Abstract
Given that the ultimate treatment goal with rheumatoid arthritis (RA) is to inhibit progressive joint damage, imaging is very important. We herein introduce the current situation of standardized ultrasonography of joints in Japan, usefulness of musculoskeletal ultrasonography in the diagnosis and treatment of RA and differential diagnosis of RA using imaging modalities.
RA is diagnosed based on the Classification Criteria for Rheumatoid Arthritis advocated by the ACR/EULAR in 2010. If it is possible to evaluate joint swelling and pain and demonstrate the presence of synovitis visually, the diagnostic accuracy can be further improved. Also, it will become able to assess RA comprehensively by considering joint changes over time by musculoskeletal ultrasonography in addition to clinical assessment including DAS.
In January 2010, the Japan College of Rheumatology Committee for the Standardization of Musculoskeletal Ultrasonography was established; “Guidelines for Imaging Technique of Musculoskeletal Ultrasonography” and “Guidelines for Evaluation of Musculoskeletal Ultrasonography” were published in February 2011 and in May 2014, respectively. This standardization has enabled anybody to obtain images on joints, tendons and abnormal blood flow using the same imaging technique. The Guidelines also provide classification of severity of joint synovitis and vaginal synovitis, pitfalls for capturing images and correction in difference between device models.
Conventionally, radiography, MRI and CT scans have been used as imaging modalities for diagnosis of RA. These Guidelines for Musculoskeletal Ultrasonography have positioned these imaging techniques as more advanced imaging tools, which has enabled these techniques to be more frequently and actively applied in clinical practice. It may also be significant in differentiating RA from the other diseases more readily.
