Ultrasound in Rheumatology Quiz

USG can asses effusion and quantify the effusion and synovitis. Bone edema can not be appreciated by the USG and is a sign of MRI. Inside the joint the

In the joint through USG one can asses the synovial membrane and its vascularity, The vascularity is assessed by Doppler and the doppler signals are grade and help in quantifying the inflammation and the stage of synovitis. The ligament oedema and its integrity can be assessed; especially it help in differentiating rheumatoid from spondyloarthropathy groups

Ultrasound being a Real-time and easy, less expensive procedure can help in assessing the response to therapy including DMARD. OMARACT has come up with a standardized protocol with reference to that. It is a useful tool for assessing ligaments, the cartilage in the joints. It is used for assessing enthesis and nail change. The disc is difficult to assess because of its location.

The ultrasound help in differentiating different artheiris, based on synovial involvement and other findings. Presence of hyperechoic foreign body is na indicator of crystal deposit. The crystal deposition pattern on hyaline cartilage help in Identifying monosodium urate (MSU) and calcium pyrophosphate dehydrate (CPP) Crystals, though not with absolute accuracy. The MSU crystals located at chondrosynovial (or superficial) margin of the hyaline cartilage and described- double contour sign in gout. CPP crystals are located within the intermediate layer of the hyaline cartilage and are seen as hyperechoic spots -as rosary beads on US.

USG is a less expensive setup. However, in a few countries, especially in the Indian context some regulatory concerns. One can assess vascularity. It helps in differentiating ligament involvement. The interpretation is significantly operator dependant and the standardization of several findings needs standardization.

The distinct advantage is the accuracy of the needle positioning and the imaging being real-time one can visualize the stream of injected drug. Injecting to the ligament can be avoided and grossly one can estimate the injected volume and can limit the volume. However, the estimation is not accurate and may not be very helpful