categories.

Cross-sectional clinical and laboratory data were collected on 43 RA patients. PDUS was performed on 9 joints (wrist, metacarpalphalangeal 2–5, proximal interphalgeal 2/3 and metatarsalphalangeal 2/5). DAS28 and clinical disease activity index (CDAI) were calculated. Patients were categorized by BMI: <25, 25–30, and >30. Demographic and clinical characteristics were compared across BMI groups with Kruskal-Wallis test and chi-square tests. Joint-level associations between PDUS and clinically SJ were evaluated with mixed effects logistic regression models.

While demographics and clinically-determined disease activity were similar among BMI groups, PDUS scores significantly differed (p = 0.02). Using PDUS activity as the reference standard for synovitis and clinically SJ as the test, the positive predictive value of SJ was significantly lower in higher BMI groups (0.71 in BMI < 25, 0.58 in BMI 25–30 and 0.44 in BMI < 30) (p = 0.02). The logistic model demonstrated that increased BMI category resulted in decreased likelihood of PDUS positivity (OR 0.52, p = 0.03).

This study suggests that in an obese RA patient, a clinically assessed SJ is less likely to represent true synovitis (as measured by PDUS). Disease activity in obese RA patients may be overestimated by CDAI/DAS28 calculations and clinicians when considering change in therapy.

The online version of this article (doi:10.1186/s12891-017-1406-7) contains supplementary material, which is available to authorized users.

• Obesity
• Outcome measures
• Rheumatoid arthritis
• Ultrasound

The main aim was to gain structured insight into the use of musculoskeletal ultrasonography (MSUS) in routine rheumatology practices in Central and Eastern European (CEE) countries. In a cross-sectional, observational, international, multicenter survey, a questionnaire was sent to investigational sites in CEE countries. Data on all subsequent routine MSUS examinations, site characteristics, MSUS equipment, and investigators were collected over 6 months or up to 100 examinations per center. A total of 95 physicians at 44 sites in 9 countries provided information on a total of 2810 MSUS examinations. The most frequent diagnoses were rheumatoid arthritis (RA) and spondyloarthritis (34.8 and 14.9 % of cases, respectively). Mean number of joints examined was 6.8. MSUS was most frequently performed for diagnostic purposes (58 %), particularly in patients with undifferentiated arthritis, suspected soft tissue disorders, or osteoarthritis (73.0–85.3 %). In RA patients, 56.3 % of examinations were conducted to monitor disease activity. Nearly all investigations (99 %) had clinical implications, while the results of 78.6 % of examinations (51.6–99.0 %) were deemed useful for patient education. This first standardized multicountry survey performed in CEEs provided a structured documentation of the routine MSUS use in participating countries. The majority of MSUS examinations were performed for diagnostic purposes, whereas one-third was conducted to monitor disease activity in RA. A majority of examinations had an impact on clinical decision making and were also found to be useful for patient education.

• Central-Eastern Europe
• Clinical practice
• Education
• Musculoskeletal
• Ultrasonography

This study aimed to compare the percentage of detection of periarthritis in patients with rheumatoid arthritis using clinical examination and ultrasound methods.

This study is a cross-sectional study which was conducted in Al-Zahra Hospital (Isfahan, Iran) during 2014–2015. In our study, ninety patients were selected based on the American College of Rheumatology 2010 criteria. All patients were examined by a rheumatologist to find the existence of effusion, and the data were filled in the checklist. The ultrasonography for detecting effusion in periarticular structures was done by an expert radiologist with two methods, including high-resolution ultrasonography and power Doppler. The percentage of effusion existence found by physical examination was compared by sonography, and the Chi-square and t-tests were used for data analysis.

The percentage of effusion found in areas with physical examination by rheumatologist was lower than the frequency distribution of effusions found by sonography (8.3% VS 14.2%) (P < 0.001). In sonography, rotator cuff tendonitis is the most common periarthritis. Other findings in sonography were biceps tendinitis (10 cases), wrist tendonitis (13 cases), olecranon bursitis (9 cases), golfers elbow (4 cases), tennis elbow (4 cases), trochanteric bursitis (6 cases), anserine bursitis (6 cases), prepatellar bursitis (11 cases), and ankle tendonitis (7 cases). Tenderness on physical examination was found in 15% of the cases, and the evidence of periarthritis was found in 21/7% through sonography (P < 0.001) and 34% through Doppler sonography (P < 0.001).

The percentage of periarthritis detection by ultrasonography and power Doppler sonography was higher than clinical examination. Hence, the ultrasonography is more accurate than physical examination.

• Periarthritis
• rheumatoid arthritis
• ultrasonography

• Arthropathy
• Biomarkers
• Hemarthrosis
• Hemophilia
• Imaging

• Clinical examination
• Clinical practice
• Knee
• Rheumatology
• Ultrasonography

• arthropathy
• bleeding
• haemophilia
• pain
• synovitis
• ultrasound

Imaging techniques to assess synovial inflammation includes radiography, ultrasound, computed tomography, magnetic resonance imaging (MRI) and recently positron emission tomography. The ideal objective of imaging approaches are to quantify synovial inflammation by capturing features such as synovial hyperplasia, neo-angiogenesis and infiltration of immune cells in the synovium. This may enable clinicians to estimate response to therapy by measuring the improvement in the inflammatory signals at the level of synovium. Ultrasound can provide information regarding thickening of the synovial membrane and can reveal increased synovial blood flow using power Doppler technique. Bone marrow edema and synovial membrane thickness on MRI scan may serve as indicators for arthritis progression. Enhancement of the synovium on dynamic contrast MRI may closely mirror the inflammatory activity in the synovium. Diffusion tensor imaging is an advance MRI approach that evaluates the inflammation related to cell infiltration or aggregation in an inflamed synovium. In this review, we summarize the newer imaging techniques and their developments to evaluate synovial inflammation.

• Synovitis
• Imaging
• Diffusion tensor imaging
• Positron emission tomography
• Computed tomography
• Ultrasound