Ultrasound at point-of-care is standard-of-care in any rheumatology practice today. It allows for early detection of synovitis for timely intervention, and informs response monitoring and tapering decision-making.
In this sonographic study in healthy adults, abnormalities are mild and confined mainly to the toe joints especially MTPJ1. This does not detract from ultrasound's unsurpassed utility in detecting early synovitis. It truly is the modern rheumatologist's stethoscope.
Can and should we move to a Treat-to-sonographic-remission-Target in RA? Yes, No, Maybe-Not-Yet. Read on.
PDUS seems a logical adjunct (a more accurate criterion perhaps) to clinical measures of disease activity in RA and other inflammatory arthritides: it can detect subclinical disease (beyond pain and systemic inflammatory markers), and circumvent patient outcome measures not due to inflammation (eg damage, degeneration, fibromyalgia). But the jury is still out as to its sensitivity (or over-sensitivity) to change and the inadequacy of assessment standardisation. For now, its usefulness is far less disputed in the early detection of inflammation, and (in my subsequent post) in informing biologic tapering/withdrawal.