Although no exact figures are available, an estimated 15% to 30% of rheumatology practices in the United States use MSUS. According to Dr. McAlindon, some rheumatologists do not support its use because they are unsure whether it would improve clinical practice, and others are concerned about its potential overuse. This document, he says, should stimulate more dialogue and will hopefully encourage the development of training programs for fellows and a certification standard. “The technology itself, its safety, and its palpable benefits will stimulate more rheumatologists to adopt it; the trainees are already adopting it readily,” he says.
There is a lot of convincing documentation about the general utility of MSUS and what it can reveal. “It is certainly very promising technology and also very low risk. When we think of reasonable use, it has very broad applicability,” he adds. MSUS may make “one-stop rheumatology” a more likely reality. A rheumatologist may be able to come up with a more definitive diagnosis at the point of care without needing to send the patient out for additional testing, he says.
Clinical Scenarios Define Use
The document lists 14 clinical scenarios where MSUS can reasonably be used, with just one of those supported by Level A, or the highest, evidence: use of MSUS to guide articular and periarticular aspiration or injection at certain sites, including the synovial, tenosynovial, bursal, peritendinous, and perientheseal areas. According to Dr. Shaver, who has been performing MSUS for several years, its use for this purpose can improve accuracy. “Sometimes it will tell me, when I view the area, that the procedure I thought I would be doing is not the procedure I should be doing. I may be injecting a tendon sheath instead of a joint, or I may be aspirating fluid when I didn’t think there was fluid there, so it can change my approach to the procedure.”
Another key point among the 14 is that MSUS can be used to monitor disease activity and structural progression in patients with inflammatory polyarthritis. Disease activity and structural progression can be monitored at the glenohumeral, acromioclavicular, elbow, wrist, hand, metacarpophalangeal, interphalangeal, hip, knee, ankle, foot, and metatarsophalangeal sites. Power Doppler, a feature of MSUS, correlates with radiographic progression of rheumatoid arthritis erosions and predicts subsequent development of erosions.
Dr. Arnold, who has been using MSUS in his practice since 2002, says MSUS plays a particularly important role in this type of diagnosis. “There is growing literature about the value of diagnosing RA early and monitoring effective treatment. If we can prevent bone erosion early on, we can prevent disability,” he says.
