Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Review Article
  • Published:

Ultrasonography in inflammatory rheumatic disease: an overview

Abstract

Modern ultrasonography enables clinicians to sensitively assess the progression of inflammatory joint and tendon disease, and to investigate vasculitides, connective tissue diseases and nerve lesions. Despite the advantages of musculoskeletal ultrasonography for diagnostic, prognostic and monitoring purposes, fewer than 10% of European rheumatologists use this technique in routine clinical practice. The reliability and limitations of rheumatic ultrasonography remain a concern, although good interobserver and intraobserver agreement in results from ultrasonography have been demonstrated among experienced sonographers. International recommendations for assessments and ultrasonography training courses are available, and will improve the standardization of the use of these techniques. In clinical practice, ultrasonography can complement the diagnostic evaluation of patients with rheumatic disease and might have value in confirming and extending clinical findings. Musculoskeletal ultrasonography can also be a valuable follow-up tool to monitor disease activity and support treatment decisions for specific patients. Furthermore, ultrasonography-guided articular injections provide better precision and a higher success rate for synovial fluid aspiration than clinically-guided injections. In the future, three-dimensional ultrasonography techniques, the fusion of ultrasonography and other imaging methods, and real time sonoelastography will be interesting new fields of investigation.

Key Points

  • The advantages of ultrasonography include its safe and non-invasive nature, the lack of contraindications, and the relatively low costs compared with other imaging tools such as MRI

  • The interobserver reliability of musculoskeletal ultrasonography is good overall, but varies depending on the disease, the disease manifestation, and the region examined

  • Characteristic ultrasonographic findings can support the diagnostic evaluation of patients with suspected inflammatory rheumatic diseases

  • Follow-up ultrasonographic examinations are helpful to monitor the course of inflammation; active inflammation as determined by ultrasonography—even in the absence of clinical symptoms—is associated with worse prognosis in rheumatoid arthritis

  • Ultrasound-guided joint and soft tissue injections are more precise than those guided by palpation

  • Ultrasonography is not suited to evaluation of certain anatomic sites or intraosseal changes, is operator-dependant, and recommendations regarding the anatomic sites for, and frequency of, follow-up ultrasonographic investigations are lacking

This is a preview of subscription content, access via your institution

Access options

Rent or buy this article

Prices vary by article type

from$1.95

to$39.95

Prices may be subject to local taxes which are calculated during checkout

Figure 1: Overview of the sites of inflammation, and attendant diagnoses, of rheumatic conditions for which there is reasonable evidence of a diagnostic role for ultrasonography.
Figure 2: Ultrasonographic images of joints showing typical signs of different rheumatic diseases.
Figure 3: Typical extra-articular findings in rheumatic diseases by ultrasonography.

Similar content being viewed by others

References

  1. Sharp, J. T. In-office imaging in the care of patients with rheumatoid arthritis. Nat. Clin. Pract. Rheumatol. 1, 64–65 (2005).

    Article  PubMed  Google Scholar 

  2. Dejaco, C. et al. Definition of remission and relapse in polymyalgia rheumatica: data from a literature search compared with a Delphi-based expert consensus. Ann. Rheum. Dis. 70, 447–453 (2011).

    Article  PubMed  Google Scholar 

  3. Schmidt, W. A. Technology insight: the role of color and power Doppler ultrasonography in rheumatology. Nat. Clin. Pract. Rheumatol. 3, 35–42 (2007).

    Article  PubMed  Google Scholar 

  4. Pipitone, N., Versari, A. & Salvarani, C. Role of imaging studies in the diagnosis and follow-up of large-vessel vasculitis: an update. Rheumatology (Oxford) 47, 403–408 (2008).

    Article  CAS  Google Scholar 

  5. Klauser, A. In Contrast media in ultrasonography (ed. Emilio, Q.) 365–379 (Springer, Heidelberg, 2005).

    Book  Google Scholar 

  6. Brown, A. K. Using ultrasonography to facilitate best practice in diagnosis and management of RA. Nat. Rev. Rheumatol. 5, 698–706 (2009).

    Article  PubMed  Google Scholar 

  7. Naredo, E. et al. Current state of musculoskeletal ultrasound training and implementation in Europe: results of a survey of experts and scientific societies. Rheumatology (Oxford) 49, 2438–2443 (2010).

    Article  Google Scholar 

  8. Naredo, E. et al. Recommendations for the content and conduct of European League Against Rheumatism (EULAR) musculoskeletal ultrasound courses. Ann. Rheum. Dis. 67, 1017–1022 (2008).

    Article  CAS  PubMed  Google Scholar 

  9. Kissin, E. Y. et al. Self-directed learning of basic musculoskeletal ultrasound among rheumatologists in the United States. Arthritis Care Res. (Hoboken) 62, 155–160 (2010).

    Google Scholar 

  10. Cunnington, J., Platt, P., Raftery, G. & Kane, D. Attitudes of United Kingdom rheumatologists to musculoskeletal ultrasound practice and training. Ann. Rheum. Dis. 66, 1381–1383 (2007).

    Article  PubMed  PubMed Central  Google Scholar 

  11. Backhaus, M. et al. Guidelines for musculoskeletal ultrasound in rheumatology. Ann. Rheum. Dis. 60, 641–649 (2001).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. D'Agostino, M. A. et al. How to evaluate and improve the reliability of power Doppler ultrasonography for assessing enthesitis in spondylarthritis. Arthritis Rheum. 61, 61–69 (2009).

    Article  PubMed  Google Scholar 

  13. De Miguel, E., Castillo, C., Rodríguez, A. & De Agustín, J. J. ; Working Group Ultrasound Giant Cell Arteritis. Learning and reliability of colour Doppler ultrasound in giant cell arteritis. Clin. Exp. Rheumatol. 27 (1 Suppl. 52), S53–S58 (2009).

    CAS  PubMed  Google Scholar 

  14. Scheel, A. K. et al. Reliability exercise for the polymyalgia rheumatica classification criteria study: the oranjewoud ultrasound substudy. Int. J. Rheumatol. 2009, 738931 (2009).

    Article  PubMed  PubMed Central  Google Scholar 

  15. Backhaus, M. et al. Evaluation of a novel 7-joint ultrasound score in daily rheumatologic practice: a pilot project. Arthritis Rheum. 61, 1194–1201 (2009).

    Article  CAS  PubMed  Google Scholar 

  16. Bruyn, G. A. et al. Reliability of ultrasonography in detecting shoulder disease in patients with rheumatoid arthritis. Ann. Rheum. Dis. 68, 357–361 (2009).

    Article  CAS  PubMed  Google Scholar 

  17. Dougados, M. et al. Evaluation of several ultrasonography scoring systems for synovitis and comparison to clinical examination: results from a prospective multicentre study of rheumatoid arthritis. Ann. Rheum. Dis. 69, 828–833 (2010).

    Article  PubMed  Google Scholar 

  18. Cheung, P. P., 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. (Hoboken) 62, 323–334 (2010).

    Article  Google Scholar 

  19. Carter, J. D. et al. An analysis of MRI and ultrasound imaging in patients with gout who have normal plain radiographs. Rheumatology (Oxford) 48, 1442–1446 (2009).

    Article  Google Scholar 

  20. Wright, S. A. et al. High-resolution ultrasonography of the first metatarsal phalangeal joint in gout: a controlled study. Ann. Rheum. Dis. 66, 859–864 (2007).

    Article  PubMed  Google Scholar 

  21. Naredo, E. et al. Interobserver reliability in musculoskeletal ultrasonography: results from a “Teach the Teachers” rheumatologist course. Ann. Rheum. Dis. 65, 14–19 (2006).

    Article  CAS  PubMed  Google Scholar 

  22. Micu, M. C., 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 (Oxford) 50, 1120–1124 (2011).

    Article  Google Scholar 

  23. Wittoek, R., Jans, L., Lambrecht, V., Carron, P., Verstraete, K. & Verbruggen, G. Reliability and construct validity of ultrasonography of soft tissue and destructive changes in erosive osteoarthritis of the interphalangeal finger joints: a comparison with MRI. Ann. Rheum. Dis. 70, 278–283 (2011).

    Article  PubMed  Google Scholar 

  24. Cuomo, G. et al. Ultrasonographic features of the hand and wrist in systemic sclerosis. Rheumatology (Oxford) 48, 1414–1417 (2009).

    Article  Google Scholar 

  25. Iagnocco, A. et al. Wrist joint involvement in systemic lupus erythematosus. An ultrasonographic study. Clin. Exp. Rheumatol. 22, 621–624 (2004).

    CAS  PubMed  Google Scholar 

  26. Schmidt, W. A. et al. Utility of ultrasound in the diagnostic assessment of shoulder pain in polymyalgia rheumatica: Results from an international, prospective, multi-center longitudinal study. ACR/EULAR Study Group for Development of Classification Criteria for PMR. Arthritis Rheum. 62 (Suppl.), S682 (2010).

    Google Scholar 

  27. Aletaha, D. et al. 2010 rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Ann. Rheum. Dis. 69, 1580–1588 (2010).

    Article  PubMed  Google Scholar 

  28. Filer, A. et al. Utility of ultrasound joint counts in the prediction of rheumatoid arthritis in patients with very early synovitis. Ann. Rheum. Dis. 70, 500–507 (2011).

    Article  PubMed  Google Scholar 

  29. Machado, P. et al. Multinational evidence-based recommendations on how to investigate and follow-up undifferentiated peripheral inflammatory arthritis: integrating systematic literature research and expert opinion of a broad international panel of rheumatologists in the 3E Initiative. Ann. Rheum. Dis. 70, 15–24 (2011).

    Article  CAS  PubMed  Google Scholar 

  30. Zhang, W. et al. EULAR evidence-based recommendations for the diagnosis of knee osteoarthritis. Ann. Rheum. Dis. 69, 483–489 (2010).

    Article  CAS  PubMed  Google Scholar 

  31. Landewé, R. B. et al. EULAR/EFORT recommendations for the diagnosis and initial management of patients with acute or recent onset swelling of the knee. Ann. Rheum. Dis. 69, 12–19 (2010).

    Article  PubMed  Google Scholar 

  32. Zhang, W. et al. European League Against Rheumatism recommendations for calcium pyrophosphate deposition. Part I: terminology and diagnosis. Ann. Rheum. Dis. 70, 563–570 (2011).

    Article  CAS  PubMed  Google Scholar 

  33. Grassi, W., Meenagh, G., Pascual, E. & Filippucci, E. “Crystal clear”-sonographic assessment of gout and calcium pyrophosphate deposition disease. Semin. Arthritis Rheum. 36, 197–202 (2006).

    Article  CAS  PubMed  Google Scholar 

  34. Gaitini, D. Current approaches and controversial issues in the diagnosis of deep vein thrombosis via duplex Doppler ultrasound. J. Clin. Ultrasound 34, 289–297 (2006).

    Article  PubMed  Google Scholar 

  35. Arida, A., Kyprianou, M., Kanakis, M. & Sfikakis, P. P. The diagnostic value of ultrasonography-derived edema of the temporal artery wall in giant cell arteritis: a second meta-analysis. BMC Musculoskelet. Disord. 11, 44 (2010).

    Article  PubMed  PubMed Central  Google Scholar 

  36. Ball, E. L., Walsh, S. R., Tang, T. Y., Gohil, R. & Clarke, J. M. Role of ultrasonography in the diagnosis of temporal arteritis. Br. J. Surg. 97, 1765–1771 (2010).

    Article  CAS  PubMed  Google Scholar 

  37. Schmidt, W. A., Seifert, A., Gromnica-Ihle E., Krause A. & Natusch A. Ultrasound of proximal upper extremity arteries to increase the diagnostic yield in large-vessel giant cell arteritis. Rheumatology (Oxford) 47, 96–101 (2008).

    Article  CAS  Google Scholar 

  38. Salaffi, F. et al. All features: Ultrasonography of salivary glands in primary Sjögren's syndrome: a comparison with contrast sialography and scintigraphy. Rheumatology (Oxford) 47, 1244–1249 (2008).

    Article  CAS  Google Scholar 

  39. Wernicke, D., Hess, H., Gromnica-Ihle, E., Krause, A. & Schmidt, W. A. Ultrasonography of salivary glands—a highly specific imaging procedure for diagnosis of Sjögren's syndrome. J. Rheumatol. 35, 285–293 (2008).

    PubMed  Google Scholar 

  40. Schmidt, W. A., Krause, A., Schicke, B. & Wernicke, D. Color Doppler ultrasonography of hand and finger arteries to differentiate primary from secondary forms of Raynaud's phenomenon. J. Rheumatol. 35, 1591–1598 (2008).

    PubMed  Google Scholar 

  41. Adler, R. S. & Garofalo, G. Ultrasound in the evaluation of the inflammatory myopathies. Curr. Rheumatol. Rep. 11, 302–308 (2009).

    Article  PubMed  Google Scholar 

  42. Fowler, J. R., Gaughanm, J. P. & Ilyas, A. M. The sensitivity and specificity of ultrasound for the diagnosis of carpal tunnel syndrome: A meta-analysis. Clin. Orthop. Relat. Res. 469, 1089–1094 (2011).

    Article  PubMed  Google Scholar 

  43. Marhadour, T. et al. Reproducibility of joint swelling assessments in long-lasting rheumatoid arthritis: influence on Disease Activity Score-28 values (SEA-Repro study part I). J. Rheumatol. 37, 932–937 (2010).

    Article  PubMed  Google Scholar 

  44. Jousse-Joulin, S. et al. Reproducibility of joint swelling assessment by sonography in patients with long-lasting rheumatoid arthritis (SEA-Repro study part II). J. Rheumatol. 37, 938–945 (2010).

    Article  PubMed  Google Scholar 

  45. Larché, M. J. et al. Quantitative power Doppler ultrasonography is a sensitive measure of metacarpophalangeal joint synovial vascularity in rheumatoid arthritis and declines significantly following a 2-week course of oral low-dose corticosteroids. J. Rheumatol. 37, 2493–2501 (2010).

    Article  CAS  PubMed  Google Scholar 

  46. Hammer, H. B., Sveinsson, M., Kongtorp, A. K. & Kvien, T. K. 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. 69, 1349–1351 (2010).

    Article  CAS  PubMed  Google Scholar 

  47. Døhn, U. M. et al. No overall progression and occasional repair of erosions despite persistent inflammation in adalimumab-treated rheumatoid arthritis patients: results from a longitudinal comparative MRI, ultrasonography, CT and radiography study. Ann. Rheum. Dis. 70, 252–258 (2011).

    Article  PubMed  Google Scholar 

  48. Haavardsholm, E. A. et al. Monitoring anti-TNFalpha treatment in rheumatoid arthritis: responsiveness of magnetic resonance imaging and ultrasonography of the dominant wrist joint compared with conventional measures of disease activity and structural damage. Ann. Rheum. Dis. 68, 1572–1579 (2009).

    Article  CAS  PubMed  Google Scholar 

  49. Naredo, E. et al. Power Doppler ultrasonography assessment of entheses in spondyloarthropathies: response to therapy of entheseal abnormalities. J. Rheumatol. 37, 2110–2117 (2010).

    Article  PubMed  Google Scholar 

  50. Aydin, S. Z. et al. Monitoring Achilles enthesitis in ankylosing spondylitis during TNF-alpha antagonist therapy: an ultrasound study. Rheumatology (Oxford) 49, 578–582 (2010).

    Article  CAS  Google Scholar 

  51. Genc, H. et al. The effects of sulfasalazine treatment on enthesal abnormalities of inflammatory rheumatic diseases. Clin. Rheumatol. 26, 1104–1110 (2007).

    Article  PubMed  Google Scholar 

  52. Lehtinen, A., Leirisalo-Repo, M. & Taavitsainen, M. Persistence of enthesopathic changes in patients with spondylarthropathy during a 6-month follow-up. Clin. Exp. Rheumatol. 13, 733–736 (1995).

    CAS  PubMed  Google Scholar 

  53. Macchioni, P., Catanoso, M. G., Pipitone, N., Boiardi, L. & Salvarani, C. Longitudinal examination with shoulder ultrasound of patients with polymyalgia rheumatica. Rheumatology (Oxford) 48, 1566–1569 (2009).

    Article  Google Scholar 

  54. Jiménez-Palop, M. et al. Ultrasonographic monitoring of response to therapy in polymyalgia rheumatica. Ann. Rheum. Dis. 69, 879–882 (2010).

    Article  PubMed  Google Scholar 

  55. Micu, M. C., Bogdan, G. D. & Fodor, D. Steroid injection for hip osteoarthritis: efficacy under ultrasound guidance. Rheumatology (Oxford) 49, 1490–1494 (2010).

    Article  Google Scholar 

  56. Ceccarelli, F. et al. Exploratory data analysis on the effects of non pharmacological treatment for knee osteoarthritis. Clin. Exp. Rheumatol. 28, 250–253 (2010).

    CAS  PubMed  Google Scholar 

  57. Wakefield, R. J. et al. Delay in imaging versus clinical response: a rationale for prolonged treatment with anti-tumor necrosis factor medication in early rheumatoid arthritis. Arthritis Rheum. 57, 1564–1567 (2007).

    Article  PubMed  Google Scholar 

  58. Scirè, C. A. et al. Ultrasonographic evaluation of joint involvement in early rheumatoid arthritis in clinical remission: power Doppler signal predicts short-term relapse. Rheumatology (Oxford) 48, 1092–1097 (2009).

    Article  CAS  Google Scholar 

  59. Peluso, G. et al. Clinical and ultrasonographic remission determines different chances of relapse in early and long standing rheumatoid arthritis. Ann. Rheum. Dis. 70, 172–175 (2011).

    Article  PubMed  Google Scholar 

  60. Brown, A. K. 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. 54, 3761–3773 (2006).

    Article  CAS  PubMed  Google Scholar 

  61. Schmidt, W. A. et al. Prognosis of large-vessel giant cell arteritis. Rheumatology (Oxford) 47, 1406–1408 (2008).

    Article  CAS  Google Scholar 

  62. Aschwanden, M. et al. Vascular involvement in patients with giant cell arteritis determined by duplex sonography of 2x11 arterial regions. Ann. Rheum. Dis. 69, 1356–1359 (2010).

    Article  PubMed  Google Scholar 

  63. Balsa, A., de Miguel, E., Castillo, C., Peiteado, D. & Martín-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 (Oxford) 49, 683–690 (2010).

    Article  Google Scholar 

  64. Ruta, S. et al. Prevalence of subclinical enthesopathy in patients with spondyloarthropathy: an ultrasound study. J. Clin. Rheumatol. 17, 18–22 (2011).

    Article  PubMed  Google Scholar 

  65. Alcalde, M. et al. A sonographic enthesitis index (SEI) at lower limbs is a valuable tool in the assessment of ankylosing spondylitis. Ann. Rheum. Dis. 66, 1015–1019 (2007).

    Article  CAS  PubMed  Google Scholar 

  66. D'Agostino, M. A. et al. Assessment of peripheral enthesitis in the spondylarthropathies by ultrasonography combined with power Doppler. Arthritis Rheum. 48, 523–533 (2003).

    Article  PubMed  Google Scholar 

  67. Gutierrez, M. et al. Subclinical entheseal involvement in patients with psoriasis: an ultrasound study. Semin. Arthritis Rheum. 40, 407–412 (2011).

    Article  PubMed  Google Scholar 

  68. Gisondi, P. et al. Lower limb enthesopathy in patients with psoriasis without clinical signs of arthropathy: a hospital-based case–control study. Ann. Rheum. Dis. 67, 26–30 (2008).

    Article  CAS  PubMed  Google Scholar 

  69. Bajaj, S., Lopez-Ben, R., Oster, R. & Alarcón, G. S. Ultrasound detects rapid progression of erosive disease in early rheumatoid arthritis: a prospective longitudinal study. Skeletal Radiol. 36, 123–128 (2007).

    Article  PubMed  Google Scholar 

  70. Døhn, U. 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. 8, R110 (2006).

    Article  PubMed  PubMed Central  Google Scholar 

  71. Scheel, A. K. et al. Prospective 7 year follow up imaging study comparing radiography, ultrasonography, and magnetic resonance imaging in rheumatoid arthritis finger joints. Ann. Rheum. Dis. 65, 595–600 (2006).

    Article  CAS  PubMed  Google Scholar 

  72. Gutierrez, M. et al. Inter-observer reliability of high-resolution ultrasonography in the assessment of bone erosions in patients with rheumatoid arthritis: experience of an intensive dedicated training programme. Rheumatology (Oxford) 50, 373–380 (2011).

    Article  Google Scholar 

  73. Weiner, S. M. et al. Ultrasonography in the assessment of peripheral joint involvement in psoriatic arthritis: a comparison with radiography, MRI and scintigraphy. Clin. Rheumatol. 27, 983–989 (2008).

    Article  CAS  PubMed  Google Scholar 

  74. Wiell, C. et al. Ultrasonography, magnetic resonance imaging, radiography, and clinical assessment of inflammatory and destructive changes in fingers and toes of patients with psoriatic arthritis. Arthritis Res. Ther. 9, R119 (2007).

    Article  PubMed  PubMed Central  Google Scholar 

  75. Vlychou, M., Koutroumpas, A., Malizos, K. & Sakkas, L. I. Ultrasonographic evidence of inflammation is frequent in hands of patients with erosive osteoarthritis. Osteoarthritis Cartilage 17, 1283–1287 (2009).

    Article  CAS  PubMed  Google Scholar 

  76. Wittoek, R., Carron, P. & Verbruggen, G. Structural and inflammatory sonographic findings in erosive and non-erosive osteoarthritis of the interphalangeal finger joints. Ann. Rheum. Dis. 69, 2173–2176 (2010).

    Article  PubMed  Google Scholar 

  77. Keen, H. I. et al. Can ultrasonography improve on radiographic assessment in osteoarthritis of the hands? A comparison between radiographic and ultrasonographic detected pathology. Ann. Rheum. Dis. 67, 1116–1120 (2008).

    Article  CAS  PubMed  Google Scholar 

  78. Thiele, R. G. & Schlesinger, N. Ultrasonography shows disappearance of monosodium urate crystal deposition on hyaline cartilage after sustained normouricemia is achieved. Rheumatol. Int. 30, 495–503 (2010).

    Article  PubMed  Google Scholar 

  79. Perez-Ruiz, F. et al. Ultrasonographic measurement of tophi as an outcome measure for chronic gout. J. Rheumatol. 34, 1888–1893 (2007).

    PubMed  Google Scholar 

  80. Marie, I. et al. Long-term follow-up of aortic involvement in giant cell arteritis: a series of 48 patients. Medicine (Baltimore) 88, 182–192 (2009).

    Article  Google Scholar 

  81. Salaffi, F. et al. 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. 28, 686–694 (2010).

    CAS  PubMed  Google Scholar 

  82. Freeston, J. E. et al. 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. 69, 417–419 (2010).

    Article  CAS  PubMed  Google Scholar 

  83. van de Stadt, L. A. et al. The value of ultrasonography in predicting arthritis in auto-antibody positive arthralgia patients: a prospective cohort study. Arthritis Res. Ther. 12, R98 (2010).

    Article  PubMed  PubMed Central  Google Scholar 

  84. Schmidt, W. A., Krause, A., Schicke, B., Kuchenbecker, J. & Gromnica-Ihle, E. Do temporal artery duplex ultrasound findings correlate with ophthalmic complications in giant cell arteritis? Rheumatology (Oxford) 48, 383–385 (2009).

    Article  Google Scholar 

  85. Kamishima, T. et al. Semi-quantitative analysis of rheumatoid finger joint synovitis using power Doppler ultrasonography: when to perform follow-up study after treatment consisting mainly of antitumor necrosis factor alpha agent. Skeletal Radiol. 39, 457–465 (2010).

    Article  PubMed  Google Scholar 

  86. Ellegaard, K. et al. Ultrasound Doppler measurements predict success of treatment with anti-TNF-α drug in patients with rheumatoid arthritis: a prospective cohort study. Rheumatology (Oxford) 50, 506–512 (2011).

    Article  CAS  Google Scholar 

  87. Chao, J. et al. Inflammatory characteristics on ultrasound predict poorer longterm response to intraarticular corticosteroid injections in knee osteoarthritis. J. Rheumatol. 37, 650–655 (2010).

    Article  CAS  PubMed  Google Scholar 

  88. Pendleton, A., Millar, A., O'Kane, D., Wright, G. D. & Taggart, A. J. Can sonography be used to predict the response to intra-articular corticosteroid injection in primary osteoarthritis of the knee? Scand. J. Rheumatol. 37, 395–397 (2008).

    Article  CAS  PubMed  Google Scholar 

  89. Naranjo, A. et al. Usefulness of clinical findings, nerve conduction studies and ultrasonography to predict response to surgical release in idiopathic carpal tunnel syndrome. Clin. Exp. Rheumatol. 27, 786–793 (2009).

    CAS  PubMed  Google Scholar 

  90. Mondelli, M., Filippou, G., Aretini, A., Frediani, B. & Reale, F. Ultrasonography before and after surgery in carpal tunnel syndrome and relationship with clinical and electrophysiological findings. A new outcome predictor? Scand. J. Rheumatol. 37, 219–224 (2008).

    Article  CAS  PubMed  Google Scholar 

  91. Smidt, M. H. & Visser, L. H. Carpal tunnel syndrome: clinical and sonographic follow-up after surgery. Muscle Nerve 38, 987–991 (2008).

    Article  PubMed  Google Scholar 

  92. Fukae, J. 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. (Hoboken) 62, 657–663 (2010).

    Article  Google Scholar 

  93. Bøyesen, P. et al. Prediction of MRI erosive progression: a comparison of modern imaging modalities in early rheumatoid arthritis patients. Ann. Rheum. Dis. 70, 176–179 (2011).

    Article  PubMed  Google Scholar 

  94. Naredo, E. 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. 57, 116–124 (2007).

    Article  PubMed  Google Scholar 

  95. Conaghan, P. G. et al. Clinical and ultrasonographic predictors of joint replacement for knee osteoarthritis: results from a large, 3-year, prospective EULAR study. Ann. Rheum. Dis. 69, 644–647 (2010).

    Article  CAS  PubMed  Google Scholar 

  96. Sconfienza, L. M., Silvestri, E., Bartolini, B., Garlaschi, G. & Cimmino M. A. Sonoelastography may help in the differential diagnosis between rheumatoid nodules and tophi. Clin. Exp. Rheumatol. 28, 144–145 (2010).

    CAS  PubMed  Google Scholar 

  97. Balint, P. V. et al. Ultrasound guided versus conventional joint and soft tissue fluid aspiration in rheumatology practice: a pilot study. J. Rheumatol. 29, 2209–2213 (2002).

    PubMed  Google Scholar 

  98. Raza, K. et al. Ultrasound guidance allows accurate needle placement and aspiration from small joints in patients with early inflammatory arthritis. Rheumatology 42, 976–979 (2003).

    Article  CAS  PubMed  Google Scholar 

  99. Fredberg, U., van Overeem Hansen, G. & Bolvig, L. Placement of intra-articular injections verified by ultrasonography and injected air as contrast medium. Ann. Rheum. Dis. 60, 542 (2001).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  100. Delle Sedie, A., Riente, L. & Bombardieri, S. Limits and perspectives of ultrasound in the diagnosis and management of rheumatic diseases. Mod. Rheumatol. 18, 125–131 (2008).

    Article  PubMed  Google Scholar 

  101. Wiell, C. et al. Ultrasonography, magnetic resonance imaging, radiography, and clinical assessment of inflammatory and destructive changes in fingers and toes of patients with psoriatic arthritis. Arthritis Res. Ther. 9, R119 (2007).

    Article  PubMed  PubMed Central  Google Scholar 

  102. Døhn, U. 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. 8, R110 (2006).

    Article  PubMed  PubMed Central  Google Scholar 

  103. Naredo, E. et al. Validity, reproducibility, and responsiveness of a twelve-joint simplified power doppler ultrasonographic assessment of joint inflammation in rheumatoid arthritis. Arthritis Rheum. 59, 515–522 (2008).

    Article  PubMed  Google Scholar 

  104. Filippucci, E. et al. Ultrasound imaging for the rheumatologist. XX. Sonographic assessment of hand and wrist joint involvement in rheumatoid arthritis: comparison between two- and three-dimensional ultrasonography. Clin. Exp. Rheumatol. 27, 197–200 (2009).

    CAS  PubMed  Google Scholar 

  105. Klauser, A. S. et al. Fusion of real-time US with CT images to guide sacroiliac joint injection in vitro and in vivo. Radiology 256, 547–553 (2010).

    Article  PubMed  Google Scholar 

  106. Silvestri, E. et al. Sonoelastography can help in the localization of soft tissue damage in polymyalgia rheumatica (PMR). Clin. Exp. Rheumatol. 25, 796 (2007).

    CAS  PubMed  Google Scholar 

  107. De Zordo, T. et al. Real-time sonoelastography: findings in patients with symptomatic Achilles tendons and comparison to healthy volunteers. Ultraschall. Med. 31, 394–400 (2010).

    Article  CAS  PubMed  Google Scholar 

  108. Hatemi, G., Fresko, I., Tascilar, K. & Yazici, H. Increased enthesopathy among Behçet's syndrome patients with acne and arthritis: an ultrasonography study. Arthritis Rheum. 58, 1539–1545 (2008).

    Article  PubMed  Google Scholar 

  109. Kluge, S., Kreutziger, J., Hennecke, B. & Vögelin, E. Inter- and intraobserver reliability of predefined diagnostic levels in high-resolution sonography of the carpal tunnel syndrome—a validation study on healthy volunteers. Ultraschall. Med. 31, 43–47 (2010).

    Article  CAS  PubMed  Google Scholar 

  110. Filippucci, E., Riveros, M. G., Georgescu, D., Salaffi, F. & Grassi, W. Hyaline cartilage involvement in patients with gout and calcium pyrophosphate deposition disease. An ultrasound study. Osteoarthritis Cartilage 17, 178–181 (2009).

    Article  CAS  PubMed  Google Scholar 

  111. Carotti, M. et al. Colour Doppler ultrasonography evaluation of vascularization in the wrist and finger joints in rheumatoid arthritis patients and healthy subjects. Eur. J. Radiol. doi:10.1016/j.ejrad.2010.01.005

  112. Filippucci, E. et al. Interobserver reliability of ultrasonography in the assessment of cartilage damage in rheumatoid arthritis. Ann. Rheum. Dis. 69, 1845–1848 (2010).

    Article  PubMed  Google Scholar 

  113. Szkudlarek, M. et al. Interobserver agreement in ultrasonography of the finger and toe joints in rheumatoid arthritis. Arthritis Rheum. 48, 955–962 (2003).

    Article  PubMed  Google Scholar 

  114. Wakefield, R. J. et al. The value of sonography in the detection of bone erosions in patients with rheumatoid arthritis: a comparison with conventional radiography. Arthritis Rheum. 43, 2762–2770 (2000).

    Article  CAS  PubMed  Google Scholar 

  115. Kaloudi O. et al. High frequency ultrasound measurement of digital dermal thickness in systemic sclerosis. Ann. Rheum. Dis. 69, 1140–1143 (2010).

    Article  PubMed  Google Scholar 

  116. Schmidt, W. A., Kraft, H. E., Vorpahl, K., Völker, L. & Gromnica-Ihle, E. J. Color duplex ultrasonography in the diagnosis of temporal arteritis. N. Engl. J. Med. 337, 1336–1342 (1997).

    Article  CAS  PubMed  Google Scholar 

  117. Salvarani, C. et al. Is duplex ultrasonography useful for the diagnosis of giant-cell arteritis?. Ann. Intern. Med. 137, 232–238 (2002).

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

M. Schirmer is supported by a project grant from the Austrian Society of Rheumatology and Rehabilitation.

Author information

Authors and Affiliations

Authors

Contributions

All authors contributed equally to all aspects of the preparation of this manuscript.

Corresponding author

Correspondence to Michael Schirmer.

Ethics declarations

Competing interests

The authors declare no competing financial interests.

Supplementary information

Supplementary Table 1

Selected indications and diagnostic value of ultrasonography in the management of rheumatic diseases. (DOC 72 kb)

Supplementary Table 2

Indications and evidence for ultrasonography as a tool to guide injections, aspiration and biopsy. (DOC 92 kb)

Rights and permissions

Reprints and permissions

About this article

Cite this article

Schirmer, M., Duftner, C., Schmidt, W. et al. Ultrasonography in inflammatory rheumatic disease: an overview. Nat Rev Rheumatol 7, 479–488 (2011). https://doi.org/10.1038/nrrheum.2011.95

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/nrrheum.2011.95

This article is cited by

Search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing