Improving the Value of Musculoskeletal Ultrasound in Rheumatology Care Save

Musculoskeletal ultrasound (MSUS) has emerged as a powerful asset in rheumatology, providing a real-time, non-invasive, and cost-effective solution for diagnosing and managing inflammatory arthritis conditions such as rheumatoid arthritis (RA) and psoriatic arthritis (PsA).

Unlike traditional imaging techniques, MSUS can be easily used at the point-of-care and offers high-resolution images of joints, tendons, and soft tissues, facilitating the early detection of inflammation and structural damage. This is crucial for the timely diagnosis and assessment of disease activity, allowing rheumatologists to create more tailored and effective treatment plans. MSUS can also identify subclinical inflammation that may not be evident through clinical examination alone, thereby guiding more proactive and targeted therapeutic interventions.

On Saturday, November 16th at the ACR Convergence 2024, Dr. Veena Ranganath, Dr. Gurjit Kaeley, and Dr. Catherine Bakewell will present the “Proposed ACR Guidance for Use of Musculoskeletal Ultrasound in Rheumatoid and Psoriatic Arthritis.”

This is the first update in a decade since the 2012 ACR guidance on the reasonable use of MSUS in rheumatology clinical practice. The initial guidance focused on developing a consensus for clinical scenarios where MSUS could be utilized for diagnosis, monitoring, and procedures. The field continues to advance with an exponential rise in the number of publications. In addition, MSUS has become an ACGME procedural milestone in rheumatology training. The ACR has also administered certification for MSUS through RhMSUS. Training for certification and competency has been undertaken by rheumatology fellowship programs as well as through Ultrasound School of North American Rheumatologists (USSONAR) educational program.

When MSUS is applied indiscriminately outside the context of a clinical question, the benefit of its use is not always as readily evident. For instance, the ARTIC and TaSER trials demonstrated that outcomes did not differ significantly when MSUS was compared to a strict treat-to-target approach in early RA patients.

Prior to ACR 2024, Drs. Ranganath, Kaeley, and Bakewell shared that MSUS is undoubtedly valuable, however its clinical utility has not been specifically characterized. Despite the large body of literature, consensus has not been reached on what defines an inflamed joint or enthesis, and which views are needed to confirm active disease. Additionally, should MSUS-based definitions differ for various stages of inflammatory arthritis, such as suspected RA/PsA, early, active, or remission? The influence of concomitant diagnoses such as osteoarthritis, CPPD, and fibromyalgia on MSUS findings also merits consideration. This is particularly relevant as the population is aging, and a growing number of older adults with inflammatory arthritis are living with chronic pain syndromes that may confound clinical disease activity measures.

The ACR MSUS inflammatory arthritis project leaders are working to establish evidence-informed, expert consensus-based definitions of MSUS for RA and PsA to better guide clinical decision-making. They are confident that the upcoming guidance document will further inform the ACR members on the utility of MSUS in enhancing patient care in rheumatology clinical practice.