Kenneth F. Baker and John D. Isaacs
clinical remission but with active power Doppler
synovitis on ultrasound
scans are more likely to experience future arthritis flares and joint erosions compared to patients without this finding. Nevertheless, recent trials exploring the escalation of therapy to achieve ultrasound
-defined targets of disease control have failed to show superiority when compared to clinical disease activity targets alone.
Complications of rheumatoid
The cardiovascular (CV) complications of rheumatoid
arthritis make the largest contribution
Mike Backhouse and Heidi Siddle
multisegment foot kinematics and ultrasound
features. Arthritis Care Res (Hoboken). 2013;65(4):495–502.
77. Woodburn J , Helliwell PS. Relation between heel position and the distribution of forefoot plantar pressures and skin callosities in rheumatoid
arthritis. Ann Rheum Dis. 1996;55(11):806–10.
78. Bouysset M , et al. The rheumatoid
heel: its relationship to other disorders in the rheumatoid
foot. Clin Rheumatol. 1989;8(2):208–14.
79. Helliwell P , et al. The Foot and Ankle in Rheumatoid
Arthritis. A Comprehensive Guide. London: Churchill
Common Conditions in Women
determining the progression of joint damage, there are many instances where ultrasound
(US), magnetic resonance imaging (MRI) and computed tomography (CT) scanning provide added information. Clinicians now regularly use MRI and US to help diagnose RA in the preradiographic stage, as they offer improved visualization of joint erosions. They also have the potential to provide prognostic information as MRI bone edema/osteitis is linked to the later development of erosions. Power Doppler ultrasound
(PDUS) joint positivity is also a predictor of joint damage ( McQueen, 2013
Kevin B. Hoover
and edema ( block arrow ).
■ Findings detected on MRI are reproducibly identified on US with notable exceptions of BME (osteitis) and joint-space loss because of cartilage thinning.
■ Power Doppler
signal is especially valuable in evaluating synovitis.
■ It correlates with the histologic severity of synovitis.
■ Elevated signal within at least 1 joint in a patient in clinical remission may be predictive of disease relapse.
■ Discussed in more detail in Chapter 127 , “ Ultrasound
for Rheumatologic Diseases.”
Derrick J. Todd and Jonathan S. Coblyn
These can be given intravascularly or intra-articularly (MR arthrogram) for definition of intra-articular structures such as ligaments and menisci. CT scan is most useful in the assessment of bony structures, especially when MRI may be contraindicated. Musculoskeletal ultrasound
with power Doppler
has an emerging role in identifying bone erosions and synovitis. Bone scan is a fading technology that still has limited diagnostic utility in the patient with polyarthralgias but few objective findings of RA.
RA involvement of the cervical
Richard Watts, Gavin Clunie, Frances Hall, and Tarnya Marshall (eds)
Magnetic resonance (MR) imaging and ultrasound
(US) Patients with subclinical disease may have erosions on presentation. Also radiographs can miss erosions. • MR scanning and high-resolution ultrasound
(US) with colour flow Doppler
are more sensitive at detecting early erosive disease, subclinical synovitis and small joint effusions compared with radiographs. • MR with IV gadolinium contrast permits accurate assessment of synovial invasion though discrimination of tissue from fluid can be difficult. Figure 6.1 Severe erosive rheumatoid
arthritis. Dual X-ray absorptiometry
Raashid Luqmani, Maarten Boers, and Theodore Pincus (eds)
disease affecting the shoulders The availability of musculoskeletal ultrasound
means that joints can be imaged in greater detail, revealing the presence of soft tissue swelling, increased vascular supply to the joints (on colour Doppler
) and also shows the presence of erosions more commonly than can be seen on X-ray ( Figure 3.9 ). However, it is not entirely clear that ‘erosions’ seen on ultrasound
scans long before they are apparent on X-ray indicate the same phenomena. It is possible that ultrasound
is showing what may be potentially reversible bony changes, whilst
Eugen Feist and Gerd-R. Burmester
protein; ESR—erythrocyte sedimentation rate; RF— rheumatoid
Conventional radiographic examinations (including wrists, hands, and forefeet as well as other affected joints) are still the gold standard for the documentation of the erosive nature and progress of RA, but provide relatively low sensitivity for detection of early soft tissue and erosive bone changes. Therefore, as useful imaging techniques for documentation of the inflammatory soft tissue process in early RA, ultrasound
including power Doppler
examination (US with PD: visualization of effusion
Practical investigation of rheumatic disease
David Kane and Philip Platt
structural deterioration in rheumatoid
arthritis. Arthritis Rheum 2008;58(10):2958–2967.
18. Bruyn GA , Hanova P , Iagnocco A ,, 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 2014;73:1929–1934.
19. Walther M , Harms H , Krenn V , et al. Correlation of power Doppler
sonography with vascularity of the synovial tissue of the knee joint in patients with osteoarthritis and rheumatoid
arthritis. Arthritis Rheum
Special Topics in Emergency Radiology
Michael A. Bruno
ultrasonography: a reliable measurement tool for quantifying tendon pathology. Br J Sports Med . 2005;39:700–703.
Farrant JM , O’Connor PJ , Grainger AJ. Advanced imaging in rheumatoid
arthritis: Part 1—synovitis. Skeletal Radiol . Apr 2007;36(4):269–279.
Fiocco U , Ferro F , Vezzu M , et al. Rheumatoid
and psoriatic knee synovitis: clinical, grey scale, and power Doppler ultrasound
assessment of the response to Etanercept. Ann Rheum Dis . 2005;64:899–905.
Fornage B. Musculoskeletal Ultrasound
, Clinics in Diagnostic Ultrasound