|LETTER TO EDITOR
|Year : 2018 | Volume
| Issue : 4 | Page : 291-292
Comments on: Use and scope of ultrasonography in rheumatology in India
Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
|Date of Web Publication||18-Nov-2018|
Dr. Sakir Ahmed
Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow - 226 014, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Ahmed S. Comments on: Use and scope of ultrasonography in rheumatology in India. Indian J Rheumatol 2018;13:291-2
The recent Indian Journal of Rheumatology supplement on musculoskeletal ultrasound (MSUS) was a much welcome issue. The supplement contained well-written concise reviews covering the entire body region wise. Even pediatrics MSUS, that can be confusing compared to adult MSUS, was also covered separately. The review on use and scope of ultrasonography (US) in rheumatology has greatly clarified the scope of US in the diagnosis of rheumatoid arthritis, spondyloarthropathies (detection of enthesitis), and crystal arthropathies and in the evaluation of osteoarthritis and juvenile idiopathic arthritis. It can also be used to quantify skin thickness in systemic sclerosis or grade parotid involvement in Sjögren syndrome.
MSUS is a very dynamic field today and it is not possible to cover all aspects in any review, however exhaustive. Nevertheless, it may be noteworthy to add the following to our knowledge.
| Role of Musculoskeletal Ultrasound in Soft-Tissue Rheumatism|| |
Besides its role in nerve entrapment syndromes such as carpal tunnel syndrome, US can help establish distal (de Quervain's) and proximal intersection syndromes, trigger fingers, and lateral and medial epicondylitis. And more often than not, clinicians would prefer US-guided injections for these conditions.
Another important aspect of US is evaluation foot pain where US can easily pick up stress fractures missed by radiography, or Morton's neuroma or even plantar fasciitis. Again in the evaluation of shoulder pain, US can help differentiate bursitis, rotator cuff tears, greater trochanter fractures, and other pathologies. US allows dynamic imaging for the diagnosis of conditions such as shoulder and hip impingement syndromes. There is also an overlap with sports medicine, but with experience, the rheumatologist practicing MSUS should also be able to exclude causes of pain such as chronic ligament injuries or conditions such as “Tennis leg” (rupture of the plantaris muscle and possibly the medial head of the gastrocnemius muscle).
| Limitations of Musculoskeletal Ultrasound|| |
Even the American College of Rheumatology and the European League Against Rheumatism 2010 classification criteria for the rheumatoid arthritis acknowledges the application of MSUS. However, A couple of trials, “Targeting Synovitis in Early Rheumatoid Arthritis (TaSER)” and the “Aiming for Remission in rheumatoid arthritis: A randomized trial examining the benefit of ultrasound in a Clinical Tight Control regimen (ARTIC),” failed to show benefit of adding MSUS in the treat to target strategy in RA. Thus, there are currently no recommendations in utilizing US for follow-up and management (treat to target). The rheumatologist needs to be aware of such limitations of MSUS.
| Future Prospects in India|| |
A few upcoming prospects of MSUS could be detection of thickened nerves in suspect cases of leprosy arthritis and screening for early interstitial lung disease in systemic sclerosis. The purist may argue that US of the lung and pleura may not strictly come under MSUS, but the rheumatologist is often the all-rounder and should be easily able to perform such screening!
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Conflicts of interest
There are no conflicts of interest.
| References|| |
Ghosh P, Rath PD. Use and scope of ultrasonography in rheumatology in India. Indian J Rheumatol 2018;13 Suppl S1:65-71.
Pegrum J, Dixit V, Padhiar N, Nugent I. The pathophysiology, diagnosis, and management of foot stress fractures. Phys Sportsmed 2014;42:87-99.
Tran G, Hensor EM, Ray A, Kingsbury SR, O'Connor P, Conaghan PG, et al.
Ultrasound-detected pathologies cluster into groups with different clinical outcomes: Data from 3000 community referrals for shoulder pain. Arthritis Res Ther 2017;19:30.
Caporali R, Smolen JS. Back to the future: Forget ultrasound and focus on clinical assessment in rheumatoid arthritis management. Ann Rheum Dis 2018;77:18-20.
Barskova T, Gargani L, Guiducci S, Randone SB, Bruni C, Carnesecchi G, et al.
Lung ultrasound for the screening of interstitial lung disease in very early systemic sclerosis. Ann Rheum Dis 2013;72:390-5.