Interventional rheumatology, an unsettled issue.

The objective proposed by clinical rheumatologists over the last 2 decades has been to acquire new skills that enable them to carry out an increasing number of procedures. This is now a reality in fields like ultrasound, capillaroscopy, densitometry and biopsies, among others. Thus, in the 21st century, rheumatologists have come to be more technically proficient, with dedicated clinics and training, and through their collaboration with research units. However, there are still a number of unresolved matters.1–3 Interventional rheumatology is a field in which rheumatologists are responsible for performing minimally invasive procedures for diagnostic and therapeutic purposes in patients with mechanical and/or inflammatory musculoskeletal diseases accompanied by acute or chronic pain that is refractory to standard treatment. Since the first reports published by Hollander et al. in 1951, that introduced the use of corticosteroids injected into the joint for the treatment of pain and inflammation,4 intraarticular injections have come to be a frequently employed tool in rheumatology, and their success is based on knowledge of certain anatomical references. However, over the years and with the advent of new technologies, and the understanding and training in the use of ultrasound, the capability of performing these procedures with ultrasound guidance was achieved, making them more efficient and safer.5 These advances and our experience with medical imaging systems, in addition to new discoveries concerning chemical mediation of pain and inflammation, as well as the development of injection techniques with a greater diagnostic and therapeutic accuracy, led to a wider use of minimally invasive techniques in the management of pain. The performance of these procedures requires more time than that allotted to the patient visit, with radiological monitoring (ultrasound or fluoroscopy) to locate the anatomical structures to be treated, an appropriate setting and the necessary equipment to carry out the technique and patient monitoring. Thus, these treatments traditionally take place in pain clinics, where diverse interventions can be performed with reasonable evidence, including intraarticular and periarticular injections,