Sonography in patients with rheumatoid arthritis: hand and elbow

After clinical and radiological examination, ultrasound has an important place in the diagnostic procedures for patients with chronic inflammatory diseases. Synovitis and effusion of the joint can be documented. Sonography may be helpful in providing an earlier diagnosis. Erosive lesions of the articular surface in the sonographic field of view can be detected at a very early stage, often when the clinical and radiological examinations are still unremarkable. This may lead to an earlier start of drug therapy or an earlier indication for operative treatment. Sonography gives a good impression of the inflammatory changes of the elbow joint and the distribution of synovitis and joint effusion in the different parts of the joint. It is a good method to document the therapeutic effects. The sonographic echogenicity of the muscle of rheumatoid patients seems to change. Synovitis and effusion of the hand can be documented with ultrasound. Infiltration of the synovitis into the tendon could not be visualized. The sonographic diagnostic accuracy in tendon ruptures of the hand was reduced in comparison with the clinical examination. Whether ultrasound will be an efficient method to identify patients at risk for a tendon rupture will be seen with further developments of the technical possibilities.