Clinical Case Studies
How might ultrasound add value to aid diagnosis, inform therapeutic response and the assessment of disease state.
Scenario 1: Minimal grey scale in on wrist
Non-significant inflammation, possibly element of overuse in benign hypermobility. Suggested management: conservative (splint +/- IA injection), exercise advice)
Scenario 2: Grade 2 grey scale and grade 2 power Doppler (PD) in both ulnar carpal joints + mild erosive change of the ulna styloids bilaterally?
Evolving inflammatory arthritis – risk of persistent erosive arthritis – grade 2 PD and erosions; suggested management: conventional sDMARD (csDMARD) +/- IA injection
Changed diagnosis and management
Evidence of aggressive, sub-clinical disease, predictive of flare and radiological damage; suggested management: initiate biologic therapy.
Clinically unimportant synovitis in patient (i.e.) clinical remission on biologic
Ultrasound was reassuring but not essential as biologics provide protection against radiological damage. This is when an ultrasound examination is of questionable value as a patient is clinically very well, and under biological “protection”.
No MTP synovitis but several intermetatarsal bursae
History equivocal for continued, active disease
Can taper biologic
Local injections under ultrasound guidance
Changed diagnosis and management; used in management (ultrasound – guided injection)