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Task force weighs best practices for MSUS in diagnosing, managing rheumatic diseases

Musculoskeletal ultrasound is reasonable to use for treating patients with rheumatic diseases that include articular pain, swelling or mechanical symptoms at specific joints without definitive diagnosis on clinical exam, according to one of 14 recommendations made by an American College of Rheumatology task force panel.

The panel included rheumatologists in academic and practice settings, methodology experts, a pediatric rheumatologist and a patient representative. It reviewed medical literature from Medline, Ovid and Embase databases to devise a list of how musculoskeletal ultrasound (MSUS) could be adopted in rheumatology practice for “reasonable use.” The panel rated its recommendations on three levels of supporting evidence it found and how they were based on established methodology by the American College of Rheumatology. Level A was supported by two or more randomized clinical trials, Level B by one randomized trial and Level C by consensus of expert opinion, standard of care, or case studies.

Among the other recommendations and levels of evidence:

• It is reasonable to use MSUS to guide articular and periarticular aspiration or injection at sites that include the synovial, tenosynovial, bursal, peritendinous and perientheseal areas. Level A.
• For a patient with pain or mechanical symptoms of the hip region without definitive diagnosis on clinical examination, it is reasonable to use MSUS to evaluate effusion, intraarticular and periarticular lesions, and adjacent regional soft tissue structures. Level B.
• It is reasonable to use MSUS to evaluate the parotid and submandibular glands in a patient being evaluated for Sjögren’s disease to determine whether they have typical changes as further evidence of disorder. Level B.

“Our findings, together with practice trends in the US and in Europe, foresee the likelihood of increased adoption of [MSUS] in rheumatology,” the researchers concluded.

The lack of cost-effectiveness studies and long-term outcomes of MSUS should be addressed in further study to ascertain the technology’s value compared with other interventions, according to the investigators.

Disclosure: See the study for a full list of relevant disclosures.