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Role Of Ultrasound as a diagnostic tool to measure prognosis of Rheumatoid Arthritis
Transcript of Role Of Ultrasound as a diagnostic tool to measure prognosis of Rheumatoid Arthritis
From bats and ships to babies and hips
The first detailed experiments that indicated that non-audible sound might exist were performed on bats by Lazzaro Spallanzani (1729–1799) an Italian priest and physiologist. Seeking to explain the ability of bats to navigate flight in darkness.
The application of directional sound reflections being used to detect objects and measure distances—termed echolocation—was initially developed for nautical purposes.
The threat of German submarines to Allied shipping in World War I provided a pressing impetus to the development of ultrasound technology. Paul Langevin and Constantin Chilowsky constructed an underwater sandwich sound generator using quartz crystals and two steel plates, considered to be the prototype of modern ultrasound devices
A key figure in the development of medical ultrasound in clinical practice was Professor Ian Donald of Glasgow. Having gained initial experience in radar and sonar techniques while serving in the Royal Air Force during World War II
The first report of musculoskeletal ultrasonography was published in 1958 by K. T. Dussik who measured the acoustic attenuation of articular and periarticular tissues including skin, adipose tissue, muscle, tendon, articular capsule, articular cartilage and bone
The ultrasound is important in the practice of the rheumatologist to prevent future structural damage, providing more comfort to the patient by fast, unlimited and safer scanning without irradiation. It can be considered a useful tool in the diagnosis of synovitis in early RA and can lead to an early change in the therapeutic decision.
Early diagnosis of rheumatoid arthritis
Monitoring response to therapeutic intervention and more accurately assessing remission
Ultrasonography is useful in assessing early rheumatoid arthritis activity.
Modern drug therapies have reportedly decreased synovial proliferation and bone marrow edema and prevented the development of bone erosions. Ultrasonography can quantify synovial inflammation.
Treatment response can be identified on ultrasonography in patients who respond to treatment .
More recently, methods of semiquantitative scoring of early rheumatoid arthritis changes (i.e., synovitis, bone erosions, and bone edema) at the wrist and MCP joints have been developed and standardized on MRI by the OMERACT (Outcome Measures in Rheumatology Clinical Trials) and EULAR (European League Against Rheumatism) groups. These scoring systems may also be useful in assessing rheumatoid arthritis activity and bone damage.
Advantages of Ultrasound
Multiple joints from
Accurate assessment of disease activity and joint damage in rheumatoid arthritis (RA) is important for monitoring treatment efficacy and for predicting the outcome of the disease. It has been shown that in early RA, synovitis appears to be the primary abnormality.
Wrist ultrasound analysis of patients with
early rheumatoid arthritis
However, US scoring methods with quantitative assessment of joint inflammation have yet not been standardized or appropriately validated.
There is a need for quantification of US-detected synovitis and evaluation of a US synovitis measurement system that can be easily applied, especially for evaluation of treatment efficacy in the new era of highly effective biologic agents.
In the present study, we evaluated 42 wrists using the semi-quantitative scales power Doppler ultrasound (PDUS) and gray scale ultrasound (GSUS) with scores ranging from 0 to 3 and correlated the results with clinical, laboratory and radiographic data.
Twenty-one patients (17 women and 4 men) with rheumatoid arthritis according to criteria of the American College of Rheumatology were enrolled in the study from September 2008 to July 2009 at Universidade Estadual de Campinas (UNICAMP)
A dorsal longitudinal scan was performed by ultrasound on the radiocarpal and midcarpal joints using GE LOGIQ XP-linear ultrasound and a high frequency (8-10 MHz) transducer. All patients were X-rayed, and the Larsenscore was determined for the joints, with grades ranging from 0 to V.
This study showed significant correlations between clinical,sonographic and laboratory data.
Ultrasound can be considered a useful tool in the diagnosis of synovitis in early rheumatoid arthritis mainly when the anti-cyclic citrullinated peptide and rheumatoid factor are negative, and can lead to an early change in the therapeutic decision.
Detection of bone erosions
Use of MUSKUS in Current rheumatology practice
as a decrease in synovial thickness
and disappearance of the Doppler signal
US has a multiplanar capacity that allows joints to be visualized on multiple planes, enabling the detection of smaller erosions in the range of 1 mm to 5 mm.
A study comparing detection of erosions by US or radiography showed that US detects significantly more bone abnormalities than X-rays do, with a 6.5-fold increase in the number of erosions detected by US versus X-rays in patients with
Many studies have highlighted the ability of US to detect early synovial disease in both large and small joints and its superiority over clinical examination.
power Doppler(PD) has become increasingly popular with the advantage of being able to assess synovial vascularity