Ultrasound in practice

Clinical case studies

How might ultrasound add value to aid diagnosis, assessment of therapeutic response and the assessment of disease state?

Background
  • 55-year-old male
  • Diagnosed seropositive rheumatoid arthritis 12 months ago
  • Treated with methotrexate, 25 mg/week
  • Still-active disease; Disease Activity Score 28 (DAS28) = 6.0
  • Biologic added
  • Excellent response; DAS28 = 2.1 (remission) after 6 months
  • No swollen or tender joints but persistent pain when walking
  • No morning stiffness
Examination
  • Positive squeeze test of metatarsophalangeal (MTP) joints, bilaterally
  • Tender metacarpophalangeal (MCP), proximal interphalangeal (PIP) and MTP joints
  • C-reactive protein (CRP) = 4 mg/l
  • ESR <20 mm/h
  • Referred for ultrasound of feet
Ultrasound findings
  • No MTP synovitis but several intermetatarsal bursae
Summary
  • History equivocal for continued, active disease
Ongoing management
  • Can taper biologic
  • Local injections under ultrasound guidance
How did ultrasound add value?
  • Changed diagnosis and management; used in management
    (ultrasound-guided injection)

Case study 3

Remission

Case study 1

Diagnosis

Case study 2

Therapeutic Response

© TUI 2019