Over the years, the role of subspecialties in internal medicine has expanded. Many procedures, which were previously under the purview of other specialties, have since been mandatory skills to be obtained during subspecialty training. In rheumatology, ultrasound is gaining acceptance as a vital tool in aiding diagnosis and monitoring of therapeutic responses to assisting invasive procedures, for example, intraarticular joint injections.

Ultrasound is an imaging modality that is very operator dependant. The skill of the ultrasonographer can determine the quality of images obtained as well as the interpretation of those grainy images. Even existing grading systems are subjective and reproducibility is suspect. Time constraints during patient consultations can also be a deterrent for busy rheumatologists in performing ultrasounds in clinics.

However, if performed well, it could be a potentially important diagnostic tool. In rheumatoid arthritis for example, early damages to the cartilage can be detected even before any changes in Xrays is evident. Even the microarchitecture of tendons and its surrounding structures can be scrutinised for damages.

Ultrasounds can also be used to aid invasive procedures like intraarticular joint injections. Even a fluid collection of 1mm2 can be aspirated under ultrasound guidance. It can also aid in more accurate delivery of drugs to intended targets, like steroid injections which were previously done blindly.

Would musculoskeletal radiologist be pleased? I think that it will be an opportunity for a greater collaboration between specialties.

Guidelines for musculoskeletal ultrasound in rheumatology

MSK ultrasound in rheumatology

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