Ultrasound in rheumatology: where are we and where are we going?

OBJECTIVE To know rheumatologists' opinion on the usefulness of ultrasound in diagnostic and therapeutic decision making as applied to rheumatic diseases. MATERIAL AND METHODS A National survey was sent to all rheumatology units in hospitals with at least 200 beds. The questionnaire included: a) general data, b) purpose and most common areas of ultrasound exploration and c) assessment of the usefulness of ultrasound in routine clinical practice in general and in some rheumatologic diseases. RESULTS One-hundred-sixty-nine out of 234 rheumatology units contacted answered the questionnaire. The utility in routine clinical practice was scored at 7.8 (scale 0-10) and ultrasound was integrated in making diagnostic and therapeutic decisions. Half of the indications (50.9%) were ultrasound related to the process of diagnosis of diseases or treatment decision making (monitoring synovitis 14.6%, guided puncture 11.4%, early detection of joint erosion or synovitis 10.3%, early detection of enthesopathy 5.9%, carpal tunnel syndrome or other peripheral neuropathies 3.4%, detection of uric acid or pyrophosphate deposits 3%, vasculitis 1% and others 1.1%. On a 1-5 Likert, scale most of the answers support the use of ultrasound in clinical practice, especially in diagnostic and therapeutic decision making for detection of subclinical synovitis, erosions and treatment decisions in rheumatoid arthritis, enthesitis diagnosis, crystal diseases, polymyalgia rheumatica and giant cell arteritis. CONCLUSIONS Ultrasound is becoming a useful tool integrated into clinical practice and is linked to the decision making processes in the areas of diagnosis, activity and treatment.