MSK USG in Diagnosing Inflammatory Arthritis: Pearls and Pitfalls

Abstracts cities, and in some economically developed areas, it has already entered tier four cities. More patients have the opportunity to receive this exam at hometown, which providing great help for early diagnosis of arthritis and the evaluation of accurate clinical outcomes. Same as international counterparts, the development of MSU will encounter some bottlenecks, such as rheumatism need higher performance of ultrasonic instrument and special setting and technical. The characteristic of ultrasound itself leads to the cost time of physicians in the exploration process, and the ultrasonic probing technique has the potential to optimize the demand and the potential. In China, there are some policy barriers for rheumatologist physician to do MSU, the related association is putting efforts to improve the situation. While Chinese health care system is also in reforming and severe changes, there will great enhance ultrasound in the diagnosis and treatment of rheumatism. Clinicians also recognized that the new information technologies have huge helps to MSU. In the near future, greatly change will appears in MSU, not only on the mode of exam but also the efficiency. In general, the development of MSU in mainland is flourishing, more and more doctors and center are involving this work, and more and more patients are benefiting from it. T15-14-IN06 MSK USG in Diagnosing Inflammatory Arthritis: Pearls and Pitfalls Dr Lee Ka Wing Gavin Rheumatology Centre, Department of Medicine, Hong Kong Sanatorium & Hospital Musculoskeletal ultrasound (MSK USG) has become interesting popular among rheumatologists in their clinical practice. Inflammatory arthritis is one of the major scopes of rheumatology and the focus of clinical research in the field of MSK USG. Inflammatory diseases like rheumatoid arthritis (RA), psoriatic arthritis (PsA), spondyloarthritis (SpA) and gouty arthritis are some of common examples. Studies have demonstrated ultrasound is a useful tool to assist the management of patients suspected or diagnosed to have inflammatory arthritis. MSK USG has shown to be more sensitive in the detection of abnormalities in RA. Detection of synovitis and bone erosion would be important for early diagnosis of RA. Enthesitis on the other hand is a characteristic feature of SpA that may guide clinician for such diagnosis in a patient with undifferentiated early arthritis. Various sonographic features may also distinguish PsA from RA. Furthermore, gouty arthritis also has some characteristic USG findings to differentiate from other crystal arthropathy. Though ultrasound allows clinicians to see much more than what can be detected in clinical examination, one should be alerted to the possibility of non-specific findings and be avoided of over-interpreting the sonographic findings. Other pitfalls would also be highlighted and discussed. T15-14-IN07 Ultrasound Is a Better Target Than Clinical Disease Activity Scores in Rheumatoid Arthritis Ying-Chou Chen Chang Gung Memorial Hospital at Kaohsiung The assessment of joint inflammation is essential for diagnosing and monitoring response to therapies in patients affected by inflammatory arthropathies like rheumatoid arthritis (RA). For this, the use of musculoskeletal ultrasonography (US) with the power Doppler (PD) method has increased in the past decade. Also, US is known to detect B-mode synovitis and synovial Doppler activity in RA patients treated with either synthetic or biologic disease-modifying anti-rheumatic drugs. The US-detected synovitis has a predictive value in relation to radiographic damage progression and disease flare-up or relapse. Assessment by US ranges from wrist and hand joints to a comprehensive examination of 44 joints.

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Ultrasonographic (US) assessment has been shown to be useful in the management of RA and for monitoring the disease course. The application of US is helpful in such evaluations and is a complementary tool for classic methods used to detect RA, such as clinical evaluation and radiography, particularly when the MCP, PIP, and MTP joints are considered. Evidence has confirmed that GS and PD evaluation demonstrates a correlation between disease activity and degree of inflammation of synovial tissue. Moreover, US can be used for evaluating response to biological drugs. Naredo et al. have found a significant improvement in US parameters in RA patients undergoing therapy with a TNF blocking agent. Thus, US evaluation may be a valid method for monitoring response to biological therapy in RA patients. Finally, sonographic synovitis predicts erosion better than swollen joint count, C-reactive protein and erythrocyte sedimentation rate, US should be considered a promising treatment target in RA patients. T15-14-IN08 Salivary Gland Ultrasonography in Comprehensive Assessment of Patients with Sjogren’s Syndrome Hsin-Hua Chen Department of Medical Research, Taichung Veterans General Hospital, Taiwan Salivary gland ultrasonography (SGUS) has recently been used to help diagnose Sjogren’s syndrome (SS) as well as monitor disease severity of SS. SGUS has the advantage of radiation-free, convenience, low cost, and a potential ability to quantify disease severity. For diagnosis, SGUS has been suggested to serve as an alternative or additional item to the ACR classification. SGUS has also been found to be valuable to predict treatment effectiveness in SS patients. The aim of this talk is to review the application of SGUS in comprehensive assessment of patients with SS, provide personal experience on SGUS use in SS patients, and provide future potential research questions. T15-15-IN01 WFUMB Guidelines and Recommendations for Clinical Use of Ultrasound Elastography: Part 1: Basic Principles and Terminology Tsuyoshi Shiina Dept of Human Health Sciences, Grad School of Medicine, Kyoto University, Kyoto, Japan Ultrasound elasticity images are able to reveal the differences in the elastic properties of soft tissues (e.g., elasticity and viscosity) that can be used to clearly visualize normal anatomy and delineate pathologic lesions even when similar ultrasonic echogenicities are observed. The rapid dissemination of ultrasound elastography machines into the market place, the range of apparently different elasticity imaging methods available such as stain imaging and shear wave imaging, and the significant increase in research literature on the physics and medical applications of elastography have created a potentially confusing situation for those who may be considering using elastography. The definite need was therefore strongly advocated by the WFUMB to create the guidelines and recommendations on the clinical use of ultrasound elastography at the WFUMB congress in Vienna in August 2011. At the first consensus meeting held in March 2013 in Washington, DC, elastography experts from around the world have come together to create unified guidelines on the clinical use of this technique. The guidelines which consist of two clinical papers regarding diagnosis of liver and breast diseases, and a basic paper to describe the fundamental physics and the associated terminology underlying these