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Rheumatoid Arthritis

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Musculoskeletal Ultrasonography in Rheumatic Diseases

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Abstract

Rheumatoid arthritis (RA) is a chronic disease characterized mainly by joint inflammation that can lead to permanent structural damage. An accurate assessment of joint inflammation is of outmost importance for disease management. Over the past years, musculoskeletal ultrasound (MSUS) has proved to be a sensitive tool not only in detecting joint and periarticular inflammation, i.e., synovitis, tenosynovitis, and bursitis, but also in evaluating structural damages such as erosion and tendon damage. In addition to clinical and laboratory evaluation, MSUS has been successfully used to early diagnose RA. In RA patients, B-mode (BM) and Doppler techniques characterize better than clinical assessment joint inflammation (either synovial hypertrophy or effusion, either active or inactive synovitis) and reflect accurately disease inflammatory activity. Doppler-detected synovitis has been shown to be predictive for structural damage, even in patients in clinical remission. Furthermore, MSUS has proved successful in monitoring response to treatment and is also a valuable tool for guiding MSUS injections.

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Abbreviations

ACPA:

Anti-citrullinated protein antibodies

ACR:

American College of Rheumatology

ADA:

Adalimumab

b:

Biologic

BM:

B-mode

BME:

Bone marrow edema

CD:

Color Doppler

CR:

Conventional radiography

CRP:

C-reactive protein

cs:

Conventional synthetic

CT:

Computed tomography

DAS:

Disease activity index

DMARDs:

Disease-modifying antirheumatic drugs

ECU:

Extensor carpi ulnaris

ESR:

Erythrocyte sedimentation rate

EULAR:

European League Against Rheumatism

GH:

Glenohumeral

IFX:

infliximab

IgM-RF:

immunoglobulin M-rheumatoid factor

MCP:

Metacarpophalangeal

MMP:

Matrix metalloprotease

MRI:

Magnetic resonance imaging

MS:

Musculoskeletal

MTP:

Metatarsophalangeal

MTX:

Methotrexate

NSAIDs:

Nonsteroidal anti-inflammatory drugs

OA:

Osteoarthritis

OMERACT:

Outcome measures in Rheumatology

OR:

Odds ratio

PD:

Power Doppler

PIP:

Proximal interphalangeal

PsA:

Psoriatic arthritis

RA:

Rheumatoid arthritis

SASD:

Subacromial subdeltoid

SDAI:

Simplified disease activity index

SE:

Synovial fluid/effusion

SH:

Synovial hypertrophy

SOLAR:

Sonography of large joints in rheumatology

SpA:

Spondyloarthropathy

TA:

Tibialis anterior

TIMP:

Metallopeptidase inhibitor

TNF:

Tumor necrosis factor

TP:

Tibialis posterior

US:

Ultrasound

VEGF:

Vascular endothelial growth factor

References

  1. Pincus T, Callahan LF, Sale WG, Brooks AL, Payne LE, Vaughn WK. Severe functional declines, work disability, and increased mortality in seventy-five rheumatoid arthritis patients studied over nine years. Arthritis Rheum. 1984;27(8):864–72.

    CAS  PubMed  Google Scholar 

  2. Scott DL, Symmons DP, Coulton BL, Popert AJ. Long-term outcome of treating rheumatoid arthritis: results after 20 years. Lancet 1987;1:1108–11.

    Google Scholar 

  3. Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT, Bingham CO 3rd, et al. Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rheum. 2010;62(9):2569–81.

    PubMed  Google Scholar 

  4. Barnabe C, Martin BJ, Ghali WA. Systematic review and meta-analysis: anti-tumor necrosis factor alpha therapy and cardiovascular events in rheumatoid arthritis. Arthritis Care Res. 2011;63(4):522–9.

    CAS  Google Scholar 

  5. Smolen JS, Aletaha D, Bijlsma JW, Breedveld FC, Boumpas D, Burmester G, et al. Treating rheumatoid arthritis to target: recommendations of an international task force. Ann Rheum Dis. 2010;69(4):631–7.

    PubMed Central  PubMed  Google Scholar 

  6. Nam JL, Ramiro S, Gaujoux-Viala C, Takase K, Leon-Garcia M, Emery P, et al. Efficacy of biological disease-modifying antirheumatic drugs: a systematic literature review informing the 2013 update of the EULAR recommendations for the management of rheumatoid arthritis. Ann Rheum Dis. 2014;73(3):516–28.

    CAS  PubMed  Google Scholar 

  7. Karim Z, Wakefield RJ, Quinn M, Conaghan PG, Brown AK, Veale DJ, et al. Validation and reproducibility of ultrasonography in the detection of synovitis in the knee: a comparison with arthroscopy and clinical examination. Arthritis Rheum. 2004;50(2):387–94.

    CAS  PubMed  Google Scholar 

  8. Kane D, Balint PV, Sturrock RD. Ultrasonography is superior to clinical examination in the detection and localization of knee joint effusion in rheumatoid arthritis. J Rheumatol. 2003;30(5):966–71.

    PubMed  Google Scholar 

  9. Wakefield RJ, Green MJ, Marzo-Ortega H, Conaghan PG, Gibbon WW, McGonagle D, et al. Should oligoarthritis be reclassified? Ultrasound reveals a high prevalence of subclinical disease. Ann Rheum Dis. 2004;63(4):382–5.

    PubMed Central  CAS  PubMed  Google Scholar 

  10. Naredo E, Bonilla G, Gamero F, Uson J, Carmona L, Laffon A. Assessment of inflammatory activity in rheumatoid arthritis: a comparative study of clinical evaluation with grey scale and power Doppler ultrasonography. Ann Rheum Dis. 2005;64(3):375–81.

    PubMed Central  CAS  PubMed  Google Scholar 

  11. Scheel AK, Schmidt WA, Hermann KG, Bruyn GA, D’Agostino MA, Grassi W, et al. Interobserver reliability of rheumatologists performing musculoskeletal ultrasonography: results from a EULAR ‟Train the trainers” course. Ann Rheum Dis. 2005;64(7):1043–9.

    PubMed Central  CAS  PubMed  Google Scholar 

  12. Szkudlarek M, Klarlund M, Narvestad E, Court-Payen M, Strandberg C, Jensen KE, et al. Ultrasonography of the metacarpophalangeal and proximal interphalangeal joints in rheumatoid arthritis: a comparison with magnetic resonance imaging, conventional radiography and clinical examination. Arthritis Res Ther. 2006;8(2):R52.

    PubMed Central  PubMed  Google Scholar 

  13. Salaffi F, Filippucci E, Carotti M, Naredo E, Meenagh G, Ciapetti A, et al. Inter-observer agreement of standard joint counts in early rheumatoid arthritis: a comparison with grey scale ultrasonography–a preliminary study. Rheumatology 2008;47(1):54–8.

    CAS  PubMed  Google Scholar 

  14. Scire CA, Montecucco C, Codullo V, Epis O, Todoerti M, Caporali R. Ultrasonographic evaluation of joint involvement in early rheumatoid arthritis in clinical remission: power Doppler signal predicts short-term relapse. Rheumatology 2009;48(9):1092–7.

    CAS  PubMed  Google Scholar 

  15. Hammer HB, Sveinsson M, Kongtorp AK, Kvien TK. A 78-joints ultrasonographic assessment is associated with clinical assessments and is highly responsive to improvement in a longitudinal study of patients with rheumatoid arthritis starting adalimumab treatment. Ann Rheum Dis. 2010;69(7):1349–51.

    CAS  PubMed  Google Scholar 

  16. Naredo E, Valor L, De la Torre I, Martinez-Barrio J, Hinojosa M, Aramburu F, et al. Ultrasound joint inflammation in rheumatoid arthritis in clinical remission: how many and which joints should be assessed? Arthritis Care Res. 2013;65(4):512–7.

    Google Scholar 

  17. Wakefield RJ, Balint PV, Szkudlarek M, Filippucci E, Backhaus M, D’Agostino MA, et al. Musculoskeletal ultrasound including definitions for ultrasonographic pathology. J Rheumatol. 2005;32(12):2485–7.

    PubMed  Google Scholar 

  18. Szkudlarek M, Court-Payen M, Jacobsen S, Klarlund M, Thomsen HS, Ostergaard M. Interobserver agreement in ultrasonography of the finger and toe joints in rheumatoid arthritis. Arthritis Rheum. 2003;48(4):955–62.

    PubMed  Google Scholar 

  19. Naredo E, D’Agostino MA, Wakefield RJ, Moller I, Balint PV, Filippucci E, et al. Reliability of a consensus-based ultrasound score for tenosynovitis in rheumatoid arthritis. Ann Rheum Dis. 2013;72(8):1328–34.

    PubMed  Google Scholar 

  20. Bruyn GA, Moller I, Garrido J, Bong D, dʼAgostino MA, Iagnocco A, et al. Reliability testing of tendon disease using two different scanning methods in patients with rheumatoid arthritis. Rheumatology 2012;51(9):1655–61.

    PubMed  Google Scholar 

  21. Wakefield RJ, O’Connor PJ, Conaghan PG, McGonagle D, Hensor EM, Gibbon WW, et al. Finger tendon disease in untreated early rheumatoid arthritis: a comparison of ultrasound and magnetic resonance imaging. Arthritis Rheum. 2007;57(7):1158–64.

    CAS  PubMed  Google Scholar 

  22. Micu MC, Serra S, Fodor D, Crespo M, Naredo E. Inter-observer reliability of ultrasound detection of tendon abnormalities at the wrist and ankle in patients with rheumatoid arthritis. Rheumatology 2011;50(6):1120–4.

    PubMed  Google Scholar 

  23. Colebatch AN, Edwards CJ, Ostergaard M, van der Heijde D, Balint PV, DʼAgostino MA, et al. EULAR recommendations for the use of imaging of the joints in the clinical management of rheumatoid arthritis. Ann Rheum Dis. 2013;72(6):804–14.

    PubMed  Google Scholar 

  24. Fiocco U, Cozzi L, Rigon C, Chieco-Bianchi F, Baldovin M, Cassisi GA, et al. Arthroscopic synovectomy in rheumatoid and psoriatic knee joint synovitis: long-term outcome. Br J Rheumatol. 1996;35(5):463–70.

    CAS  PubMed  Google Scholar 

  25. Walther M, Harms H, Krenn V, Radke S, Faehndrich TP, Gohlke F. Correlation of power Doppler sonography with vascularity of the synovial tissue of the knee joint in patients with osteoarthritis and rheumatoid arthritis. Arthritis Rheum. 2001;44(2):331–8.

    CAS  PubMed  Google Scholar 

  26. Walther M, Harms H, Krenn V, Radke S, Kirschner S, Gohlke F. Synovial tissue of the hip at power Doppler US: correlation between vascularity and power Doppler US signal. Radiology 2002;225(1):225–31.

    PubMed  Google Scholar 

  27. Andersen M, Ellegaard K, Hebsgaard JB, Christensen R, Torp-Pedersen S, Kvist PH, et al. Ultrasound colour Doppler is associated with synovial pathology in biopsies from hand joints in rheumatoid arthritis patients: a cross-sectional study. Ann Rheum Dis. 2014;73(4):678–83.

    PubMed  Google Scholar 

  28. Takase K, Ohno S, Takeno M, Hama M, Kirino Y, Ihata A, et al. Simultaneous evaluation of long-lasting knee synovitis in patients undergoing arthroplasty by power Doppler ultrasonography and contrast-enhanced MRI in comparison with histopathology. Clin Exp Rheumatol. 2012;30(1):85–92.

    CAS  PubMed  Google Scholar 

  29. Koski JM, Saarakkala S, Helle M, Hakulinen U, Heikkinen JO, Hermunen H. Power Doppler ultrasonography and synovitis: correlating ultrasound imaging with histopathological findings and evaluating the performance of ultrasound equipments. Ann Rheum Dis. 2006;65(12):1590–5.

    PubMed Central  CAS  PubMed  Google Scholar 

  30. Fukae J, Kon Y, Henmi M, Sakamoto F, Narita A, Shimizu M, et al. Change of synovial vascularity in a single finger joint assessed by power Doppler sonography correlated with radiographic change in rheumatoid arthritis: comparative study of a novel quantitative score with a semiquantitative score. Arthritis Care Res. 2010;62(5):657–63.

    Google Scholar 

  31. Szkudlarek M, Narvestad E, Klarlund M, Court-Payen M, Thomsen HS, Ostergaard M. Ultrasonography of the metatarsophalangeal joints in rheumatoid arthritis: comparison with magnetic resonance imaging, conventional radiography, and clinical examination. Arthritis Rheum. 2004;50(7):2103–12.

    PubMed  Google Scholar 

  32. Szkudlarek M, Court-Payen M, Strandberg C, Klarlund M, Klausen T, Ostergaard M. Power Doppler ultrasonography for assessment of synovitis in the metacarpophalangeal joints of patients with rheumatoid arthritis: a comparison with dynamic magnetic resonance imaging. Arthritis Rheum. 2001;44(9):2018–23.

    CAS  PubMed  Google Scholar 

  33. Scheel AK, Hermann KG, Kahler E, Pasewaldt D, Fritz J, Hamm B, et al. A novel ultrasonographic synovitis scoring system suitable for analyzing finger joint inflammation in rheumatoid arthritis. Arthritis Rheum. 2005;52(3):733–43.

    PubMed  Google Scholar 

  34. Terslev L, Torp-Pedersen S, Savnik A, von der Recke P, Qvistgaard E, Danneskiold-Samsoe B, et al. Doppler ultrasound and magnetic resonance imaging of synovial inflammation of the hand in rheumatoid arthritis: a comparative study. Arthritis Rheum. 2003;48(9):2434–41.

    CAS  PubMed  Google Scholar 

  35. Kawashiri SY, Suzuki T, Nakashima Y, Horai Y, Okada A, Nishino A, et al. Synovial inflammation assessed by ultrasonography correlates with MRI-proven osteitis in patients with rheumatoid arthritis. Rheumatology 2014;53(8):1452–6.

    CAS  PubMed  Google Scholar 

  36. Kawashiri SY, Kawakami A, Iwamoto N, Fujikawa K, Satoh K, Tamai M, et al. The power Doppler ultrasonography score from 24 synovial sites or 6 simplified synovial sites, including the metacarpophalangeal joints, reflects the clinical disease activity and level of serum biomarkers in patients with rheumatoid arthritis. Rheumatology 2011;50(5):962–5.

    CAS  PubMed  Google Scholar 

  37. Naredo E, Moller I, Moragues C, de Agustin JJ, Scheel AK, Grassi W, et al. Interobserver reliability in musculoskeletal ultrasonography: results from a †Teach the Teachers” rheumatologist course. Ann Rheum Dis. 2006;65(1):14–9.

    PubMed Central  CAS  PubMed  Google Scholar 

  38. Brown AK, Quinn MA, Karim Z, Conaghan PG, Peterfy CG, Hensor E, et al. Presence of significant synovitis in rheumatoid arthritis patients with disease-modifying antirheumatic drug-induced clinical remission: evidence from an imaging study may explain structural progression. Arthritis Rheum. 2006;54(12):3761–73.

    CAS  PubMed  Google Scholar 

  39. Filer A, de Pablo P, Allen G, Nightingale P, Jordan A, Jobanputra P, et al. Utility of ultrasound joint counts in the prediction of rheumatoid arthritis in patients with very early synovitis. Ann Rheum Dis. 2011;70(3):500–7.

    PubMed Central  PubMed  Google Scholar 

  40. Cheung PP, Dougados M, Gossec L. Reliability of ultrasonography to detect synovitis in rheumatoid arthritis: a systematic literature review of 35 studies (1,415 patients). Arthritis Care Res. 2010;62(3):323–34.

    Google Scholar 

  41. Mandl P, Balint PV, Brault Y, Backhaus M, DʼAgostino MA, Grassi W, et al. Metrologic properties of ultrasound versus clinical evaluation of synovitis in rheumatoid arthritis: results of a multicenter, randomized study. Arthritis Rheum. 2012;64(4):1272–82.

    CAS  PubMed  Google Scholar 

  42. Hau M, Kneitz C, Tony HP, Keberle M, Jahns R, Jenett M. High resolution ultrasound detects a decrease in pannus vascularisation of small finger joints in patients with rheumatoid arthritis receiving treatment with soluble tumour necrosis factor alpha receptor (etanercept). Ann Rheum Dis. 2002;61(1):55–8.

    PubMed Central  CAS  PubMed  Google Scholar 

  43. Ribbens C, Andre B, Marcelis S, Kaye O, Mathy L, Bonnet V, et al. Rheumatoid hand joint synovitis: gray-scale and power Doppler US quantifications following anti-tumor necrosis factor-alpha treatment: pilot study. Radiology 2003;229(2):562–9.

    PubMed  Google Scholar 

  44. Terslev L, Torp-Pedersen S, Qvistgaard E, Kristoffersen H, Rogind H, Danneskiold-Samsoe B, et al. Effects of treatment with etanercept (Enbrel, TNRF:Fc) on rheumatoid arthritis evaluated by Doppler ultrasonography. Ann Rheum Dis. 2003;62(2):178–81.

    PubMed Central  CAS  PubMed  Google Scholar 

  45. Filippucci E, Iagnocco A, Salaffi F, Cerioni A, Valesini G, Grassi W. Power Doppler sonography monitoring of synovial perfusion at the wrist joints in patients with rheumatoid arthritis treated with adalimumab. Ann Rheum Dis. 2006;65(11):1433–7.

    PubMed Central  CAS  PubMed  Google Scholar 

  46. Naredo E, Moller I, Cruz A, Carmona L, Garrido J. Power Doppler ultrasonographic monitoring of response to anti-tumor necrosis factor therapy in patients with rheumatoid arthritis. Arthritis Rheum. 2008;58(8):2248–56.

    PubMed  Google Scholar 

  47. Scheel AK, Hermann KG, Ohrndorf S, Werner C, Schirmer C, Detert J, et al. Prospective 7 year follow up imaging study comparing radiography, ultrasonography, and magnetic resonance imaging in rheumatoid arthritis finger joints. Ann Rheum Dis. 2006;65(5):595–600.

    PubMed Central  CAS  PubMed  Google Scholar 

  48. Naredo E, Collado P, Cruz A, Palop MJ, Cabero F, Richi P, et al. Longitudinal power Doppler ultrasonographic assessment of joint inflammatory activity in early rheumatoid arthritis: predictive value in disease activity and radiologic progression. Arthritis Rheum. 2007;57(1):116–24.

    PubMed  Google Scholar 

  49. Taylor PC, Steuer A, Gruber J, Cosgrove DO, Blomley MJ, Marsters PA, et al. Comparison of ultrasonographic assessment of synovitis and joint vascularity with radiographic evaluation in a randomized, placebo-controlled study of infliximab therapy in early rheumatoid arthritis. Arthritis Rheum. 2004;50(4):1107–16.

    CAS  PubMed  Google Scholar 

  50. Newman JS, Laing TJ, McCarthy CJ, Adler RS. Power Doppler sonography of synovitis: assessment of therapeutic response–preliminary observations. Radiology 1996;198(2):582–4.

    CAS  PubMed  Google Scholar 

  51. Terslev L, Torp-Pedersen S, Qvistgaard E, Danneskiold-Samsoe B, Bliddal H. Estimation of inflammation by Doppler ultrasound: quantitative changes after intra-articular treatment in rheumatoid arthritis. Ann Rheum Dis. 2003;62(11):1049–53.

    PubMed Central  CAS  PubMed  Google Scholar 

  52. Filippucci E, Farina A, Carotti M, Salaffi F, Grassi W. Grey scale and power Doppler sonographic changes induced by intra-articular steroid injection treatment. Ann Rheum Dis. 2004;63(6):740–3.

    PubMed Central  CAS  PubMed  Google Scholar 

  53. Stone M, Bergin D, Whelan B, Maher M, Murray J, McCarthy C. Power Doppler ultrasound assessment of rheumatoid hand synovitis. J Rheumatol. 2001;28(9):1979–82.

    CAS  PubMed  Google Scholar 

  54. Teh J, Stevens K, Williamson L, Leung J, McNally EG. Power Doppler ultrasound of rheumatoid synovitis: quantification of therapeutic response. Br J Radiol. 2003;76(912):875–9.

    CAS  PubMed  Google Scholar 

  55. Qvistgaard E, Rogind H, Torp-Pedersen S, Terslev L, Danneskiold-Samsoe B, Bliddal H. Quantitative ultrasonography in rheumatoid arthritis: evaluation of inflammation by Doppler technique. Ann Rheum Dis. 2001;60(7):690–3.

    PubMed Central  CAS  PubMed  Google Scholar 

  56. Terslev L, Ellegaard K, Christensen R, Szkudlarek M, Schmidt WA, Jensen PS, et al. Head-to-head comparison of quantitative and semi-quantitative ultrasound scoring systems for rheumatoid arthritis: reliability, agreement and construct validity. Rheumatology 2012;51(11):2034–8.

    PubMed  Google Scholar 

  57. Sakellariou G, Iagnocco A, Filippucci E, Ceccarelli F, Di Geso L, Carli L, et al. Ultrasound imaging for the rheumatologist XLVIII. Ultrasound of the shoulders of patients with rheumatoid arthritis. Clin Exp Rheumatol. 2013;31(6):837–42.

    PubMed  Google Scholar 

  58. Di Geso L, Filippucci E, Riente L, Sakellariou G, Delle Sedie A, Meenagh G, et al. Ultrasound imaging for the rheumatologist XL. Sonographic assessment of the hip in rheumatoid arthritis patients. Clin Exp Rheumatol. 2012;30(4):464–8.

    PubMed  Google Scholar 

  59. Hoving JL, Buchbinder R, Hall S, Lawler G, Coombs P, McNealy S, et al. A comparison of magnetic resonance imaging, sonography, and radiography of the hand in patients with early rheumatoid arthritis. J Rheumatol. 2004;31(4):663–75.

    PubMed  Google Scholar 

  60. Hammer HB, Kvien TK. Ultrasonography shows significant improvement in wrist and ankle tenosynovitis in rheumatoid arthritis patients treated with adalimumab. Scand J Rheumatol. 2011;40(3):178–82.

    CAS  PubMed  Google Scholar 

  61. Filippucci E, Gabba A, Di Geso L, Girolimetti R, Salaffi F, Grassi W. H and tendon involvement in rheumatoid arthritis: an ultrasound study. Semin Arthritis Rheum. 2012;41(6):752–60.

    PubMed  Google Scholar 

  62. Wakefield RJ, Freeston JE, O’Connor P, Reay N, Budgen A, Hensor EM, et al. The optimal assessment of the rheumatoid arthritis hindfoot: a comparative study of clinical examination, ultrasound and high field MRI. Ann Rheum Dis. 2008;67(12):1678–82.

    CAS  PubMed  Google Scholar 

  63. Wakefield RJ, Gibbon WW, Conaghan PG, OʼConnor P, McGonagle D, Pease C, et al. The value of sonography in the detection of bone erosions in patients with rheumatoid arthritis: a comparison with conventional radiography. Arthritis Rheum. 2000;43(12):2762–70.

    CAS  PubMed  Google Scholar 

  64. Schmidt WA, Schicke B, Ostendorf B, Scherer A, Krause A, Walther M. Low-field MRI versus ultrasound: which is more sensitive in detecting inflammation and bone damage in MCP and MTP joints in mild or moderate rheumatoid arthritis? Clin Exp Rheumatol. 2013;31(1):91–6.

    PubMed  Google Scholar 

  65. Weidekamm C, Koller M, Weber M, Kainberger F. Diagnostic value of high-resolution B-mode and doppler sonography for imaging of hand and finger joints in rheumatoid arthritis. Arthritis Rheum. 2003;48(2):325–33.

    CAS  PubMed  Google Scholar 

  66. Finzel S, Ohrndorf S, Englbrecht M, Stach C, Messerschmidt J, Schett G, et al. A detailed comparative study of high-resolution ultrasound and micro-computed tomography for detection of arthritic bone erosions. Arthritis Rheum. 2011;63(5):1231–6.

    PubMed  Google Scholar 

  67. Dohn UM, Terslev L, Szkudlarek M, Hansen MS, Hetland ML, Hansen A, et al. Detection, scoring and volume assessment of bone erosions by ultrasonography in rheumatoid arthritis: comparison with CT. Ann Rheum Dis. 2013;72(4):530–4.

    PubMed  Google Scholar 

  68. Dohn UM, Ejbjerg BJ, Court-Payen M, Hasselquist M, Narvestad E, Szkudlarek M, et al. Are bone erosions detected by magnetic resonance imaging and ultrasonography true erosions? A comparison with computed tomography in rheumatoid arthritis metacarpophalangeal joints. Arthritis Res Ther. 2006;8(4):R110.

    PubMed Central  PubMed  Google Scholar 

  69. Baillet A, Gaujoux-Viala C, Mouterde G, Pham T, Tebib J, Saraux A, et al. Comparison of the efficacy of sonography, magnetic resonance imaging and conventional radiography for the detection of bone erosions in rheumatoid arthritis patients: a systematic review and meta-analysis. Rheumatology 2011;50(6):1137–47.

    PubMed  Google Scholar 

  70. Riente L, Delle Sedie A, Scire CA, Filippucci E, Meenagh G, Iagnocco A, et al. Ultrasound imaging for the rheumatologist. XXXI. Sonographic assessment of the foot in patients with rheumatoid arthritis. Clin Exp Rheumatol. 2011;29(1):1–5.

    PubMed  Google Scholar 

  71. Grassi W, Filippucci E, Farina A, Salaffi F, Cervini C. Ultrasonography in the evaluation of bone erosions. Ann Rheum Dis. 2001;60(2):98–103.

    PubMed Central  CAS  PubMed  Google Scholar 

  72. Salaffi F, Carotti M, Ciapetti A, Ariani A, Gasparini S, Grassi W. Validity of a computer-assisted manual segmentation software to quantify wrist erosion volume using computed tomography scans in rheumatoid arthritis. BMC Musculoskelet Disord. 2013;14:265.

    PubMed Central  PubMed  Google Scholar 

  73. Schmidt WA, Schmidt H, Schicke B, Gromnica-Ihle E. Standard reference values for musculoskeletal ultrasonography. Ann Rheum Dis. 2004;63(8):988–94.

    PubMed Central  CAS  PubMed  Google Scholar 

  74. Swen WA, Jacobs JW, Hubach PC, Klasens JH, Algra PR, Bijlsma JW. Comparison of sonography and magnetic resonance imaging for the diagnosis of partial tears of finger extensor tendons in rheumatoid arthritis. Rheumatology 2000;39(1):55–62.

    CAS  PubMed  Google Scholar 

  75. Bruyn GA, Hanova P, Iagnocco A, d’Agostino MA, Moller I, Terslev L, et al. Ultrasound definition of tendon damage in patients with rheumatoid arthritis. Results of a OMERACT consensus-based ultrasound score focussing on the diagnostic reliability. Ann Rheum Dis. 2013;73:1929–34

    Google Scholar 

  76. Bruyn GA, Naredo E, Moller I, Moragues C, Garrido J, de Bock GH, et al. Reliability of ultrasonography in detecting shoulder disease in patients with rheumatoid arthritis. Ann Rheum Dis. 2009;68(3):357–61.

    CAS  PubMed  Google Scholar 

  77. Bowen CJ, Culliford D, Dewbury K, Sampson M, Burridge J, Hooper L, et al. The clinical importance of ultrasound detectable forefoot bursae in rheumatoid arthritis. Rheumatology 2010;49(1):191–2.

    PubMed  Google Scholar 

  78. Andonopoulos AP, Yarmenitis S, Sfountouris H, Siamplis D, Zervas C, Bounas A. Baker’s cyst in rheumatoid arthritis: an ultrasonographic study with a high resolution technique. Clin Exp Rheumatol. 1995;13(5):633–6.

    CAS  PubMed  Google Scholar 

  79. Riente L, Delle Sedie A, Filippucci E, Scire CA, Iagnocco A, Gutierrez M, et al. Ultrasound Imaging for the rheumatologist XXVII. Sonographic assessment of the knee in patients with rheumatoid arthritis. Clin Exp Rheumatol. 2010;28(3):300–3.

    PubMed  Google Scholar 

  80. Genc H, Cakit BD, Tuncbilek I, Erdem HR. Ultrasonographic evaluation of tendons and enthesal sites in rheumatoid arthritis: comparison with ankylosing spondylitis and healthy subjects. Clin Rheumatol. 2005;24(3):272–7.

    PubMed  Google Scholar 

  81. Nalbant S, Corominas H, Hsu B, Chen LX, Schumacher HR, Kitumnuaypong T. Ultrasonography for assessment of subcutaneous nodules. J Rheumatol. 2003;30(6):1191–5.

    PubMed  Google Scholar 

  82. Nakagomi D, Ikeda K, Okubo A, Iwamoto T, Sanayama Y, Takahashi K, et al. Ultrasound can improve the accuracy of the 2010 American College of Rheumatology/European League against rheumatism classification criteria for rheumatoid arthritis to predict the requirement for methotrexate treatment. Arthritis Rheum. 2013;65(4):890–8.

    CAS  PubMed  Google Scholar 

  83. Agrawal S, Bhagat SS, Dasgupta B. Improvement in diagnosis and management of musculoskeletal conditions with one-stop clinic-based ultrasonography. Mod Rheumatol. 2009;19(1):53–6.

    PubMed  Google Scholar 

  84. Freeston JE, Wakefield RJ, Conaghan PG, Hensor EM, Stewart SP, Emery P. A diagnostic algorithm for persistence of very early inflammatory arthritis: the utility of power Doppler ultrasound when added to conventional assessment tools. Ann Rheum Dis. 2010;69(2):417–9.

    CAS  PubMed  Google Scholar 

  85. Ten Cate DF, Luime JJ, Swen N, Gerards AH, De Jager MH, Basoski NM, et al. Role of ultrasonography in diagnosing early rheumatoid arthritis and remission of rheumatoid arthritis–a systematic review of the literature. Arthritis Res Ther. 2013;15(1):R4.

    PubMed Central  PubMed  Google Scholar 

  86. Terslev L, Torp-Pedersen S, Bang N, Koenig MJ, Nielsen MB, Bliddal H. Doppler ultrasound findings in healthy wrists and finger joints before and after use of two different contrast agents. Ann Rheum Dis. 2005;64(6):824–7.

    PubMed Central  CAS  PubMed  Google Scholar 

  87. Millot F, Clavel G, Etchepare F, Gandjbakhch F, Grados F, Saraux A, et al. Musculoskeletal ultrasonography in healthy subjects and ultrasound criteria for early arthritis (the ESPOIR cohort). J Rheumatol. 2011;38(4):613–20.

    PubMed  Google Scholar 

  88. Scire CA, Iagnocco A, Meenagh G, Riente L, Filippucci E, Delle Sedie A, et al. Ultrasound imaging for the rheumatologist XXXIII. Sonographic assessment of the foot in early arthritis patients. Clin Exp Rheumatol. 2011;29(3):465–9.

    CAS  PubMed  Google Scholar 

  89. Eshed I, Feist E, Althoff CE, Hamm B, Konen E, Burmester GR, et al. Tenosynovitis of the flexor tendons of the hand detected by MRI: an early indicator of rheumatoid arthritis. Rheumatology 2009;48(8):887–91.

    PubMed  Google Scholar 

  90. Zayat AS, Ellegaard K, Conaghan PG, Terslev L, Hensor EM, Freeston JE, Emery P, Wakefield RJ. The specificity of ultrasound-detected bone erosions for rheumatoid arthritis. Ann Rheum Dis. 2014 Apr 30 [Epub ahead of print].

    Google Scholar 

  91. Kawashiri SY, Suzuki T, Okada A, Yamasaki S, Tamai M, Nakamura H, et al. Musculoskeletal ultrasonography assists the diagnostic performance of the 2010 classification criteria for rheumatoid arthritis. Mod Rheumatol. 2013;23(1):36–43.

    PubMed  Google Scholar 

  92. Salaffi F, Ciapetti A, Gasparini S, Carotti M, Filippucci E, Grassi W. A clinical prediction rule combining routine assessment and power Doppler ultrasonography for predicting progression to rheumatoid arthritis from early-onset undifferentiated arthritis. Clin Exp Rheumatol. 2010;28(5):686–94.

    CAS  PubMed  Google Scholar 

  93. van de Stadt LA, Bos WH, Meursinge Reynders M, Wieringa H, Turkstra F, van der Laken CJ, et al. The value of ultrasonography in predicting arthritis in auto-antibody positive arthralgia patients: a prospective cohort study. Arthritis Res Ther. 2010;12(3):R98.

    Google Scholar 

  94. Navalho M, Resende C, Rodrigues AM, Ramos F, Gaspar A, Pereira da Silva JA, et al. Bilateral MR imaging of the hand and wrist in early and very early inflammatory arthritis: tenosynovitis is associated with progression to rheumatoid arthritis. Radiology 2012;264(3):823–33.

    PubMed  Google Scholar 

  95. Gutierrez M, Filippucci E, Salaffi F, Di Geso L, Grassi W. Differential diagnosis between rheumatoid arthritis and psoriatic arthritis: the value of ultrasound findings at metacarpophalangeal joints level. Ann Rheum Dis. 2011;70(6):1111–4.

    PubMed  Google Scholar 

  96. D’Agostino MA, Said-Nahal R, Hacquard-Bouder C, Brasseur JL, Dougados M, Breban M. Assessment of peripheral enthesitis in the spondylarthropathies by ultrasonography combined with power Doppler: a cross-sectional study. Arthritis Rheum. 2003;48(2):523–33.

    PubMed  Google Scholar 

  97. Backhaus M, Ohrndorf S, Kellner H, Strunk J, Backhaus TM, Hartung W, et al. Evaluation of a novel 7-joint ultrasound score in daily rheumatologic practice: a pilot project. Arthritis Rheum. 2009;61(9):1194–201.

    Google Scholar 

  98. Backhaus TM, Ohrndorf S, Kellner H, Strunk J, Hartung W, Sattler H, et al. The US7 score is sensitive to change in a large cohort of patients with rheumatoid arthritis over 12 months of therapy. Ann Rheum Dis. 2013;72(7):1163–9.

    PubMed Central  PubMed  Google Scholar 

  99. Perricone C, Ceccarelli F, Modesti M, Vavala C, Di Franco M, Valesini G, et al. The 6-joint ultrasonographic assessment: a valid, sensitive-to-change and feasible method for evaluating joint inflammation in RA. Rheumatology 2012;51(5):866–73.

    PubMed  Google Scholar 

  100. Ellegaard K, Torp-Pedersen S, Terslev L, Danneskiold-Samsoe B, Henriksen M, Bliddal H. Ultrasound colour Doppler measurements in a single joint as measure of disease activity in patients with rheumatoid arthritis–assessment of concurrent validity. Rheumatology 2009;48(3):254–7.

    CAS  PubMed  Google Scholar 

  101. Damjanov N, Radunovic G, Prodanovic S, Vukovic V, Milic V, Simic Pasalic K, et al. Construct validity and reliability of ultrasound disease activity score in assessing joint inflammation in RA: comparison with DAS-28. Rheumatology 2012;51(1):120–8.

    PubMed  Google Scholar 

  102. Hartung W, Kellner H, Strunk J, Sattler H, Schmidt WA, Ehrenstein B, et al. Development and evaluation of a novel ultrasound score for large joints in rheumatoid arthritis: one year of experience in daily clinical practice. Arthritis Care Res. 2012;64(5):675–82.

    Google Scholar 

  103. Hammer HB, Kvien TK. Comparisons of 7- to 78-joint ultrasonography scores: all different joint combinations show equal response to adalimumab treatment in patients with rheumatoid arthritis. Arthritis Res Ther. 2011;13(3):R78.

    PubMed Central  PubMed  Google Scholar 

  104. Witt M, Mueller F, Nigg A, Reindl C, Leipe J, Proft F, et al. Relevance of grade 1 Gy-scale ultrasound findings in wrists and small joints to the assessment of subclinical synovitis in rheumatoid arthritis. Arthritis Rheum. 2013;65(7):1694–701.

    PubMed  Google Scholar 

  105. Brown AK, Conaghan PG, Karim Z, Quinn MA, Ikeda K, Peterfy CG, et al. An explanation for the apparent dissociation between clinical remission and continued structural deterioration in rheumatoid arthritis. Arthritis Rheum. 2008;58(10):2958–67.

    CAS  PubMed  Google Scholar 

  106. Foltz V, Gandjbakhch F, Etchepare F, Rosenberg C, Tanguy ML, Rozenberg S, et al. Power Doppler ultrasound, but not low-field magnetic resonance imaging, predicts relapse and radiographic disease progression in rheumatoid arthritis patients with low levels of disease activity. Arthritis Rheum. 2012;64(1):67–76.

    PubMed  Google Scholar 

  107. Szkudlarek M, Wakefield RJ, Backhaus M, Terslev L. The discriminatory capacity of ultrasound in rheumatoid arthritis: active vs inactive, early vs advanced, and more. Rheumatology 2012;51(Suppl 7):vii6–9.

    Google Scholar 

  108. Cheung PP, Gossec L, Ruyssen-Witrand A, Le Bourlout C, Mezieres M, Dougados M. The relationship of patient-reported joints with active synovitis detected by power Doppler ultrasonography in rheumatoid arthritis. Clin Exp Rheumatol. 2013;31(4):490–7.

    PubMed  Google Scholar 

  109. Ramirez J, Ruiz-Esquide V, Pomes I, Celis R, Cuervo A, Hernandez MV, et al. Patients with rheumatoid arthritis in clinical remission and ultrasound-defined active synovitis exhibit higher disease activity and increased serum levels of angiogenic biomarkers. Arthritis Res Ther. 2014;16(1):R5.

    PubMed Central  PubMed  Google Scholar 

  110. Zayat AS, Conaghan PG, Sharif M, Freeston JE, Wenham C, Hensor EM, et al. Do non-steroidal anti-inflammatory drugs have a significant effect on detection and grading of ultrasound-detected synovitis in patients with rheumatoid arthritis? Results from a randomised study. Ann Rheum Dis. 2011;70(10):1746–51.

    CAS  PubMed  Google Scholar 

  111. Naredo E, Hinojosa M, Valor L, Hernandez-Florez D, Mata-Martinez C, Serrano-Benavente B, et al. Does ultrasound-scored synovitis depend on the pharmacokinetics of subcutaneous anti-TNF agents in patients with rheumatoid arthritis? Rheumatology. 2014;53:2088–94

    Google Scholar 

  112. Backhaus M, Burmester GR, Sandrock D, Loreck D, Hess D, Scholz A, et al. Prospective two year follow up study comparing novel and conventional imaging procedures in patients with arthritic finger joints. Ann Rheum Dis. 2002;61(10):895–904.

    PubMed Central  CAS  PubMed  Google Scholar 

  113. Boyesen P, Haavardsholm EA, van der Heijde D, Ostergaard M, Hammer HB, Sesseng S, et al. Prediction of MRI erosive progression: a comparison of modern imaging modalities in early rheumatoid arthritis patients. Ann Rheum Dis. 2011;70(1):176–9.

    PubMed  Google Scholar 

  114. Lillegraven S, Boyesen P, Hammer HB, Ostergaard M, Uhlig T, Sesseng S, et al. Tenosynovitis of the extensor carpi ulnaris tendon predicts erosive progression in early rheumatoid arthritis. Ann Rheum Dis. 2011;70(11):2049–50.

    PubMed  Google Scholar 

  115. Dougados M, Devauchelle-Pensec V, Ferlet JF, Jousse-Joulin S, D’Agostino MA, Backhaus M, et al. The ability of synovitis to predict structural damage in rheumatoid arthritis: a comparative study between clinical examination and ultrasound. Ann Rheum Dis. 2013;72(5):665–71.

    PubMed Central  PubMed  Google Scholar 

  116. Ellegaard K, Christensen R, Torp-Pedersen S, Terslev L, Holm CC, Konig MJ, et al. Ultrasound Doppler measurements predict success of treatment with anti-TNF- & alpha; drug in patients with rheumatoid arthritis: a prospective cohort study. Rheumatology 2011;50(3):506–12.

    CAS  PubMed  Google Scholar 

  117. Peluso G, Michelutti A, Bosello S, Gremese E, Tolusso B, Ferraccioli G. Clinical and ultrasonographic remission determines different chances of relapse in early and long standing rheumatoid arthritis. Ann Rheum Dis. 2011;70(1):172–5.

    PubMed  Google Scholar 

  118. Saleem B, Brown AK, Keen H, Nizam S, Freeston J, Wakefield R, et al. Should imaging be a component of rheumatoid arthritis remission criteria? A comparison between traditional and modified composite remission scores and imaging assessments. Ann Rheum Dis. 2011;70(5):792–8.

    PubMed  Google Scholar 

  119. Saleem B, Brown AK, Quinn M, Karim Z, Hensor EM, Conaghan P, et al. Can flare be predicted in DMARD treated RA patients in remission, and is it important? A cohort study. Ann Rheum Dis. 2012;71(8):1316–21.

    PubMed  Google Scholar 

  120. Balsa A, de Miguel E, Castillo C, Peiteado D, Martin-Mola E. Superiority of SDAI over DAS-28 in assessment of remission in rheumatoid arthritis patients using power Doppler ultrasonography as a gold standard. Rheumatology 2010;49(4):683–90.

    PubMed  Google Scholar 

  121. Saleem B, Brown AK, Keen H, Nizam S, Freeston J, Karim Z, et al. Disease remission state in patients treated with the combination of tumor necrosis factor blockade and methotrexate or with disease-modifying antirheumatic drugs: a clinical and imaging comparative study. Arthritis Rheum. 2009;60(7):1915–22.

    CAS  PubMed  Google Scholar 

  122. Kawashiri SY, Suzuki T, Nakashima Y, Horai Y, Okada A, Iwamoto N, et al. Ultrasonographic examination of rheumatoid arthritis patients who are free of physical synovitis: power Doppler subclinical synovitis is associated with bone erosion. Rheumatology 2014;53(3):562–9.

    PubMed  Google Scholar 

  123. Molenaar ET, Voskuyl AE, Dinant HJ, Bezemer PD, Boers M, Dijkmans BA. Progression of radiologic damage in patients with rheumatoid arthritis in clinical remission. Arthritis Rheum. 2004;50(1):36–42.

    PubMed  Google Scholar 

  124. Conaghan PG, O’Connor P, McGonagle D, Astin P, Wakefield RJ, Gibbon WW, et al. Elucidation of the relationship between synovitis and bone damage: a randomized magnetic resonance imaging study of individual joints in patients with early rheumatoid arthritis. Arthritis Rheum. 2003;48(1):64–71.

    PubMed  Google Scholar 

  125. Fukae J, Isobe M, Kitano A, Henmi M, Sakamoto F, Narita A, et al. Structural deterioration of finger joints with ultrasonographic synovitis in rheumatoid arthritis patients with clinical low disease activity. Rheumatology 2014;53(9):1608–12.

    PubMed  Google Scholar 

  126. Raza K, Lee CY, Pilling D, Heaton S, Situnayake RD, Carruthers DM, et al. Ultrasound guidance allows accurate needle placement and aspiration from small joints in patients with early inflammatory arthritis. Rheumatology 2003;42(8):976–9.

    CAS  PubMed  Google Scholar 

  127. Naredo E, Cabero F, Beneyto P, Cruz A, Mondejar B, Uson J, et al. A randomized comparative study of short term response to blind injection versus sonographic-guided injection of local corticosteroids in patients with painful shoulder. J Rheumatol. 2004;31(2):308–14.

    PubMed  Google Scholar 

  128. Sibbitt WL, Jr., Peisajovich A, Michael AA, Park KS, Sibbitt RR, B and PA, et al. Does sonographic needle guidance affect the clinical outcome of intraarticular injections? J Rheumatol. 2009;36(9):1892–902.

    PubMed  Google Scholar 

  129. Cunnington J, Marshall N, Hide G, Bracewell C, Isaacs J, Platt P, et al. A randomized, double-blind, controlled study of ultrasound-guided corticosteroid injection into the joint of patients with inflammatory arthritis. Arthritis Rheum. 2010;62(7):1862–9.

    PubMed  Google Scholar 

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  1. Department of Rheumatology, Hospital General Universitario Gregorio Marañon, Madrid, Spain

    Esperanza Naredo MD, María Montoro MD & Iustina Janţă MD

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  1. Department of Rheumatology, Darent Valley Hospital, Dartford, United Kingdom

    Yasser El Miedany

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Naredo, E., Montoro, M., Janţă, I. (2015). Rheumatoid Arthritis. In: El Miedany, Y. (eds) Musculoskeletal Ultrasonography in Rheumatic Diseases. Springer, Cham. https://doi.org/10.1007/978-3-319-15723-8_3

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