The use of musculoskeletal ultrasound of the wrist and hand in the assessment of treatment response in rheumatoid arthritis patients

Abstract

Objective: Rheumatoid arthritis is a debilitating disease with accrual of joint damage during each flare of the disease that progresses to considerable functional disability. Early treatment is thus aimed to achieve remission  status so as to reduce the progression of joint damage. Currently the disease activity parameter DAS28 (amongst others) is used to define a remission status and thus demonstrate the efficacy of a treatment regimen, however musculoskeletal ultrasound (MSUS) is proving to be superior at determining the amount of inflammation within joints by grading synovial hypertrophy and neo-vascularization of the inflamed synovium. This article is thus intended to shed light on the usefulness of musculoskeletal  ultrasound both greyscale and Doppler in the determination of treatment response in rheumatoid arthritis patients.

Design: This article will elaborate the importance and effectiveness of musculoskeletal ultrasound. Thus it will involve a discussion on the need for
an effective tool to detect inflammatory activity, the ability of ultrasound to detect and grade the disease activity i.e. being sensitive to change, the various scoring systems currently used, and lastly a comparison of musculoskeletal ultrasound to other modalities and clinical and serological evaluation.

Data source and extraction: Published studies, reviews and guidelines  regarding the use of musculoskeletal ultrasound of the wrist/hand in assessing treatment response in rheumatoid arthritis patients were sourced through the internet and library searches and the relevant data extracted.

Conclusion: Musculoskeletal ultrasound of the wrist and hand is a highly effective and sensitive to change tool for demonstrating the amount of inflammation within joints and can give an objective assessment of the difference in inflammatory activity between a given time period, thus enabling us to gauge the treatment efficacy of a particular regimen.

Key words: Rheumatoid arthritis, Musculoskeletal ultrasound, Synovitis, Tenosynovitis, Erosions