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Turning the Page in Osteoarthritis Assessment with the Use of Ultrasound

  • Imaging (J Samuels, Section Editor)
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Abstract

Purpose of Review

This narrative review summarizes the last 5 years of published, peer-reviewed research on the use of musculoskeletal ultrasound (US) in osteoarthritis (OA).

Recent Findings

Multiple features relevant to OA can be visualized on US, including synovitis, erosion, enthesitis, osteophytes, cartilage damage, meniscal extrusion, and popliteal cysts. US can be used to confirm a diagnosis of OA or make an alternate diagnosis in the clinical setting. When a standardized protocol is used, US is a reliable modality for assessment of the features of OA. Findings on US can predict progression and response to therapy in OA of the hand and knee and can allow characterization of risk factors in a cost-effective, non-invasive, repeatable manner.

Summary

US is becoming more widely used in OA imaging and has clear value in addition to radiography and clinical assessment. US will likely prove useful in defining phenotypes and providing treatment guidance in OA.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Hootman JM, Helmick CG, Barbour KE, Theis KA, Boring MA. Updated projected prevalence of self-reported doctor-diagnosed arthritis and arthritis-attributable activity limitation among US adults, 2015-2040. Arthritis Rheum. 2016;68(7):1582–7. https://doi.org/10.1002/art.39692.

    Article  Google Scholar 

  2. Murphy L, Schwartz TA, Helmick CG, Renner JB, Tudor G, Koch G, et al. Lifetime risk of symptomatic knee osteoarthritis. Arthritis Rheum. 2008;59(9):1207–13. https://doi.org/10.1002/art.24021.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Qin J, Barbour KE, Murphy LB, Nelson AE, Schwartz TA, Helmick CG, et al. Lifetime risk of symptomatic hand osteoarthritis: the Johnston County Osteoarthritis Project. Arthritis Rheum. 2017;69(6):1204–12. https://doi.org/10.1002/art.40097.

    Article  Google Scholar 

  4. Murphy LB, Helmick CG, Schwartz TA, Renner JB, Tudor G, Koch GG, et al. One in four people may develop symptomatic hip osteoarthritis in his or her lifetime. Osteoarthr Cartil. 2010;18(11):1372–9. https://doi.org/10.1016/j.joca.2010.08.005.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. •• Oo WM, Linklater JM, Daniel M, Saarakkala S, Samuels J, Conaghan PG, et al. Clinimetrics of ultrasound pathologies in osteoarthritis: systematic literature review and meta-analysis. Osteoarthr Cartil. 2018;26(5):601–11. https://doi.org/10.1016/j.joca.2018.01.021A systematic review and meta-analysis summarizing the clinimetric attributes (e.g., reliability, validity, responsiveness, and feasibility) of US for osteoarthritis of the knee, hand, and hip joints including 100 studies, 8542 patients, and more than 32,000 OA joints.

    Article  CAS  PubMed  Google Scholar 

  6. McAlindon T, Kissin E, Nazarian L, Ranganath V, Prakash S, Taylor M, et al. American College of Rheumatology report on reasonable use of musculoskeletal ultrasonography in rheumatology clinical practice. Arthritis Care Res (Hoboken). 2012;64(11):1625–40. https://doi.org/10.1002/acr.21836.

    Article  Google Scholar 

  7. •• Sakellariou G, Conaghan PG, Zhang W, Bijlsma JWJ, Boyesen P, D’Agostino MA, et al. EULAR recommendations for the use of imaging in the clinical management of peripheral joint osteoarthritis. Ann Rheum Dis. 2017;76(9):1484–94. https://doi.org/10.1136/annrheumdis-2016-210815EULAR recommendations for the use of imaging modalities, including ultrasound, for clinical management of peripheral joint osteoarthritis, including future research directions.

    Article  PubMed  Google Scholar 

  8. •• Bruyn GA, Iagnocco A, Naredo E, Balint PV, Gutierrez M, Hammer HB, et al. OMERACT definitions for ultrasonographic pathologies and elementary lesions of rheumatic disorders 15 years on. J Rheumatol. 2019;46(10):1388–93. https://doi.org/10.3899/jrheum.181095Newly updated (from prior in 2005) OMERACT definitions of ultrasonographic pathologies in rheumatic disorders in general, including several that are relevant for osteoarthritis.

    Article  PubMed  Google Scholar 

  9. Gibson N, Guermazi A, Clancy M, Niu J, Grayson P, Aliabadi P, et al. Relation of hand enthesophytes with knee enthesopathy: is osteoarthritis related to a systemic enthesopathy? J Rheumatol. 2012;39(2):359–64. https://doi.org/10.3899/jrheum.110718.

    Article  PubMed  Google Scholar 

  10. Rogers J, Shepstone L, Dieppe P. Is osteoarthritis a systemic disorder of bone? Arthritis Rheum. 2004;50(2):452–7. https://doi.org/10.1002/art.20136.

    Article  PubMed  Google Scholar 

  11. Yumusakhuylu Y, Kasapoglu-Gunal E, Murat S, Kurum E, Keskin H, Icagasioglu A, et al. A preliminary study showing that ultrasonography cannot differentiate between psoriatic arthritis and nodal osteoarthritis based on enthesopathy scores. Rheumatology (Oxford). 2016;55(9):1703–4. https://doi.org/10.1093/rheumatology/kew218.

    Article  Google Scholar 

  12. • Okano T, Mamoto K, Di Carlo M, Salaffi F. Clinical utility and potential of ultrasound in osteoarthritis. Radiol Med. 2019;124(11):1101–11. https://doi.org/10.1007/s11547-019-01013-zDetailed review of osteoarthritis imaging with a focus on ultrasound, includes specific findings of osteoarthritis on US by feature and by joint site, including discussion of guided injections, with helpful images.

    Article  PubMed  Google Scholar 

  13. Mohammed RHA, Kotb H, Amir M, Di Matteo A. Subclinical crystal arthropathy: a silent contributor to inflammation and functional disability in knees with osteoarthritis-an ultrasound study. J Med Ultrason (2001). 2019;46(1):137–46. https://doi.org/10.1007/s10396-018-0912-z.

    Article  Google Scholar 

  14. Gossec L, Jordan JM, Mazzuca SA, Lam MA, Suarez-Almazor ME, Renner JB, et al. Comparative evaluation of three semi-quantitative radiographic grading techniques for knee osteoarthritis in terms of validity and reproducibility in 1759 X-rays: report of the OARSI-OMERACT task force. Osteoarthr Cartil. 2008;16(7):742–8. https://doi.org/10.1016/j.joca.2008.02.021.

    Article  CAS  PubMed  Google Scholar 

  15. Hunter DJ, Zhang W, Conaghan PG, Hirko K, Menashe L, Reichmann WM, et al. Responsiveness and reliability of MRI in knee osteoarthritis: a meta-analysis of published evidence. Osteoarthr Cartil. 2011;19(5):589–605. https://doi.org/10.1016/j.joca.2010.10.030.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. •• Bruyn GA, Naredo E, Damjanov N, Bachta A, Baudoin P, Hammer HB, et al. An OMERACT reliability exercise of inflammatory and structural abnormalities in patients with knee osteoarthritis using ultrasound assessment. Ann Rheum Dis. 2016;75(5):842–6. https://doi.org/10.1136/annrheumdis-2014-206774An OMERACT study demonstrating reliability of assessing features of knee osteoarthritis on ultrasound, including a standardized protocol and reference images.

    Article  PubMed  Google Scholar 

  17. Hammer HB, Iagnocco A, Mathiessen A, Filippucci E, Gandjbakhch F, Kortekaas MC, et al. Global ultrasound assessment of structural lesions in osteoarthritis: a reliability study by the OMERACT ultrasonography group on scoring cartilage and osteophytes in finger joints. Ann Rheum Dis. 2016;75(2):402–7. https://doi.org/10.1136/annrheumdis-2014-206289.

    Article  CAS  PubMed  Google Scholar 

  18. Sivakumaran P, Hussain S, Ciurtin C. Comparison between several ultrasound hand joint scores and conventional radiography in diagnosing hand osteoarthritis. Ultrasound Med Biol. 2018;44(3):544–50. https://doi.org/10.1016/j.ultrasmedbio.2017.11.009.

    Article  PubMed  Google Scholar 

  19. Spolidoro Paschoal NO, Natour J, Machado FS, Alcantara Veiga de Oliveira H, Vilar Furtado RN. Interphalangeal joint sonography of symptomatic hand osteoarthritis: clinical and functional correlation. J Ultrasound Med. 2017;36(2):311–9. https://doi.org/10.7863/ultra.16.01031.

    Article  PubMed  Google Scholar 

  20. Hussain S, Sivakumaran P, Gill A, Dhas D, Ciurtin C. Ultrasonography-detected subclinical inflammation in patients with hand osteoarthritis and established rheumatoid arthritis: a comparison between two different pathologies using the same ultrasound examination protocol. Musculoskeletal Care. 2018;16(1):26–31. https://doi.org/10.1002/msc.1197.

    Article  PubMed  Google Scholar 

  21. Hurnakova J, Filippucci E, Cipolletta E, Di Matteo A, Salaffi F, Carotti M, et al. Prevalence and distribution of cartilage damage at the metacarpal head level in rheumatoid arthritis and osteoarthritis: an ultrasound study. Rheumatology (Oxford). 2019;58(7):1206–13. https://doi.org/10.1093/rheumatology/key443.

    Article  Google Scholar 

  22. • Marshall M, Watt FE, Vincent TL, Dziedzic K. Hand osteoarthritis: clinical phenotypes, molecular mechanisms and disease management. Nat Rev Rheumatol. 2018;14(11):641–56. https://doi.org/10.1038/s41584-018-0095-4Useful review of hand osteoarthritis overall, including epidemiology, clinical features, current and future imaging techniques, potential phenotypes, and treatment options.

    Article  PubMed  Google Scholar 

  23. Haugen IK, Mathiessen A, Slatkowsky-Christensen B, Magnusson K, Boyesen P, Sesseng S, et al. Synovitis and radiographic progression in non-erosive and erosive hand osteoarthritis: is erosive hand osteoarthritis a separate inflammatory phenotype? Osteoarthr Cartil. 2016;24(4):647–54. https://doi.org/10.1016/j.joca.2015.11.014.

    Article  CAS  PubMed  Google Scholar 

  24. Mancarella L, Addimanda O, Pelotti P, Pignotti E, Pulsatelli L, Meliconi R. Ultrasound detected inflammation is associated with the development of new bone erosions in hand osteoarthritis: a longitudinal study over 3.9 years. Osteoarthr Cartil. 2015;23(11):1925–32. https://doi.org/10.1016/j.joca.2015.06.004.

    Article  CAS  PubMed  Google Scholar 

  25. Kortekaas MC, Kwok WY, Reijnierse M, Stijnen T, Kloppenburg M. Brief report: association of inflammation with development of erosions in patients with hand osteoarthritis: a prospective ultrasonography study. Arthritis Rheum. 2016;68(2):392–7. https://doi.org/10.1002/art.39438.

    Article  Google Scholar 

  26. Kortekaas MC, Kwok WY, Reijnierse M, Kloppenburg M. Inflammatory ultrasound features show independent associations with progression of structural damage after over 2 years of follow-up in patients with hand osteoarthritis. Ann Rheum Dis. 2015;74(9):1720–4. https://doi.org/10.1136/annrheumdis-2013-205003.

    Article  PubMed  Google Scholar 

  27. • Mathiessen A, Slatkowsky-Christensen B, Kvien TK, Hammer HB, Haugen IK. Ultrasound-detected inflammation predicts radiographic progression in hand osteoarthritis after 5 years. Ann Rheum Dis. 2016;75(5):825–30. https://doi.org/10.1136/annrheumdis-2015-207241A rare relatively large study of ultrasound in osteoarthritis with 5-year follow-up allowing determination of associations between ultrasound features at baseline and key radiographic outcomes, finding that gray scale synovitis and power Doppler signal at baseline were associated with radiographic progression.

    Article  PubMed  Google Scholar 

  28. Bijsterbosch J, Visser W, Kroon HM, Stamm T, Meulenbelt I, Huizinga TW, et al. Thumb base involvement in symptomatic hand osteoarthritis is associated with more pain and functional disability. Ann Rheum Dis. 2010;69(3):585–7. https://doi.org/10.1136/ard.2009.104562.

    Article  PubMed  Google Scholar 

  29. • Oo WM, Deveza LA, Duong V, Fu K, Linklater JM, Riordan EA, et al. Musculoskeletal ultrasound in symptomatic thumb-base osteoarthritis: clinical, functional, radiological and muscle strength associations. BMC Musculoskelet Disord. 2019;20(1):220. https://doi.org/10.1186/s12891-019-2610-4A paper describing baseline ultrasound of participants enrolled in a clinical trial of symptomatic thumb base osteoarthritis, demonstrating associations between power Doppler and pain by visual analog scale but no other associations between ultrasound and clinical variables.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Kroon FPB, van Beest S, Ermurat S, Kortekaas MC, Bloem JL, Reijnierse M, et al. In thumb base osteoarthritis structural damage is more strongly associated with pain than synovitis. Osteoarthr Cartil. 2018;26(9):1196–202. https://doi.org/10.1016/j.joca.2018.04.009.

    Article  CAS  PubMed  Google Scholar 

  31. Nevalainen MT, Kauppinen K, Pylvalainen J, Pamilo K, Pesola M, Haapea M, et al. Ultrasonography of the late-stage knee osteoarthritis prior to total knee arthroplasty: comparison of the ultrasonographic, radiographic and intra-operative findings. Sci Rep. 2018;8(1):17742. https://doi.org/10.1038/s41598-018-35824-3.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Koski JM, Kamel A, Waris P, Waris V, Tarkiainen I, Karvanen E, et al. Atlas-based knee osteophyte assessment with ultrasonography and radiography: relationship to arthroscopic degeneration of articular cartilage. Scand J Rheumatol. 2016;45(2):158–64. https://doi.org/10.3109/03009742.2015.1055797.

    Article  CAS  PubMed  Google Scholar 

  33. • Okano T, Filippucci E, Di Carlo M, Draghessi A, Carotti M, Salaffi F, et al. Ultrasonographic evaluation of joint damage in knee osteoarthritis: feature-specific comparisons with conventional radiography. Rheumatology (Oxford). 2016;55(11):2040–9. https://doi.org/10.1093/rheumatology/kew304Comparison of ultrasonography and conventional radiography among patients with symptomatic knee OA, supporting the validity and sensitivity of ultrasound for assessment of knee OA.

    Article  Google Scholar 

  34. Podlipska J, Guermazi A, Lehenkari P, Niinimaki J, Roemer FW, Arokoski JP, et al. Comparison of diagnostic performance of semi-quantitative knee ultrasound and knee radiography with MRI: Oulu Knee Osteoarthritis Study. Sci Rep. 2016;6:22365. https://doi.org/10.1038/srep22365.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. •• Yerich NV, Alvarez C, Schwartz TA, Savage-Guin S, Renner JB, Bakewell CJ, et al. A standardized, pragmatic approach to knee ultrasound for clinical research in osteoarthritis: the Johnston County Osteoarthritis Project. ACR Open Rheumatol. 2020;2(7):438–48. https://doi.org/10.1002/acr2.11159Comparison of ultrasonography and conventional radiography in a community-based cohort including individuals with and without OA, assessing feasibility, reliability, and validity of a standardized protocol and scoring atlas (both included with the publication).

    Article  PubMed  PubMed Central  Google Scholar 

  36. Hannan MT, Felson DT, Pincus T. Analysis of the discordance between radiographic changes and knee pain in osteoarthritis of the knee. J Rheumatol. 2000;27(6):1513–7.

    CAS  PubMed  Google Scholar 

  37. Serban O, Porojan M, Deac M, Cozma F, Solomon C, Lenghel M, et al. Pain in bilateral knee osteoarthritis - correlations between clinical examination, radiological, and ultrasonographical findings. Med Ultrason. 2016;18(3):318–25. https://doi.org/10.11152/mu.2013.2066.183.pin.

    Article  PubMed  Google Scholar 

  38. Razek AA, El-Basyouni SR. Ultrasound of knee osteoarthritis: interobserver agreement and correlation with Western Ontario and McMaster Universities Osteoarthritis. Clin Rheumatol. 2016;35(4):997–1001. https://doi.org/10.1007/s10067-015-2990-2.

    Article  PubMed  Google Scholar 

  39. Chen YJ, Chen CH, Wang CL, Huang MH, Chen TW, Lee CL. Association between the severity of femoral condylar cartilage erosion related to knee osteoarthritis by ultrasonographic evaluation and the clinical symptoms and functions. Arch Phys Med Rehabil. 2015;96(5):837–44. https://doi.org/10.1016/j.apmr.2015.01.004.

    Article  PubMed  Google Scholar 

  40. Bernardo-Bueno MM, Gonzalez-Suarez CB, Malvar AK, Cua R, Feliciano D, Tan-Sales BG, et al. Stratifying minimal versus severe pain in knee osteoarthritis using a musculoskeletal ultrasound protocol. J Ultrasound Med. 2019;38(6):1411–23. https://doi.org/10.1002/jum.14819.

    Article  PubMed  Google Scholar 

  41. Sarmanova A, Hall M, Fernandes GS, Bhattacharya A, Valdes AM, Walsh DA, et al. Association between ultrasound-detected synovitis and knee pain: a population-based case-control study with both cross-sectional and follow-up data. Arthritis Res Ther. 2017;19(1):281. https://doi.org/10.1186/s13075-017-1486-7.

    Article  PubMed  PubMed Central  Google Scholar 

  42. • Sarmanova A, Hall M, Moses J, Doherty M, Zhang W. Synovial changes detected by ultrasound in people with knee osteoarthritis - a meta-analysis of observational studies. Osteoarthr Cartil. 2016;24(8):1376–83. https://doi.org/10.1016/j.joca.2016.03.004A meta-analysis of 29 studies to examine the prevalence of ultrasound-detected synovial changes (effusion, hypertrophy, and power Doppler) in people with knee OA and knee pain, and in asymptomatic/health controls, finding a higher prevalence of synovial changes among those with OA compared with those with pain, and both compared with controls.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  43. Chiba D, Maeda S, Sasaki E, Ota S, Nakaji S, Tsuda E, et al. Meniscal extrusion seen on ultrasonography affects the development of radiographic knee osteoarthritis: a 3-year prospective cohort study. Clin Rheumatol. 2017;36(11):2557–64. https://doi.org/10.1007/s10067-017-3803-6.

    Article  PubMed  Google Scholar 

  44. Murakami T, Enokida M, Kawaguchi K, Otsuki R, Nagashima H. Useful ultrasonographic evaluation of the medial meniscus as a feature predicting the onset of radiographic knee osteoarthritis. J Orthop Sci. 2017;22(2):318–24. https://doi.org/10.1016/j.jos.2016.11.021.

    Article  PubMed  Google Scholar 

  45. • Bevers K, Vriezekolk JE, Bijlsma JW, van den Ende CH, den Broeder AA. Ultrasonographic predictors for clinical and radiological progression in knee osteoarthritis after 2 years of follow-up. Rheumatology (Oxford). 2015;54(11):2000–3. https://doi.org/10.1093/rheumatology/kev224An important slightly older study demonstrating that popliteal cyst presence at baseline in patients with clinical knee OA was significantly associated with both clinical and radiological progression over 2 years.

    Article  Google Scholar 

  46. Calvet J, Orellana C, Galisteo C, Garcia-Manrique M, Navarro N, Caixas A, et al. Clinical and ultrasonographic features associated to response to intraarticular corticosteroid injection. A one year follow up prospective cohort study in knee osteoarthritis patient with joint effusion. PLoS One. 2018;13(1):e0191342. https://doi.org/10.1371/journal.pone.0191342.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  47. Keen HI, Hensor EM, Wakefield RJ, Mease PJ, Bingham CO 3rd, Conaghan PG. Ultrasound assessment of response to intra-articular therapy in osteoarthritis of the knee. Rheumatology (Oxford). 2015;54(8):1385–91. https://doi.org/10.1093/rheumatology/keu529.

    Article  CAS  Google Scholar 

  48. Gellhorn AC, Stumph JM, Zikry HE, Creelman CA, Welbel R. Ultrasound measures of muscle thickness may be superior to strength testing in adults with knee osteoarthritis: a cross-sectional study. BMC Musculoskelet Disord. 2018;19(1):350. https://doi.org/10.1186/s12891-018-2267-4.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Nelson AE. The importance of hip shape in predicting hip osteoarthritis. Curr Treatm Opt Rheumatol. 2018;4(2):214–22. https://doi.org/10.1007/s40674-018-0096-0.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Orellana C, Moreno M, Calvet J, Navarro N, Garcia-Manrique M, Gratacos J. Ultrasound findings in patients with femoracetabular impingement without radiographic osteoarthritis: a pilot study. J Ultrasound Med. 2019;38(4):895–901. https://doi.org/10.1002/jum.14768.

    Article  PubMed  Google Scholar 

  51. Humby F, Romao VC, Manzo A, Filer A, Bugatti S, Vieira-Sousa E, et al. A multicenter retrospective analysis evaluating performance of synovial biopsy techniques in patients with inflammatory arthritis: arthroscopic versus ultrasound-guided versus blind needle biopsy. Arthritis Rheum. 2018;70(5):702–10. https://doi.org/10.1002/art.40433.

    Article  CAS  Google Scholar 

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Funding

Dr. Nelson’s work on this paper was funded in part by NIH/NIAMS R01 AR077060 and a Rheumatology Research Foundation Innovative Research Award.

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  1. Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, 3300 Doc J. Thurston Building, Campus Box #7280, Chapel Hill, NC, 27599-7280, USA

    Amanda E. Nelson

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Correspondence to Amanda E. Nelson.

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Conflict of Interest

Dr. Nelson reports grants from NIH/NIAMS and the Rheumatology Research Foundation, during the conduct of the study; reports personal fees from Flexion Therapeutics, Inc., GlaxoSmithKline, MedScape, and Health Press, Ltd., outside the submitted work; and is the current Chair of the Examination Subcommittee for the American College of Rheumatology Musculoskeletal Ultrasound Certification (RhMSUS) Oversight Committee.

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Nelson, A.E. Turning the Page in Osteoarthritis Assessment with the Use of Ultrasound. Curr Rheumatol Rep 22, 66 (2020). https://doi.org/10.1007/s11926-020-00949-w

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