Musculoskeletal Ultrasound Aids in Diagnosis & Disease Management of RA & PsA
WASHINGTON, D.C.—At a Nov. 15 session of ACR Convergence, speakers shared insights from their ongoing work on the updated guidance document on the use of musculoskeletal ultrasound (MSUS) for rheumatoid arthritis (RA) and psoriatic arthritis (PsA). The panel emphasized the importance of the supplementary tool in clinical decision making and patient collaboration.
Evolution of MSUS
For the past two years, researchers have been working through the stages of guidance document production, from the development of initial PICO (Patient/Intervention/Comparison/Outcome) questions, literature search and voting processes. The goal was to update the ACR’s 2012 report, creating two different guidance documents for RA and PsA that reflect the changing landscape of ultrasound in rheumatology.1
Dr. Ranganath
One of the clinicians working on the guidance documents is Veena K. Ranganath, MD, MS, RhMSUS, co-director of the UCLA Masters of Science in Clinical Research Program and director of the Rheumatology Fellowship Musculoskeletal Ultrasound Training Program, University of California, Los Angeles.
Dr. Ranganath pointed out that in the last 12 years, MSUS technology has significantly improved, and substantive advancements have been made in systems for ultrasound scoring and defining ultrasound features. Research interest in the area has increased substantially, and ultrasound has become more widely used in clinical practice, in part because of educational efforts by the ACR, EULAR and the Ultrasound School of North American Rheumatologists (USSONAR).
“New therapeutic agents and treatment strategies have emerged for both RA and PsA, and that definitively impacts the question of how to incorporate musculoskeletal ultrasound into our clinical practices,” said Dr. Ranganath.
The following is a discussion of a selection of the approved guidance statements discussed in the session at ACR Convergence.
Guiding Diagnosis
The Voting Panel reached strong consensus that adding MSUS to the clinical exam can aid in both the diagnosis of early RA and early PsA in patients with psoriasis and musculoskeletal symptoms, promoting earlier intervention.
Dr. Kaeley
Gurjit Kaeley, MBBS, RhMSUS, MRCP, a rheumatologist and a professor in the Department of Medicine at the University of Florida, Jacksonville, who has been working on the guidance document, explained that ultrasound is more sensitive than clinical exam in detecting synovitis. Studies suggest that adding sonography improves the prediction of the development of RA.
“Patients’ ultrasounds—especially with Doppler technique—provide critical insights into disease activity and structural changes not always apparent during standard clinical examinations,” he said.
