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The Journal of Rheumatology Volume 32, no.


Musculoskeletal ultrasound including definitions for ultrasonographic
Richard J Wakefield, Peter V Balint, Marcin Szkudlarek, Emilio Filippucci, Marina
Backhaus, Maria-Antonietta D'Agostino, Esperanza Naredo Sanchez, Annamaria
Iagnocco, Wolfgang A Schmidt, George A W Bruyn, George Bruyn, David Kane, Philip J
O'Connor, Bernhard Manger, Fred Joshua, Juhani Koski, Walter Grassi, Marissa N D
Lassere, Nanno Swen, Franz Kainberger, Andrea Klauser, Mikkel Ostergaard, Andrew K
Brown, Klaus P Machold, Philip G Conaghan and OMERACT 7 Special Interest Group

J Rheumatol 2005;32;2485-2487

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The Journal of Rheumatology is a monthly international serial edited by Earl D.
Silverman featuring research articles on clinical subjects from scientists working
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Journal of Rheumatology

Paris. Department of Internal Rheumatology Department. Medical Center Rheumatology. George Hospital and University of New South Wales. M. Department of Rheumatology. Radiologist. Brown. St. University of of Vienna. ESPERANZA NAREDO SANCHEZ. ANDREW K. Wakefield. Conaghan. making interpretation and comparison of studies difficult. M-A. KLAUS P. MARIA-ANTONIETTA D’AGOSTINO. J. Consultant Copenhagen and Hvidovre Hospital. PhD. MD. Finland. GEORGE BRUYN. Hungary. University of Newcastle. Associate Professor of Rheumatology. FRCR. Personal non-commercial use only.K. Academic Unit of Musculoskeletal Disease. Rheumatology Division. University of Vienna. P. Rheumatology.32:2485–7) Key Indexing Terms: ULTRASOUND EROSIONS SYNOVITIS TENOSYNOVITIS ENTHESOPATHY Ultrasound (US) has been used for the investigation and larger joints and soft tissue structures such as Baker’s cysts. Consultant Rheumatologist. Iagnocco. P. DAVID KANE. Grad Dip Epi. Consultant Skeletal Radiologist. MBBS. Rheumatology Unit. Medical Centre for Rheumatology and Physiotherapy. M. It has a number of distinct advantages over magnetic resonance imaging. St. Mikkeli Central Hospital. Staff Specialist in Rheumatology. MIKKEL OSTERGAARD. PhD. G. University La Sapienza. E. Balint. Academic Department of Consultant Rheumatologist. Australia. Filippucci. MD. Newcastle. Charité Hospital. Rheumatology Consultant and Senior Lecturer in Rheumatology. George Hospital and University of New South FRACP. Professor of Clinical Research Fellow. The Journal of Rheumatology Copyright © 2005. Department of Rheumatology Unit. Innsbruck. A. M. Austria. Rome. E. Third Rheumatology. however. Szkudlarek. Ancona. MD. Jesi. Wakefield. there are limited data describing standardized scanning methodology and standardized definitions of US pathologies. Mikkeli. Professor of Rheumatology. MD. FRED JOSHUA. O’CONNOR. A. (J Rheumatol Department of Rheumatology. In particular. BS. BALINT. of Rheumatology. However. Rheumatology Department. University of Department. MARISSA N. N. D. Backhaus. Associate Professor in Leeds. Joshua. University of Musculoskeletal Medicine. A. Ultrasound (US) has great potential as an outcome in rheumatoid arthritis trials for detecting bone erosions. Austria. Professor of Rheumatology/Arthritis. P.Published by The Journal of Rheumatology . National Institute of W. Consultant Rheumatologist. K. Academic Unit of Musculoskeletal Disease. Consultant Rheumatologist. Kane. Klauser. Chapel Allerton Hospital. and responsiveness to change. Medicine. Senior Lecturer in Wales. MRCP. Denmark. Leeds. Germany. MD. George Hospital and Department of Rheumatology. MD. D’Agostino. MARINA BACKHAUS.jrheum. University of Rheumatology. there are scarce data regarding its validity. Consultant Skeletal Radiologist. Copenhagen. MD. Fellow in for Rheumatology BerlinBuch. University of Leeds. Medical Centre Leeuwarden. synovitis. MD. least 30 years1. University of Rheumatology BerlinBuch. PhD. M. MBBS (Hons). University Hospital Innsbruck. MD. Spain. reproducibility. Consultant Rheumatologist. Consultant Rheumatologist. MD. University of Hospital at Hvidovre. LASSERE. PhD. University of Ancona. on October 31. Third Rheumatology Department. ANNAMARIA IAGNOCCO. Severo Ochoa Hospital. MD. Erlangen. E-mail: medrjw@leeds. Berlin. O’Connor. JUHANI KOSKI. Machold. Leeuwarden. University of Erlangen. Severo Ochoa Hospital. ANDREA KLAUSER. MD. FRACP. UK. Leeds. Koski. Consultant Netherlands.D. Charité Hospital. This article presents the first report from the OMERACT ultrasound special inter- est group. Rene Descartes University. Department of Rheumatologist. Leeuwarden. UK. et al: Musculoskeletal ultrasound 2485 Downloaded from www.OMERACT 7 Special Interest Group Musculoskeletal Ultrasound Including Definitions for Ultrasonographic Pathology RICHARD J. Senior Lecturer and Consultant in DMSc. MD. University of Vienna. Professor of Rheumatology. Madrid. Leeds General Infirmary. management of patients with musculoskeletal disease for at Technological improvements in the early 1990s. Budapest. UK. PhD. Medical Centre Rheumatology. Its initial use was limited to investigating greatly improved image resolution and tissue contrast and From the Academic Unit of Musculoskeletal Disease. Consultant Skeletal Cochin Hospital and Rene Descartes University. Bruyn. Naredo.J. Department of Rheumatology. Department Vienna. University of Leeds. SCHMIDT. Leeds. All rights reserved. Division Gasthuis. PhD. of Radiology II. MB. BM. tendon disease. University of University of Copenhagen and Hvidovre Hospital. PETER V. Kainberger. Lecturer in Physiotherapy. Department of Internal Medicine III. Department of Rheumatology. France. PhD. Division of Rheumatology. Leeds LS7 4SA. Hospital Westfries Radiology II. PhD. R. Department of Radiology. University La Sapienza. Mikkeli Central Hospital.J. Vienna. WAKEFIELD. BROWN. UK. Also proposed for the first time are consensus US definitions for common pathological lesions seen in patients with inflammatory arthritis. Department of Rheumatology. Consultant Rheumatologist.V. MD. F. Wakefield. W. Hospital Westfries Gasthuis. EMILIO FILIPPUCCI. WALTER GRASSI. FRANZ KAINBERGER.G. Italy. Berlin. University Hospital Innsbruck. Address reprint requests to Dr. CONAGHAN ABSTRACT. University of Ancona. including good patient tolerability and ability to scan multiple joints in a short period of time. Department Rheumatologist. St. MACHOLD. MD. Manger. NANNO SWEN. Hoorn. The Netherlands. Leeds General Infirmary. R.A. MARCIN SZKUDLAREK. MD. Academic Unit of Musculoskeletal Disease. FRCP. and enthesopathy. Department of Radiology. Copenhagen University Rheumatology. University of Erlangen. MRCP. The University of New South Wales. FAFPHM. MD. MD. WOLFGANG A. Swen. Rheumatology Division. and PHILIP G. Austria. Cochin Hospital and Musculoskeletal Disease. F. National Institute of Rheumatology and Medicine III. Sydney. Lassere. Germany. Schmidt. PhD. PHILIP J. 2016 . Department of Rheumatology. BERNHARD MANGER. Ostergaard. Italy. which has compared US against the criteria of the OMERACT filter. B. Germany.J. MD. Grassi. Department of Rheumatology.

but some- Exercise 2. Interobserver reli- ing standardized scanning methodology4 and standardized ability was the most investigated area. Exclusions included non-English language articles. it was further decid- initions were agreed on. Reliability exercises were also often per- came together under the auspices of OMERACT. The following general comments can be ment). knee. A large amount of literature ical understanding of the patient’s problem can scan in the was reviewed and it is intended that the results will be pub- clinic (rather than sending the patient for another appoint. and enthesopathy. As some col- should be on those features commonly measured by ultra. These were coordinated at one site and draft consensus definitions Tenosynovitis obtained. and virtually none relating to interma- ties. ing to intraobserver. ison with histology and MRI. and occasions during the meeting to discuss the results of the enthesopathy. 32:12 Downloaded from www. In order to address lated to all members for their comments. There was general These definitions served as a basis for the 2 further meetings agreement that in the first instance. seen in patients with inflammatory arthritis. The Journal of Rheumatology Copyright © 2005. Synovial Hypertrophy letters. synovitis. 1980 and April 2004 were used for the majority of searches. is often perceived as an imperfect and studied pathology. 2486 The Journal of Rheumatology 2005. Exercise 1. however. and hindfoot. 1. To achieve consensus on pathological US defi. focusing on erosions. ed that 2 preliminary exercises would be performed prior to the OMERACT 7 meeting. a group of interested international ultrasonographers chine reliability. The hand was the most studied area and synovitis most US. hand. Prior to OMERACT 7 4. times may be isoechoic or hyperechoic) intraarticular tissue nitions. US has a number of distinct advantages over exercises (including review of methodologies). Abnormal hypoechoic (relative to subdermal fat. tendon disease. Support for a future OMERACT group was decided at the 5. Data on normal joint structures are scarce. Abnormal hypoechoic or anechoic (relative to subdermal ture search. This includes the from the questionnaires. leagues were unable to attend. and responsive. tenosynovitis. on October 31. thereby allowing rapid interpretation of the images made: and immediate decision-making. tenosynovitis. and pediatric publications. reproducibility. making interpretation and comparison of increasing. RA Bone Erosion Exercise 1. To conduct a systematic literature review. operator-dependent tool. Personal non-commercial use only. with scarce data relat- definitions of US pathologies. College of Rheumatology meeting. studies difficult. ticular material that is displaceable and compressible. 3. agenda. 2016 . As a result of these difficul. reviews. Leaders were Synovial Fluid nominated to coordinate a multicenter group for each litera. but ankle. the focus of the group held at OMERACT 7 to form a consensus. Longitudinal and blinded studies assessing responsive- EULAR Working Party for Ultrasound meeting held at the ness to therapies are scarce. Questions on definitions and methods of scoring was held in Orlando in October 2003 during the American for erosions. Pubmed and Medline searches between does not exhibit Doppler signal.jrheum. This is compounded by a lack of 2. and the rheumatologist with clin. and plan the future research scan multiple joints in a brief period of time. A questionnaire was distributed to the group asking that is nondisplaceable and poorly compressible and which for individual definitions of common pathological lesions may exhibit Doppler signal. 2003 EULAR conference in Lisbon. wrist.allowed access to the smaller joints2. Hypoechoic or anechoic thickened tissue with or with- out fluid within the tendon sheath. The following def- US issues using the OMERACT filter. The following anatomical areas were considered fat. There was a paucity of reliability data.Published by The Journal of Rheumatology . synovitis. In particular. The group then met on 2 further detection of bone erosions. patient tolerability is good. which is seen in 2 At OMERACT 7 perpendicular planes and which may exhibit Doppler The US special interest group (SIG) offered the opportunity signal. including its ability to sensus on the definitions. there are limited data describ. its for presentation of the results of the different anatomical site use has recently been directed towards the assessment of literature reviews as well as the draft definitions obtained patients with inflammatory arthritis3. group5. In rheumatology. but sometimes may be isoechoic or hyperechoic) intraar- most important: shoulder. making interpretation difficult. Additionally. and enthesopathy at specific anatomical regions. All rights reserved. An intraarticular discontinuity of the bone surface that is lar to that performed by members of the OMERACT MRI visible in 2 perpendicular planes. synovitis. achieve con- magnetic resonance imaging (MRI). A subsequent meeting Exercise 2. the definitions were recircu- sonographers in inflammatory arthritis. lished separately. elbow. There was a paucity of validity data in terms of compar- data regarding its validity. Literature reviews. simi. formed on different joints within the same study. although these data are ness to change.

28:1151-7. seen in 2 perpendicular planes that may collaborative studies on measurement issues.Enthesopathy the new OMERACT definitions. Ann Rheum Dis achieved a consensus on broad descriptive US definitions. 2016 . Gerber T. Backhaus M. Ostergaard M. A detailed research agenda includes testing the reliabili- ty of image acquisition and static image interpretation using Personal non-commercial use only. ture) and/or thickened tendon or ligament at its bony attach.43:829-38. Balint PV. Issues include lack of validation and reliability ignored. Szkudlarek M. Bird P. Rheumatology Oxford data regarding important methodological and measurement 1999. Lassere M. The Journal of Rheumatology Copyright © 2005.Published by The Journal of Rheumatology .60:641-9. All rights reserved. 4. rheumatology. Measurement of RA disease activity and damage is possible. et al: Musculoskeletal ultrasound 2487 Downloaded from www. Wakefield. Gibbon WW. Emery P. et al. Does MRI make the grade? technologies advance these may have to be modified.38:195-8. exhibit Doppler signal and/or bony changes including enthe- sophytes. Burmester GR. scarce ultrasonography in rheumatology. Kane D.32:63-73. Wakefield RJ. Guidelines for ness to change. A state of the art review in rheumatology. Grassi W. in addition to the role of US in assessing responsive. Musculoskeletal ultrasound. 3. erosions. Part 2: Summary and Future Directions Clinical indications for musculoskeletal ultrasound in US has many characteristics that make it potentially valu. The group meeting at OMERACT 7 musculoskeletal ultrasound in rheumatology. Rheumatology Oxford 2004. REFERENCES 1. reliability. Scand J Rheumatol 2003. the OMERACT ment (may occasionally contain hyperechoic foci consistent process has provided an excellent framework for ongoing with calcification). J Rheumatol 2001. able for the investigation of the musculoskeletal system and 2. The current status of in particular as a hands-on clinical tool. however.jrheum. 5. data. It 2001. Although there is much work to be done. Imaging in rheumatoid issues need to be augmented before US will gain wider arthritis — why MRI and ultrasonography can no longer be acceptance. that as new data become available and using MRI: Truth and discrimination. or irregularity. on October 31. Sturrock R. and testing intermachine Abnormally hypoechoic (loss of normal fibrillar architec.