Ultrasound Imaging of Rheumatoid Arthritis and the Importance of Image Data for the Diagnosis and Treatment of Early Disease

Review Article

Walter Grassi, Luca Di Geso and Emilio Filippucci

Affiliation: Clinica Reumatologica, Universita` Politecnica delle Marche, Ancona, Italy

ABSTRACT

Physical examinations and conventional radiography have low sensitivity for the detection of joint inflammation and damage in patients with rheumatoid arthritis, especially early in the course of the disease. New imaging modalities such as ultrasound allow for accurate and sensitive assessments of both synovitis and bone erosions. The latest generation of ultrasound systems has several advantages over other imaging methods that make them ideal tools for assessing and monitoring early disease. These advantages include reproducibility, repeatability, reduced capital expenditure, high resolution, low running costs and multi‐site examination capability. The impact of the systematic use of ultrasound in the clinical setting of early rheumatoid arthritis still needs further assessment, but there is growing evidence in favor of its value for early diagnosis and in monitoring short‐term therapy. These advantages are particularly important in light of the availability of new and effective disease‐modifying therapies that claim to rapidly induce disease remission. While very recent studies have highlighted the predictive value of sonographic signs of joint disease in terms of the progression of joint damage as documented by conventional radiography, very few reports have documented its role in the assessment of tendons and hyaline cartilage.
Advances in the ultrasound field have not yet reached the plateau phase, and new technologies such as higher frequency volumetric probes and fusion imaging will further enhance the utility of ultrasound for diagnostic applications in the near future.

Keywords: early rheumatoid arthritis, ultrasound, power Doppler, synovitis, bone erosion.
Correspondence: Walter Grassi , MD, Clinica Reumatologica, Università Politecnica delle Marche, Ospedale “A. Murri”, Via dei Colli, 52, 60035 Jesi (Ancona), Italy. Tel: +(39)‐0731‐534125; Fax: +(39)‐0731‐534124; e‐mail: walter.grassi@univpm.it