THE ROLE OF ULTRASOUND IN EXAMINATION OF A PATIENT WITH ARTICULAR SYNDROME
(LITERATURE REVIEW)
DOI:
https://doi.org/10.11603/1811-2471.2025.v.i1.15095Keywords:
articular syndrome, arthritis, effusion, synovitis, ultrasoundAbstract
SUMMARY. Ultrasound (US) in the examination of a patient with articular syndrome will allow a quick and reliable assessment of key pathological changes in the joints.
The aim – to summarize data on the capabilities of musculoskeletal US and to describe modern criteria for interpreting sonographic changes, that were identified during the examination.
Results. An analysis of modern literature shows that US in the clinic of internal medicine is a convenient tool that not only allows for a rapid diagnosis of emergency conditions, but also complements the physical examination of the patient. In the practice of a rheumatologist, this technique can be a means of a quick and targeted diagnostic search. Assessment of the presence of synovitis in arthralgia without pronounced signs of arthritis, detection of structural and inflammatory changes in patients with articular syndrome, differential diagnosis of arthritis, assessment of periarticular structures in patients – this is just a small list of the advantages of musculoskeletal US in the practice of a rheumatologist. Currently, there are distinct recommendations and evaluation criteria for the joint evaluation with the US.
Conclusions. Joint evaluation with the US is a promising diagnostic technique, the implementation of which will facilitate and accelerate the diagnostic search when examining a patient with articular syndrome.
References
Arnold MJ, Jonas CE, Carter RE. Point-of-Care Ultrasonography. Am Fam Physician. 2020;101(5):275-285.
Balmuth EA, Luan D, Jannat-Khah D, Evans A, Wong T, Scales DA. Point-of-care ultrasound (POCUS): Assessing patient satisfaction and socioemotional benefits in the hospital setting. PLoS One. 2024;19(2): e0298665. Published 2024 Feb 16. DOI:10.1371/journal.pone.0298665 DOI: https://doi.org/10.1371/journal.pone.0298665
Nakashima Y, Sunagawa T, Shinomiya R, Kodama A, Adachi N. Point-of-care ultrasound in musculoskeletal field. J Med Ultrason (2001). 2022;49(4):663-673. DOI:10.1007/s10396-022-01252-0 DOI: https://doi.org/10.1007/s10396-022-01252-0
Lee A, Kong KO, Chew LC, et al. Enhancing rheumatology training: The POCRUS model for integrating ultrasound into clinical practice. (From APLAR imaging SIG). Int J Rheum Dis. 2024;27(6):e15225. DOI:10.1111/ 1756-185X.15225 DOI: https://doi.org/10.1111/1756-185X.15225
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):2018-2023. DOI:10. 1002/1529-0131(200109)44:9<2018::AID-ART350>3.0.CO;2-C DOI: https://doi.org/10.1002/1529-0131(200109)44:9<2018::AID-ART350>3.0.CO;2-C
D'Agostino MA, Terslev L, Aegerter P, et al. Scoring ultrasound synovitis in rheumatoid arthritis: a EULAR-OMERACT ultrasound taskforce-Part 1: definition and development of a standardised, consensus-based scoring system. RMD Open. 2017;3(1):e000428. Published 2017 Jul 11. DOI:10.1136/rmdopen-2016-000428 DOI: https://doi.org/10.1136/rmdopen-2016-000428
Wakefield RJ, Green MJ, Marzo-Ortega H, et al. Should oligoarthritis be reclassified? Ultrasound reveals a high prevalence of subclinical disease. Ann Rheum Dis. 2004;63(4):382-385. DOI:10.1136/ard.2003.007062 DOI: https://doi.org/10.1136/ard.2003.007062
Schmidt WA. Ultrasound in rheumatology. Int J Rheum Dis. 2014;17(7):711-715. DOI:10.1111/1756-185X. 12545 DOI: https://doi.org/10.1111/1756-185X.12545
Zaniewicz-Kaniewska K, Sudoł-Szopińska I. Usefulness of sonography in the diagnosis of rheumatoid hand. J Ultrason. 2013;13(54):329-336. DOI:10.15557/JoU. 2013.0033 DOI: https://doi.org/10.15557/JoU.2013.0033
Azzolin I, Massazza G, Iagnocco A. Spondyloarthritis: not only enthesitis. Clin Exp Rheumatol. 2020;38(1):157-163.
Balint PV, Terslev L, Aegerter P, et al. Reliability of a consensus-based ultrasound definition and scoring for enthesitis in spondyloarthritis and psoriatic arthritis: an OMERACT US initiative. Ann Rheum Dis. 2018;77(12):1730-1735. DOI:10.1136/annrheumdis-2018-213609 DOI: https://doi.org/10.1136/annrheumdis-2018-213609
Balint PV, Kane D, Wilson H, McInnes IB, Sturrock RD. Ultrasonography of entheseal insertions in the lower limb in spondyloarthropathy. Ann Rheum Dis. 2002;61(10):905-910. DOI:10.1136/ard.61.10.905 DOI: https://doi.org/10.1136/ard.61.10.905
Di Matteo A, Smerilli G, Di Donato S, et al. Power Doppler signal at the enthesis and bone erosions are the most discriminative OMERACT ultrasound lesions for SpA: results from the DEUS (Defining Enthesitis on Ultrasound in Spondyloarthritis) multicentre study. Ann Rheum Dis. 2024;83(7):847-857. Published 2024 Jun 12. DOI:10.1136/ard-2023-225443 DOI: https://doi.org/10.1136/ard-2023-225443
Desai N, Baker JF, Bucci J, Kissin EY. Ultrasound evaluation of the Achilles enthesis in inflammatory and non-inflammatory processes: a systematic review and meta-analysis. Clin Exp Rheumatol. 2023;41(1):24-31. DOI:10.55563/clinexprheumatol/6vg24c DOI: https://doi.org/10.55563/clinexprheumatol/6vg24c
De Marco G, Zabotti A, Baraliakos X, et al. Characterisation of prodromal and very early psoriatic arthritis: a systematic literature review informing a EULAR taskforce. RMD Open. 2023;9(2):e003143. DOI:10.1136/rmdopen-2023-003143 DOI: https://doi.org/10.1136/rmdopen-2023-003143
Abdelghani KB, Boussaa H, Miladi S, Zakraoui L, Fazaa A, Laatar A. Value of Hands Ultrasonography in the Differential Diagnosis Between Psoriatic Arthritis and Rheumatoid Arthritis. J Ultrasound Med. 2023;42(9):1987-1995. DOI:10.1002/jum.16215
Abdelghani KB, Boussaa H, Miladi S, Zakraoui L, Fazaa A, Laatar A. Value of Hands Ultrasonography in the Differential Diagnosis Between Psoriatic Arthritis and Rheumatoid Arthritis. J Ultrasound Med. 2023;42(9):1987-1995. DOI:10.1002/jum.16215 DOI: https://doi.org/10.1002/jum.16215
Li S, Xu G, Liang J, Wan L, Cao H, Lin J. The Role of Advanced Imaging in Gout Management. Front Immunol. 2022;12:811323. Published 2022 Jan 14. DOI:10.3389/fimmu.2021.811323 DOI: https://doi.org/10.3389/fimmu.2021.811323
Terslev L, Gutierrez M, Schmidt WA, et al. Ultrasound as an Outcome Measure in Gout. A Validation Process by the OMERACT Ultrasound Working Group. J Rheumatol. 2015;42(11):2177-2181. DOI:10.3899/jrheum.141294 DOI: https://doi.org/10.3899/jrheum.141294
Zhang W, Doherty M, Bardin T, et al. European League Against Rheumatism recommendations for calcium pyrophosphate deposition. Part I: terminology and diagnosis. Ann Rheum Dis. 2011;70(4):563-570. DOI:10.1136/ard.2010.139105 DOI: https://doi.org/10.1136/ard.2010.139105
Sirotti S, Gutierrez M, Pineda C, et al. Accuracy of synovial fluid analysis compared to histology for the identification of calcium pyrophosphate crystals: an ancillary study of the OMERACT US Working Group - CPPD subgroup. Reumatismo. 2021;73(2):106-110. Published 2021 Aug 3. DOI:10.4081/reumatismo.2021.1403 DOI: https://doi.org/10.4081/reumatismo.2021.1403
Mandl P, D'Agostino MA, Navarro-Compán V, et al. 2023 EULAR recommendations on imaging in diagnosis and management of crystal-induced arthropathies in clinical practice. Ann Rheum Dis. 2024;83(6):752-759. Published 2024 May 15. DOI:10.1136/ard-2023-224771 DOI: https://doi.org/10.1136/ard-2023-224771
Filippucci E, Riveros MG, Georgescu D, Salaffi F, Grassi W. Hyaline cartilage involvement in patients with gout and calcium pyrophosphate deposition disease. An ultrasound study. Osteoarthritis Cartilage. 2009;17(2):178-181. DOI:10.1016/j.joca.2008.06.003 DOI: https://doi.org/10.1016/j.joca.2008.06.003
Filippou G, Scirè CA, Adinolfi A, et al. Identification of calcium pyrophosphate deposition disease (CPPD) by ultrasound: reliability of the OMERACT definitions in an extended set of joints-an international multiobserver study by the OMERACT Calcium Pyrophosphate Deposition Disease Ultrasound Subtask Force. Ann Rheum Dis. 2018;77(8):1194-1199. DOI:10.1136/annrheumdis-2017- 212542 DOI: https://doi.org/10.1136/annrheumdis-2017-212542
Cipolletta E, Moscioni E, Sirotti S, et al. Diagnosis of calcium pyrophosphate crystal deposition disease by ultrasonography: how many and which sites should be scanned?. Rheumatology (Oxford). 2024;63(8):2205-2212. DOI:10.1093/rheumatology/kead565 DOI: https://doi.org/10.1093/rheumatology/kead565
Dimmick S, Hayter C, Linklater J. Acute calcific periarthritis-a commonly misdiagnosed pathology. Skeletal Radiol. 2022;51(8):1553-1561. DOI:10.1007/s00256-022-04006-8 DOI: https://doi.org/10.1007/s00256-022-04006-8
Albano D, Coppola A, Gitto S, Rapisarda S, Messina C, Sconfienza LM. Imaging of calcific tendinopathy around the shoulder: usual and unusual presentations and common pitfalls. Radiol Med. 2021;126(4):608-619. DOI:10.1007/s11547-020-01300-0 DOI: https://doi.org/10.1007/s11547-020-01300-0
Wakefield RJ, Dasgupta B. Integrating point-of-care ultrasound into rheumatology practice. Pol Arch Intern Med. 2024;134(10):16815. DOI:10.20452/pamw.16815 DOI: https://doi.org/10.20452/pamw.16815
Nevalainen MT, Uusimaa AP, Saarakkala S. The ultrasound assessment of osteoarthritis: the current status. Skeletal Radiol. 2023;52(11):2271-2282. DOI:10.1007/ s00256-023-04342-3 DOI: https://doi.org/10.1007/s00256-023-04342-3
