Skip to main content
Log in

Empfehlungen der Österreichische Gesellschaft für Rheumatologie und Rehabilitation/Austrian Radiology-Rheumatology Initiative for Musculoskeletal Ultrasound zur Anwendung des Ultraschalls bei rheumatischen Erkrankungen in der klinischen Praxis

Recommendations of the Austrian Society of Rheumatology/Austrian Radiology-Rheumatology Initiative for Musculoskeletal Ultrasound for the application of ultrasound in rheumatology

  • consensus report
  • Published:
Wiener klinische Wochenschrift Aims and scope Submit manuscript

Zusammenfassung

Die Frühdiagnostik gewinnt in der Rheumatologie zunehmend an Bedeutung. Chronisch entzündliche Erkrankungen sollten möglichst vor dem Auftreten radiologisch sichtbarer Schäden diagnostiziert werden und so ist der Einsatz funktioneller bildgebender Methoden wie des Ultraschalls oftmals unverzichtbar.

Zur Qualitätssicherung und -verbesserung der von Rheumatologen durchgeführten Ultraschalluntersuchungen wurden von der Austrian Radiology-Rheumatology Initiative for Musculoskeletal Ultrasound (ARRIMUS) Empfehlungen für die technische Ausstattung, Indikationen und Dokumentation der Ultraschall-Untersuchung, Zuhilfenahme des Ultraschalls bei Gelenkspunktion und -infiltration sowie ein Ausbildungscurriculum formuliert.

Diese Empfehlungen wurden von der Österreichischen Gesellschaft für Rheumatologie und Rehabilitation (ÖGR) befürwortet und sollen als Grundlage zur Etablierung und Qualitätssicherung der Sonographie bei rheumatischen Erkrankungen in der klinischen Praxis dienen.

Summary

It is the current goal in rheumatology to diagnose and treat inflammatory rheumatic diseases early in order to avoid structural damage. Functional imaging methods such as musculoskeletal sonography are increasingly used to support the clinical diagnosis. To ascertain the quality of ultrasound assessments performed by rheumatologists in Austria, the Austrian Radiology-Rheumatology Initiative for Musculoskeletal Ultrasound (ARRIMUS) proposed recommendations for a training curriculum, technical standards for ultrasound equipment, minimum requirements for documentation, indications for sonography and the use of ultrasound for interventions. These recommendations have been endorsed by the Austrian Society of Rheumatology and should aid rheumatologists to perform high quality ultrasound assessment in clinical practice.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Literatur

  1. Schirmer M, Duftner C, Schmidt WA, Dejaco C. Ultrasonography in inflammatory rheumatic disease: an overview. Nat Rev Rheumatol. 2011;7:479–88.

    Article  PubMed  Google Scholar 

  2. Dejaco C, Schirmer M, Duftner C. Expectations of rheumatologists on imaging results. Radiologe. 2012;110–5.

  3. Nell VP, Machold KP, Eberl G, Stamm TA, Uffmann M, Smolen JS. Benefit of very early referral and very early therapy with disease-modifying anti-rheumatic drugs in patients with early rheumatoid arthritis. Rheumatology (Oxford). 2004;43:906–14.

    Article  CAS  Google Scholar 

  4. Colebatch AN, Edwards CJ, Ostergaard M, van der Heijde D, Balint P V, D’Agostino MA, et al. EULAR recommendations for the use of imaging of the joints in the clinical management of rheumatoid arthritis. Ann Rheum Dis2013;72:804–14.

    Article  PubMed  Google Scholar 

  5. Wakefield RJ, D’Agostino MA, Naredo E, Buch MH, Iagnocco A, Terslev L, et al. After treat-to-target: can a targeted ultrasound initiative improve RA outcomes? Ann Rheum Dis2012;71:799–803.

    Article  PubMed  Google Scholar 

  6. McNally EG. Ultrasound of the small joints of the hands and feet: current status. Skeletal Radiol. 2008;37:99–113.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  7. Torp-Pedersen S, Szkudlarek M, Ellegaard K, D’Agostino MA, Iagnocco A, Naredo E, et al. Color or Power Doppler – which is more sensitive and do machine settings matter? Ann Rheum Dis. 2012;71:603.

    Article  Google Scholar 

  8. Torp-Pedersen ST, Terslev L. Settings and artefacts relevant in colour/power Doppler ultrasound in rheumatology. Ann Rheum Dis;2008;67:143–9.

    Article  CAS  PubMed  Google Scholar 

  9. Backhaus M, Burmester GR, Gerber T, Grassi W, Machold KP, Swen WA, et al. Guidelines for musculoskeletal ultrasound in rheumatology. Ann Rheum Dis.;2001;60:641–9.

  10. Backhaus M, Ohrndorf S, Kellner H, Strunk J, Backhaus TM, Hartung W, et al. Evaluation of a novel 7-joint ultrasound score in daily rheumatologic practice: a pilot project. Arthr Rheum.;2009;61:1194–201.

    Article  CAS  Google Scholar 

  11. De Miguel E, Cobo T, Munoz-Fernandez S, Naredo E, Uson J, Acebes JC, et al. Validity of enthesis ultrasound assessment in spondyloarthropathy. Ann Rheum Dis. 2009;68:169–74.

    Article  CAS  PubMed  Google Scholar 

  12. Balint PV, Kane D, Wilson H, McInnes IB, Sturrock RD. Ultrasonography of entheseal insertions in the lower limb in spondyloarthropathy. Ann Rheum Dis. 2002;61:905–10.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  13. Gutierrez M, Di Geso L, Salaffi F, Bertolazzi C, Tardella M, Filosa G, et al. Development of a preliminary US power Doppler composite score for monitoring treatment in PsA. Rheumatology (Oxford). 2012;51:1261–8.

    Article  Google Scholar 

  14. Naredo E, Rodriguez M, Campos C, Rodriguez-Heredia JM, Medina JA, Giner E, et al. Validity, reproducibility, and responsiveness of a twelve-joint simplified power Doppler ultrasonographic assessment of joint inflammation in rheumatoid arthritis. Arthr Rheum. 2008;59:515–22.

    Article  Google Scholar 

  15. Weidekamm C, Koller M, Weber M, Kainberger F. Diagnostic value of high-resolution B-mode and Doppler sonography for imaging of hand and finger joints in rheumatoid arthritis. Arthr Rheum. 2003;48:325–33.

    Article  CAS  Google Scholar 

  16. Dejaco C, Duftner C, Wipfler-Freissmuth E, Weiss H, Graninger WB, Schirmer M. Similar performance of DAS-28, CDAI, and SDAI in rheumatoid arthritis patients with and without sonographic signs of active inflammation in routine clinical practice. Scand J Rheumatol. 2011;40:234–6.

    Article  CAS  PubMed  Google Scholar 

  17. Dejaco C, Duftner C, Wipfler-Freissmuth E, Weiss H, Graninger WB, Schirmer M. Ultrasound-defined remission and active disease in rheumatoid arthritis: association with clinical and serologic parameters. Semin Arthr Rheum. 2012;41:761–7.

    Article  Google Scholar 

  18. Hocevar A, Ambrozic A, Rozman B, Kveder T, Tomsic M. Ultrasonographic changes of major salivary glands in primary Sjogren’s syndrome. Diagnostic value of a novel scoring system. Rheumatology (Oxford). 2005;44:768–72.

    Article  CAS  Google Scholar 

  19. Gutierrez M, Salaffi F, Carotti M, Tardella M, Pineda C, Bertolazzi C, et al. Utility of a simplified ultrasound assessment to assess interstitial pulmonary fibrosis in connective tissue disorders – preliminary results. Arthr Res Ther. 2011;13:R134.

    Article  Google Scholar 

  20. Mandl P, Naredo E, Wakefield RJ, Conaghan PG, D’Agostino MA, Force OUT. A systematic literature review analysis of ultrasound joint count and scoring systems to assess synovitis in rheumatoid arthritis according to the OMERACT filter. J Rheumatol. 2011;38:2055–62.

    Article  PubMed  Google Scholar 

  21. Naredo E, Bijlsma JW, Conaghan PG, Acebes C, Balint P, Berner-Hammer H, et al. Recommendations for the content and conduct of European League Against Rheumatism (EULAR) musculoskeletal ultrasound courses. Ann Rheum Dis. 2008;67:1017–22.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  22. Austrian society of Rheumatology training curriculum for musculoskeletal sonography in Rheumatology. 2013. http://www.rheumatologie.at/pdf/120522%20ARRIMUS%20Ausbildungscurriculum.pdf.

  23. Pineda C, Reginato AM, Flores V, Aliste M, Alva M, Aragon-Lainez RA, et al. Pan-American League of Associations for Rheumatology (PANLAR) recommendations and guidelines for musculoskeletal ultrasound training in the Americas for rheumatologists. J Clin Rheumatol. 2010;16:113–8.

    Article  PubMed  Google Scholar 

  24. Schueller-Weidekamm C, Schueller G, Aringer M, Weber M, Kainberger F. Impact of sonography in gouty arthritis: comparison with conventional radiography, clinical examination, and laboratory findings. Eur J Radiol. 2007;62:437–43.

    Article  PubMed  Google Scholar 

  25. Kortekaas MC, Kwok W-YY, Reijnierse M, Watt I, Huizinga TWJ, Kloppenburg M. Pain in hand osteoarthritis is associated with inflammation: the value of ultrasound. Ann Rheum Dis. 2010;69:1367–9. http://www.ncbi.nlm.nih.gov/pubmed/20472595.

    Article  PubMed  Google Scholar 

  26. Hashefi M. Ultrasound in the diagnosis of noninflammatory musculoskeletal conditions. Semin Ultrasound. 2011;32:74–90.

    Article  Google Scholar 

  27. Dasgupta B, Cimmino MA, Kremers HM, Schmidt WA, Schirmer M, Salvarani C, et al. 2012 Provisional classification criteria for polymyalgia rheumatica: a European League Against Rheumatism/American College of Rheumatology collaborative initiative. Arthr Rheum. 2012;64:943–54.

    Article  Google Scholar 

  28. Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT, Bingham CO III, et al. 2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthr Rheum. 2010;62:2569–81.

    Article  Google Scholar 

  29. Combe B, Landewe R, Lukas C, Bolosiu HD, Breedveld F, Dougados M, et al. EULAR recommendations for the management of early arthritis: report of a task force of the European Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT). Ann Rheum Dis. 2007;66:34–45.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  30. Zhang W, Doherty M, Bardin T, Barskova V, Guerne PA, Jansen TL, et al. European League Against Rheumatism recommendations for calcium pyrophosphate deposition. Part I: terminology and diagnosis. Ann Rheum Dis. 2011;70:563–70.

    Article  CAS  PubMed  Google Scholar 

  31. Grassi W, Meenagh G, Pascual E, Filippucci E. “Crystal clear”-sonographic assessment of gout and calcium pyrophosphate deposition disease. Semin Arthr Rheum. 2006;36:197–202.

    Article  CAS  Google Scholar 

  32. Dejaco C, Duftner C, Dasgupta B, Matteson EL, Schirmer M. Polymyalgia rheumatica and giant cell arteritis: management of two diseases of the elderly. Aging Health. 2011;7:633–45. http://dx.doi.org/10.2217/ahe.11.50.

    Article  Google Scholar 

  33. Arida A, Kyprianou M, Kanakis M, Sfikakis PP. The diagnostic value of ultrasonography-derived edema of the temporal artery wall in giant cell arteritis: a second meta-analysis. BMC Musculoskelet Disord. 2010;11:44.

    Article  PubMed Central  PubMed  Google Scholar 

  34. Wernicke D, Hess H, Gromnica-Ihle E, Krause A, Schmidt WA. Ultrasonography of salivary glands – a highly specific imaging procedure for diagnosis of Sjogren’s syndrome. J Rheumatol. 2008;35:285–93.

    PubMed  Google Scholar 

  35. Fowler JR, Gaughan JP, Ilyas AM. The sensitivity and specificity of ultrasound for the diagnosis of carpal tunnel syndrome: a meta-analysis. Clin Orthop Relat Res. 2011;469:1089–94.

    Article  PubMed Central  PubMed  Google Scholar 

  36. Gargani L, Doveri M, D’Errico L, Frassi F, Bazzichi ML, Delle Sedie A, et al. Ultrasound lung comets in systemic sclerosis: a chest sonography hallmark of pulmonary interstitial fibrosis. Rheumatology (Oxford). 2009;48:1382–7.

    Article  Google Scholar 

  37. Dejaco C, Stradner M, Zauner D, Seel W, Simmet NE, Klammer A, et al. Ultrasound for diagnosis of carpal tunnel syndrome: comparison of different methods to determine median nerve volume and value of power Doppler sonography. Ann Rheum Dis. 2013;72:1934–9. http://www.ncbi.nlm.nih.gov/pubmed/23212030.

    Article  PubMed  Google Scholar 

  38. Smolen JS, Aletaha D, Bijlsma JW, Breedveld FC, Boumpas D, Burmester G, et al. Treating rheumatoid arthritis to target: recommendations of an international task force. Ann Rheum Dis. 2010;69:631–7.

    Article  PubMed Central  PubMed  Google Scholar 

  39. Leeb BF, Andel I, Sautner J, Nothnagl T, Rintelen B. The DAS 28 in rheumatoid arthritis and fibromyalgia patients. Rheumatology (Oxford). 2004;43:1504–7.

  40. Saleem B, Brown AK, Quinn M, Karim Z, Hensor EM, Conaghan P, et al. Can flare be predicted in DMARD treated RA patients in remission, and is it important? A cohort study. Ann Rheum Dis. 2012;71:1316–21.

    Article  PubMed  Google Scholar 

  41. Brown AK, Quinn MA, Karim Z, Conaghan PG, Peterfy CG, Hensor E, et al. Presence of significant synovitis in rheumatoid arthritis patients with disease-modifying antirheumatic drug-induced clinical remission: evidence from an imaging study may explain structural progression. Arthr Rheum. 2006;54:3761–73.

    Article  CAS  Google Scholar 

  42. Scire CA, Montecucco C, Codullo V, Epis O, Todoerti M, Caporali R. Ultrasonographic evaluation of joint involvement in early rheumatoid arthritis in clinical remission: power Doppler signal predicts short-term relapse. Rheumatology (Oxford). 2009;48:1092–7.

    Article  CAS  Google Scholar 

  43. Mandl P, Balint P, Brault Y, Backhaus M, D’Agostino M, Grassi W, et al. Clinical and ultrasound-based composite disease activity indices in rheumatoid arthritis: results from a multicentre, randomized study. Arthr Care Res (Hoboken). 2013;65:879–87.

  44. Macchioni P, Catanoso MG, Pipitone N, Boiardi L, Salvarani C. Longitudinal examination with shoulder ultrasound of patients with polymyalgia rheumatica. Rheumatology (Oxford). 2009;48:1566–9.

    Article  Google Scholar 

  45. Jimenez-Palop M, Naredo E, Humbrado L, Medina J, Uson J, Francisco F, et al. Ultrasonographic monitoring of response to therapy in polymyalgia rheumatica. Ann Rheum Dis. 2010;69:879–82.

    Article  CAS  PubMed  Google Scholar 

  46. Hartung W, Ross CJ, Straub R, Feuerbach S, Scholmerich J, Fleck M, et al. Ultrasound-guided sacroiliac joint injection in patients with established sacroiliitis: precise IA injection verified by MRI scanning does not predict clinical outcome. Rheumatology (Oxford). 2010;49:1479–82.

    Article  Google Scholar 

  47. Fredberg U, van Overeem Hansen G, Bolvig L. Placement of intra-articular injections verified by ultrasonography and injected air as contrast medium. Ann Rheum Dis. 2001;60:542.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  48. Mandl P, Naredo E, Conaghan PG, D’Agostino MA, Wakefield RJ, Bachta A, et al. Practice of ultrasound-guided arthrocentesis and joint injection, including training and implementation, in Europe: results of a survey of experts and scientific societies. Rheumatology (Oxford). 2012;51:184–90.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Christian Dejaco MD, PhD.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Duftner, C., Dejaco, C., Kainberger, F. et al. Empfehlungen der Österreichische Gesellschaft für Rheumatologie und Rehabilitation/Austrian Radiology-Rheumatology Initiative for Musculoskeletal Ultrasound zur Anwendung des Ultraschalls bei rheumatischen Erkrankungen in der klinischen Praxis. Wien Klin Wochenschr 126, 809–814 (2014). https://doi.org/10.1007/s00508-014-0606-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00508-014-0606-5

Schlüsselwörter

Keywords

Navigation