Sonografie in der Rheumatologie – Update 2020

ZUSAMMENFASSUNG

Die muskuloskelettale Sonografie ist ein bereits seit vielen Jahren etabliertes Verfahren in der Rheumatologie zur Diagnostik und Verlaufskontrolle von entzündlich rheumatischen Gelenkerkrankungen. Die sonografisch detektierte Synovitis hat eine prognostische Bedeutung sowohl in der Vorhersage einer Arthritis bei sogenannten Risikopatienten mit Arthralgien (ohne Gelenkschwellung) für die rheumatoide Arthritis („at risk for RA“), bei undifferenzierter Arthritis und dem bestehenden Verdacht auf RA sowie bei RA-Patienten in klinischer Remission zur Vorhersage einer radiografischen Progression bzw. eines Schubs. Bei der Psoriasis-Arthritis (PsA) ist die muskuloskelettale Sonografie vor allem hilfreich in der (frühen) Diagnostik, da bisher andere sogenannte Biomarker fehlen. Zusätzlich wird die Sonografie bei anderen rheumatologischen Systemerkrankungen, wie dem primären Sjögren-Syndrom zur Detektion von spezifischen Veränderungen der Speicheldrüsen sowie der Riesenzellarteriitis zur Entzündungsdetektion von Gefäßveränderungen insbesondere der A. temporalis und A. axillaris eingesetzt und hat damit einen bedeutenden Stellenwert in der rheumatologischen Diagnostik erlangt.

SUMMARY

Musculoskeletal ultrasound (US) has become an established imaging procedure in rheumatology for many years for the diagnosis and monitoring of inflammatory rheumatic joint diseases. The US-detected synovitis is a prognostic marker both in the prediction of arthritis in “at risk” patients with arthralgia (without joint swelling) for rheumatoid arthritis, in undifferentiated arthritis with suspected RA, and in RA patients in clinical remission for the prediction of radiographic progression or relapse. In psoriatic arthritis (PsA), musculoskeletal US is particularly helpful in (early) diagnosis, as other biomarkers are still missing. In addition, sonography is used in other rheumatological diseases, such as the primary Sjögren’s syndrome for the detection of specific changes in the salivary glands and giant cell arteriitis for the inflammatory detection of vascular changes, especially in the temporal and axillary arteries, and has thus acquired an important role in different rheumatological diagnostics.

Schlüsselwörter

Muskuloskelettale Sonografie - rheumatoide Arthritis - Psoriasis-Arthritis - systemischer Lupus erythematodes mit Gelenkbeteiligung - Duplexsonografie - Riesenzellarteriitis

Keywords

Musculoskeletal ultrasound - rheumatoid arthritis - psoriatic arthritis - systemic lupus erythematosus with joint involvement - Duplexsonography - giant cell arteriitis

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