According to Maria Antonietta D’Agostino, Professor of Rheumatology at the Université de Versailles St-Quentinen- Yvelines and the Rheumatology Department of Ambroise Paré, Hospital, Boulogne-Billancourt, France:
Early diagnosis, followed by early initiation and adjustment of treatment, are essential for successful long-term management of chronic inflammatory arthritis. Sensitive and specific methods are required for detection and monitoring of disease.1,2 Of the new imaging methods, ultrasonography (US) appears highly promising.
US is now widely used in rheumatological practice for the assessment and quantification of joint inflammation and damage especially for rheumatoid arthritis (RA). Development of semi-quantitative scoring methods, combined use of imaging technologies (e.g. live US/MRI fusion imaging), and optimal visualisation of joint involvement, both in 2D and in 3D, have all contributed to the usefulness of US for detecting changes in joint inflammation in RA. For this reason, it is important to understand whether these new imaging technologies can translate into routine clinical practice. A clinician needs to quickly assess whether active inflammation is present and whether structural damage is occurring in order to instigate appropriate therapy adjustment.3,4
US allows clinicians to distinguish between joint effusion and synovial hypertrophy and between active and fibrotic synovial hypertrophy based on differences in echogenicity using a grayscale approach (i.e. morphology). More recently, the addition of Doppler techniques has provided more information about synovial vascularity (i.e. inflammation) and the morphology of the synovium as well as temporal changes in the synovium, reflective of the different stages of the disease. The ability to detect inflammation which is not clinically apparent (sub-clinical disease) enables us to consider a new way of detecting early arthritis and explain the apparent association between clinical improvement and radiological deterioration in patients who are in clinical remission.5
Learn more from Professor Maria Antonietta D’Agostino at Rheumatology congress EULAR 2012, at the GE Healthcare / Abbott co-sponsored symposium: "Treat to target: What are the benefits of using a targeted ultrasound approach?" Learn more here.
1. Ostergaard M, et al. Best Pract Res Clin Rheumatol 2008;22:1019–44.
2. Koski JM, et al. Ann Rheum Dis 2006;65:1590–5.
3. Naredo E, et al. Clin Exp Rheumatol 2010;28:79–82.
4. Lagnocco A, et al. Rheumatology (Oxford) 2010;50:1409–13.
5. Saleem B, et al. Ann Rheum Dis 2011;70:792–8.