Ultrasound Has Advantages for Rheumatologists

NEW YORK – Using ultrasound to guide the diagnosis and treatment of rheumatologic conditions has been the standard of care in Europe for several years, and now the practice is becoming more common in the United States, according to Dr. Jonathan Samuels.

In 2008, Dr. Samuels and his colleagues at New York University surveyed members of the American College of Rheumatology and rheumatology fellow trainees across the country. They found that although about 20% said they were currently using ultrasound, more than 75% said it should be a standard clinical tool in the specialty (Bull. NYU Hosp. Jt. Dis. 2010;68:292-8). This suggests a trend that more rheumatologists are using ultrasound than a decade ago, said Dr. Samuels at a rheumatology meeting sponsored by NYU.

Ultrasound is also being introduced into many U.S. fellowship programs and academic departments for both clinical and research purposes, he said, adding that physicians have an increasing number of opportunities to train in the best ways to use ultrasound for rheumatologic conditions. There are now a number of weekend courses sponsored by universities that rheumatologists can take. And the ACR has launched its own series of courses on using ultrasound. Rheumatologists can also get online education and guidance through the USSONAR (Ultrasound School of North American Rheumatologists). For the last 2 years, this institution has conducted an annual competency exam.

Meanwhile, the issue of certification remains up in the air. The ACR Musculoskeletal Ultrasound Task Force has been working to determine if and how it should certify its members in the use of ultrasound. ACR officials are currently surveying their members on this issue, said Dr. Samuels, a rheumatologist at New York University.

According to another source, the ACR is being forced into undertaking the credentialing of musculoskeletal ultrasound, if only because there is no one else to step up to do it.

Dr. Samuels said that for rheumatologists who use ultrasound in the office, this particular imaging technology offers a number of advantages. The procedure is painless, and there’s no claustrophobia or anxiety associated with it, as there may be with other imaging modalities. There’s also no need for patients to be still for long periods of time and no radiation exposure. Ultrasound is much less expensive than other imaging alternatives.

Ultrasound also allows physicians to perform a dynamic assessment, he said. With ultrasound, physicians can move the probe from side to side and patients can view the assessment as it happens rather than looking at a still image later. Another advantage is that physicians can evaluate multiple joints from multiple views in a single imaging session. In some cases, ultrasound can eliminate the need to perform an MRI, but it can also be supplemental, Dr. Samuels said.

There are a number of potential uses for ultrasound in rheumatology, such as in diagnosing and evaluating treatment for inflammatory arthritis, crystal disease, and osteoarthritis. "If used properly, ultrasound can be an extension of our clinical exam," Dr. Samuels said.

In inflammatory arthritis, ultrasound can help with diagnosis and prognosis by detecting erosions, synovitis, effusions, tenosynovitis, enthesopathy, and productive changes such as nodules and tophi. Rheumatologists can also evaluate treatment response by rescanning after prolonged treatment, he said.

In rheumatoid arthritis, clinicians can easily use ultrasound to look for erosions, Dr. Samuels said, and it is more sensitive than using conventional radiography. A study published in 2000 shows that in 40 patients with early RA, the number of erosions detected was more than sixfold greater with ultrasound than with x-ray (Arthritis. Rheum. 2000;43:2762-70). And a review of available evidence on ultrasound in rheumatoid arthritis found that it is comparable to MRI in terms of both inflammatory and destructive changes in RA finger and toe joints (Scand. J. Rheumatol. 2003;32:63-73).

Ultrasound can help to detect RA earlier by investigating synovitis. The ultrasound allows the physicians to identify synovitis through synovial fluid, synovial hypertrophy, and power Doppler signal, Dr. Samuels said.

Ultrasound can also be used to help with aspiration and injections. For example, rheumatologists can use ultrasound to detect whether they need to aspirate an effusion in patients with knee osteoarthritis. It can also help to guide injections that might otherwise be contraindicated if they were to be done blindly in the office, such as hip injections.

Dr. Samuels reported that he had no financial conflicts of interest.

NEW YORK – Using ultrasound to guide the diagnosis and treatment of rheumatologic conditions has been the standard of care in Europe for several years, and now the practice is becoming more common in the United States, according to Dr. Jonathan Samuels.

In 2008, Dr. Samuels and his colleagues at New York University surveyed members of the American College of Rheumatology and rheumatology fellow trainees across the country. They found that although about 20% said they were currently using ultrasound, more than 75% said it should be a standard clinical tool in the specialty (Bull. NYU Hosp. Jt. Dis. 2010;68:292-8). This suggests a trend that more rheumatologists are using ultrasound than a decade ago, said Dr. Samuels at a rheumatology meeting sponsored by NYU.

Ultrasound is also being introduced into many U.S. fellowship programs and academic departments for both clinical and research purposes, he said, adding that physicians have an increasing number of opportunities to train in the best ways to use ultrasound for rheumatologic conditions. There are now a number of weekend courses sponsored by universities that rheumatologists can take. And the ACR has launched its own series of courses on using ultrasound. Rheumatologists can also get online education and guidance through the USSONAR (Ultrasound School of North American Rheumatologists). For the last 2 years, this institution has conducted an annual competency exam.

Meanwhile, the issue of certification remains up in the air. The ACR Musculoskeletal Ultrasound Task Force has been working to determine if and how it should certify its members in the use of ultrasound. ACR officials are currently surveying their members on this issue, said Dr. Samuels, a rheumatologist at New York University.

According to another source, the ACR is being forced into undertaking the credentialing of musculoskeletal ultrasound, if only because there is no one else to step up to do it.

Dr. Samuels said that for rheumatologists who use ultrasound in the office, this particular imaging technology offers a number of advantages. The procedure is painless, and there’s no claustrophobia or anxiety associated with it, as there may be with other imaging modalities. There’s also no need for patients to be still for long periods of time and no radiation exposure. Ultrasound is much less expensive than other imaging alternatives.

Ultrasound also allows physicians to perform a dynamic assessment, he said. With ultrasound, physicians can move the probe from side to side and patients can view the assessment as it happens rather than looking at a still image later. Another advantage is that physicians can evaluate multiple joints from multiple views in a single imaging session. In some cases, ultrasound can eliminate the need to perform an MRI, but it can also be supplemental, Dr. Samuels said.

There are a number of potential uses for ultrasound in rheumatology, such as in diagnosing and evaluating treatment for inflammatory arthritis, crystal disease, and osteoarthritis. "If used properly, ultrasound can be an extension of our clinical exam," Dr. Samuels said.

In inflammatory arthritis, ultrasound can help with diagnosis and prognosis by detecting erosions, synovitis, effusions, tenosynovitis, enthesopathy, and productive changes such as nodules and tophi. Rheumatologists can also evaluate treatment response by rescanning after prolonged treatment, he said.

In rheumatoid arthritis, clinicians can easily use ultrasound to look for erosions, Dr. Samuels said, and it is more sensitive than using conventional radiography. A study published in 2000 shows that in 40 patients with early RA, the number of erosions detected was more than sixfold greater with ultrasound than with x-ray (Arthritis. Rheum. 2000;43:2762-70). And a review of available evidence on ultrasound in rheumatoid arthritis found that it is comparable to MRI in terms of both inflammatory and destructive changes in RA finger and toe joints (Scand. J. Rheumatol. 2003;32:63-73).

Ultrasound can help to detect RA earlier by investigating synovitis. The ultrasound allows the physicians to identify synovitis through synovial fluid, synovial hypertrophy, and power Doppler signal, Dr. Samuels said.

Ultrasound can also be used to help with aspiration and injections. For example, rheumatologists can use ultrasound to detect whether they need to aspirate an effusion in patients with knee osteoarthritis. It can also help to guide injections that might otherwise be contraindicated if they were to be done blindly in the office, such as hip injections.

Dr. Samuels reported that he had no financial conflicts of interest.

NEW YORK – Using ultrasound to guide the diagnosis and treatment of rheumatologic conditions has been the standard of care in Europe for several years, and now the practice is becoming more common in the United States, according to Dr. Jonathan Samuels.

In 2008, Dr. Samuels and his colleagues at New York University surveyed members of the American College of Rheumatology and rheumatology fellow trainees across the country. They found that although about 20% said they were currently using ultrasound, more than 75% said it should be a standard clinical tool in the specialty (Bull. NYU Hosp. Jt. Dis. 2010;68:292-8). This suggests a trend that more rheumatologists are using ultrasound than a decade ago, said Dr. Samuels at a rheumatology meeting sponsored by NYU.

Ultrasound is also being introduced into many U.S. fellowship programs and academic departments for both clinical and research purposes, he said, adding that physicians have an increasing number of opportunities to train in the best ways to use ultrasound for rheumatologic conditions. There are now a number of weekend courses sponsored by universities that rheumatologists can take. And the ACR has launched its own series of courses on using ultrasound. Rheumatologists can also get online education and guidance through the USSONAR (Ultrasound School of North American Rheumatologists). For the last 2 years, this institution has conducted an annual competency exam.

Meanwhile, the issue of certification remains up in the air. The ACR Musculoskeletal Ultrasound Task Force has been working to determine if and how it should certify its members in the use of ultrasound. ACR officials are currently surveying their members on this issue, said Dr. Samuels, a rheumatologist at New York University.

According to another source, the ACR is being forced into undertaking the credentialing of musculoskeletal ultrasound, if only because there is no one else to step up to do it.

Dr. Samuels said that for rheumatologists who use ultrasound in the office, this particular imaging technology offers a number of advantages. The procedure is painless, and there’s no claustrophobia or anxiety associated with it, as there may be with other imaging modalities. There’s also no need for patients to be still for long periods of time and no radiation exposure. Ultrasound is much less expensive than other imaging alternatives.

Ultrasound also allows physicians to perform a dynamic assessment, he said. With ultrasound, physicians can move the probe from side to side and patients can view the assessment as it happens rather than looking at a still image later. Another advantage is that physicians can evaluate multiple joints from multiple views in a single imaging session. In some cases, ultrasound can eliminate the need to perform an MRI, but it can also be supplemental, Dr. Samuels said.

There are a number of potential uses for ultrasound in rheumatology, such as in diagnosing and evaluating treatment for inflammatory arthritis, crystal disease, and osteoarthritis. "If used properly, ultrasound can be an extension of our clinical exam," Dr. Samuels said.

In inflammatory arthritis, ultrasound can help with diagnosis and prognosis by detecting erosions, synovitis, effusions, tenosynovitis, enthesopathy, and productive changes such as nodules and tophi. Rheumatologists can also evaluate treatment response by rescanning after prolonged treatment, he said.

In rheumatoid arthritis, clinicians can easily use ultrasound to look for erosions, Dr. Samuels said, and it is more sensitive than using conventional radiography. A study published in 2000 shows that in 40 patients with early RA, the number of erosions detected was more than sixfold greater with ultrasound than with x-ray (Arthritis. Rheum. 2000;43:2762-70). And a review of available evidence on ultrasound in rheumatoid arthritis found that it is comparable to MRI in terms of both inflammatory and destructive changes in RA finger and toe joints (Scand. J. Rheumatol. 2003;32:63-73).

Ultrasound can help to detect RA earlier by investigating synovitis. The ultrasound allows the physicians to identify synovitis through synovial fluid, synovial hypertrophy, and power Doppler signal, Dr. Samuels said.

Ultrasound can also be used to help with aspiration and injections. For example, rheumatologists can use ultrasound to detect whether they need to aspirate an effusion in patients with knee osteoarthritis. It can also help to guide injections that might otherwise be contraindicated if they were to be done blindly in the office, such as hip injections.

Dr. Samuels reported that he had no financial conflicts of interest.