Ultrasound of Hands and Feet may Help Diagnose and Treat Rheumatoid Arthritis

Ultrasound may be a helpful tool for diagnosing and treating rheumatoid arthritis, a

has found. Ultrasound of the hands and feet improved the ability of participating physicians to make a diagnosis as well as determine whether a certain drug was the right choice for treatment.

new study

Srinivasan Harish, of

St. Joseph’s Healthcare and McMaster University in Burlington, Canada,

and colleagues found that “

proportion of physician certainty for specific clinical findings increased for synovitis (9.7 vs. 38.7%; p<0.001), tenosynovitis (9.7 vs. 46.8%; p <0.001), erosions (1.6 vs. 58.1%; p<0.001), enthesitis (50.0 vs. 83.9%; p<0.001), and other/osteophytosis (53.2 vs. 77.4%; p= 0.003).” The confidence with which doctors made a diagnosis improved for “seronegative arthropathy (46.8 vs. 61.3%; p= 0.049), inflammatory OA (46.8 vs. 87.1%; p <0.001)” and “OA (46.0 vs. 73.0%; p=0.002).” In addition, “88.7% of patients had DMARD as a proposed management option before US vs. 48.4% after US (p<0.001). In addition, 4.84% of patients had NSAID/ review as outpatients as a proposed management option before

Lead author

US vs. 45.26% after US (p<0.001).”

All 62 patients in the study had been referred by two rheumatologists to a teaching hospital for an ultrasound of the hands, feet, or both. Measurements of “diagnostic confidence for both specific clinical findings (synovitis, erosion, enthesitis, tenosynovitis, other/osteophytosis) as well as overall diagnosis (rheumatoid arthritis, seronegative arthropathy, inflammatory osteoarthritis [OA], OA, gout, septic arthritis, normality, other diagnoses) using a Likert scale” were taken both prior to and ultrasound. Patients were questioned about what their proposed treatment regimens had been before the ultrasound and then how it may or may not have changed afterward.

"Sonography appears to play a key role in helping rheumatologists determine whether or not disease modifying anti-rheumatic drugs would be useful in patients who are difficult to assess clinically,” Harish said. “Results from our study showed that there was a significant decrease in the use of these drugs when these patients had an ultrasound examination.”