Hi Jack,
I understand your skepticism, but I do think it adds substantially to the evaluation of some new patients and also D2Ts and have been excited about this for a while. Most Rheumatologists of the older generation felt very strongly about their trust on physical exam. Although it is a fantastic skill we hone daily, it is still an imperfect and limited one. Ultrasound evaluation has been shown to change diagnosis in many new patients evaluated for polyarthralgia which was not felt to be inflammatory on exam. It is possible that over time those patients would have declared themselves more clearly and there is a risk of overdiagnosis with more sensitive tools, I would acknowledge that. However, I think this expands the possibilities of early diagnosis of inflammatory arthritis and possibly more effective management or even prevention of development into classic, "full blown", phenotypes. I agree that we need further studies before deploying this in clinical practice to better understand what patient population, if any, this would be appropriate.