Interés del ultrasonido con Doppler de potencia en el seguimiento de la artritis reumatoídea / Power Doppler ultrasound in the monitoring of rheumatoid arthritis

ABSTRACT

The use of musculoskeletal ultrasound with power Doppler in the evaluation of arthritis has already demonstrated its importance. Its use to check steroid injections can help us improve the management of arthritis. We describe the case of a woman with rheumatoid arthritis, which was controlled using methotrexate and prednisone until 6 months ago, when she presented a persistent inflammation in the left wrist, with pain and morning stiffness. A bilateral study of the wrist with ultrasound was performed. The exploration showed erosions, joint effusion and synovial thickening in both wrists, where as Doppler signal existed only in the left wrist. Patient received a steroid injection in the left wrist and was controlled a week later, the pain disappeared without signs of activity. Despite clinical improvement, ultrasound continued showing Doppler signal in this joint. This case illustrates the clinical and ultrasound correlation before the injection. The persistence of the Doppler signal, in spite of the steroid injection and clinical improvement could be explained by either a, perhaps, too precocious control or a subclinical activity of the disease. This phenomenon could explain why asymptomatic patients present a radiological aggravation. In these cases, ultrasound with power Doppler would be an important option to optimize treatment.