Our patients already wait for care. If we begin doing ultrasound in the office, they will wait even longer to see us. This is important, as, for example, just a few months of early rheumatoid arthritis is destructive to the joints. Additionally, even with rheumatologists working at their current pace, there is already a projected shortfall of nearly two-thirds in the number needed in Canada by 2026 (J. Rheumatol. 2010;37:1749-55).
Ultrasound-guided needle placement in joint spaces sounds wonderful, but we need more long-term proof that it improves outcomes. For instance, when it comes to sacroiliac joint injections, clinical outcome is the same whether the needle is placed in the joint space or in the adjacent tissue (Rheumatology 2010;49:1479-82).
Ultrasound is incredibly subjective and user dependent. You need a lot of training to become good at it: There is only fair to moderate agreement in assessing synovitis for beginners just getting up to speed (Int. J. Rheumatol. 2010;164518). So unless you are an elite expert, you are not going to be that proficient, and there is potential for doing more harm than good.
In summary, point-of-care ultrasound in rheumatology needs more investigation. At present, we recommend against widespread adoption in rheumatologists’ offices. Rheumatologists’ time is too precious to waste on ultrasound exams. Even cardiologists and obstetrician-gynecologists have techs who do the exams; if we try to do them ourselves, our patient wait lists will skyrocket. The cost to you and society makes the choice clear: We should not be doing ultrasound routinely in our office.
Dr. Christopher Penney is a rheumatologist at Foothills Hospital in Calgary, Alta. Dr. David Collins is a rheumatologist at Vancouver (B.C.) General Hospital. Dr. Penney disclosed no relevant conflicts of interest. Dr. Collins disclosed no relevant conflicts of interest. The comments were based on presentations given at the annual meeting of the Canadian Rheumatology Association in Victoria, B.C.