Recent Trends of Ultrasound in Rheumatology

Owing to the ability of musculoskeletal ultrasound (US) to depict cross sectional images of synovial joint and related structures, US has become the most reliable tool for evaluation of arthritic activity of rheumatoid arthritis (RA). US can detect early synovitis, assess disease activity, and determine true remission in patients with RA. US also can detect early enthesitis in patients with spondyloarthropathies. In addition, US can provide a reliable tool for measuring skin thickness in patients with systemic sclerosis. With guidance of injection or aspiration, US can result in a better clinical outcome. Thus, educational needs and research networks are increasing. We present a review of rheumatology US, focusing on recent trends and advances.

Value of Ultrasound in Rheumatologic Diseases

The use of musculoskeletal ultrasound in rheumatology clinical practice has rapidly increased over the past decade. Ultrasound has enabled rheumatologists to diagnose, prognosticate and monitor disease outcome. Although international standardization remains a concern still, the use of ultrasound in rheumatology is expected to grow further as costs fall and the opportunity to train in the technique improves. We present a review of value of ultrasound, focusing on major applications of ultrasound in rheumatologic diseases.

Suprascapular nerve block with Marcaine alone effectively controls chronic shoulder pain in patients with rheumatoid arthritis

Chronic shoulder pain is a frequent and disabling symptom in patients with rheumatoid arthritis [RA]. It has previously been shown that a suprascapular nerve block [SSNB] using the standard mixture of bupivacaine and adrenaline [Ba] plus methylprednisolonc [P] which is routinely used in pain clinics results in a significant improvement in pain relief and range of movement compared to conventional intra-articular steroid injections in such patients. We conducted a double blind study in 29 patients with RA to compare SSNB induced with Ba [Marcain] alone to that induced by using the conventional mixture of Ba plus P. Highly significant improvements [p < 0.001] were noted in measures of pain, stiffness and range of most movements for both treatments [up to 3 months] compared to baseline. Results favoured Marcain alone, the differences between the two therapies reached statistical significance [p < 0.05] for stiffness [at 12 weeks] and active abduction [at 1 week]. We conclude that the addition of methylprednisolone to the SSNB mixture confers no benefit. This has implications for the management of other causes of shoulder pain