Applications of real time musculoskeletal ultrasonography in rheumatology practice

Abstract

"In early arthritis, it is important to make a diagnosis before structural damage has occurred, with early disease modifying therapy effective in improving long term outcomes. The first part of this thesis addresses the deficiency in our current knowledge of standardisation and reproducibility of ultrasound (US) findings. Chapter 2 describes a standardised protocol developed for assessing the metacarphphalangeal (MCP) joints and novel measurements of synovial inflammation. Chapter 3 compares early arthritis subjects to a control group, and showed significantly more US synovitis and abnormally increased measurements, with extensor tenosynovitis (ET) and power Doppler (PD_ positivity highly specific to the early arthritis group. Chapter 4 validates HRUS findings in a subset of subjects using MRI as the reference standard..Chapter 5 presents longitudinal data which suggests that clnical swelling and PD positivity at the MCP joints were the most sensitive to change as a reseult of disease-modifying therapy. Chapter 6 validates an US assessment tooldevelopedbadsed on “sentinel joints” whilst factors that may hemp to differentiate subjects with polyarthralgias from those with early RA are identified in chapter 7. The results of this study suggest that early RA needs to be redefined in the light of our US findings. The prognostic value of early US abnormalities will contlinue to be investigated." -- from Abstract.