Subscribe to RSS
Please copy the URL and add it into your RSS Feed Reader.
https://www.thieme-connect.de/rss/thieme/en/10.1055-s-00000070.xml
Download PDF
Semin Musculoskelet Radiol 2025; 29(02): 145-155
DOI: 10.1055/s-0045-1802348
DOI: 10.1055/s-0045-1802348
Review Article
Sonography of Arthritis: Inflammatory, Infectious, Depositional
Abstract
Ultrasound (US) is a valuable tool in the evaluation of arthritis both for diagnosis and treatment response. Pertinent findings such as joint effusions, synovitis, bursitis, bone erosions, tenosynovitis, and enthesitis can all be readily evaluated sonographically. In this article, we describe specific considerations in the US evaluation of rheumatoid arthritis, psoriatic arthritis, juvenile idiopathic arthritis, crystalline arthritis (gout, calcium pyrophosphate deposition disease, and hydroxyapatite deposition disease), septic arthritis, and osteoarthritis with attention to certain differentiating features. The potential role of US in the diagnosis of specific arthritides is discussed, together with an overview of newer technologies and future directions.
Publication History
Article published online:
31 March 2025
© 2025. Thieme. All rights reserved.
Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA
-
References
- 1 Hazes JM, Luime JJ. The epidemiology of early inflammatory arthritis. Nat Rev Rheumatol 2011; 7 (07) 381-390
- 2 Filippucci E, Cipolletta E, Mashadi Mirza R. et al. Ultrasound imaging in rheumatoid arthritis. Radiol Med 2019; 124 (11) 1087-1100
- 3 Eder L, Barzilai M, Peled N, Gladman DD, Zisman D. The use of ultrasound for the assessment of enthesitis in patients with spondyloarthritis. Clin Radiol 2013; 68 (03) 219-223
- 4 Adler RS. What is the place of ultrasound in MSK imaging?. Skeletal Radiol 2024; 53 (09) 1699-1709
- 5 Wakefield RJ, Green MJ, Marzo-Ortega H. et al. Should oligoarthritis be reclassified? Ultrasound reveals a high prevalence of subclinical disease. Ann Rheum Dis 2004; 63 (04) 382-385
- 6 Patil P, Dasgupta B. Role of diagnostic ultrasound in the assessment of musculoskeletal diseases. Ther Adv Musculoskelet Dis 2012; 4 (05) 341-355
- 7 Torp-Pedersen S, Christensen R, Szkudlarek M. et al. Power and color Doppler ultrasound settings for inflammatory flow: impact on scoring of disease activity in patients with rheumatoid arthritis. Arthritis Rheumatol 2015; 67 (02) 386-395
- 8 Boylan M. Should ultrasound be used routinely in the diagnosis of rheumatoid arthritis?. Ir J Med Sci 2020; 189 (02) 735-748
- 9 Grainger AJ, Rowbotham EL. Rheumatoid arthritis. Semin Musculoskelet Radiol 2013; 17 (01) 69-73
- 10 Ellegaard K, Torp-Pedersen S, Terslev L, Danneskiold-Samsøe B, Henriksen M, Bliddal H. Ultrasound colour Doppler measurements in a single joint as measure of disease activity in patients with rheumatoid arthritis—assessment of concurrent validity. Rheumatology (Oxford) 2009; 48 (03) 254-257
- 11 Tugwell P, Boers M, Brooks P, Simon L, Strand V, Idzerda L. OMERACT: an international initiative to improve outcome measurement in rheumatology. Trials 2007; 8: 38
- 12 Wakefield RJ, Balint PV, Szkudlarek M. et al; OMERACT 7 Special Interest Group. Musculoskeletal ultrasound including definitions for ultrasonographic pathology. J Rheumatol 2005; 32 (12) 2485-2487
- 13 van der Ven M, van der Veer-Meerkerk M, Ten Cate DF. et al. Absence of ultrasound inflammation in patients presenting with arthralgia rules out the development of arthritis. Arthritis Res Ther 2017; 19 (01) 202
- 14 van Dijk BT, Wouters F, van Mulligen E, Reijnierse M, van der Helm-van Mil AHM. During development of rheumatoid arthritis, intermetatarsal bursitis may occur before clinical joint swelling: a large imaging study in patients with clinically suspect arthralgia. Rheumatology (Oxford) 2022; 61 (07) 2805-2814
- 15 Gravallese EM, Firestein GS. Rheumatoid arthritis - common origins, divergent mechanisms. N Engl J Med 2023; 388 (06) 529-542
- 16 Towiwat P, Doyle AJ, Gamble GD. et al. Urate crystal deposition and bone erosion in gout: ‘inside-out’ or ‘outside-in’? A dual-energy computed tomography study. Arthritis Res Ther 2016; 18 (01) 208
- 17 Rowbotham EL, Grainger AJ. Rheumatoid arthritis: ultrasound versus MRI. AJR Am J Roentgenol 2011; 197 (03) 541-546
- 18 Bruyn GA, Iagnocco A, Naredo E. et al; OMERACT Ultrasound Working Group. OMERACT definitions for ultrasonographic pathologies and elementary lesions of rheumatic disorders 15 years on. J Rheumatol 2019; 46 (10) 1388-1393
- 19 Torp-Pedersen S, Bartels EM, Wilhjelm J, Bliddal H. Articular cartilage thickness measured with US is not as easy as it appears: a systematic review of measurement techniques and image interpretation. Ultraschall Med 2011; 32 (01) 54-61
- 20 Kaibara N, Yamada H, Shuto T. et al. Comparative histopathological analysis between tenosynovitis and joint synovitis in rheumatoid arthritis. Histopathology 2008; 52 (07) 856-864
- 21 Wilson RL, DeVito MC. Extensor tendon problems in rheumatoid arthritis. Hand Clin 1996; 12 (03) 551-559
- 22 Ursum J, Horsten NC, Hoeksma AF. et al. Predictors of stenosing tenosynovitis in the hand and hand-related activity limitations in patients with rheumatoid arthritis. Arch Phys Med Rehabil 2011; 92 (01) 96-100
- 23 McGonagle D, Stockwin L, Isaacs J, Emery P. An enthesitis based model for the pathogenesis of spondyloarthropathy. additive effects of microbial adjuvant and biomechanical factors at disease sites. J Rheumatol 2001; 28 (10) 2155-2159
- 24 McGonagle D, Hermann KG, Tan AL. Differentiation between osteoarthritis and psoriatic arthritis: implications for pathogenesis and treatment in the biologic therapy era. Rheumatology (Oxford) 2015; 54 (01) 29-38
- 25 Feydy A, Lavie-Brion MC, Gossec L. et al. Comparative study of MRI and power Doppler ultrasonography of the heel in patients with spondyloarthritis with and without heel pain and in controls. Ann Rheum Dis 2012; 71 (04) 498-503
- 26 Sudoł-Szopińska I, Schueller-Weidekamm C, Plagou A, Teh J. Ultrasound in arthritis. Radiol Clin North Am 2017; 55 (05) 985-996
- 27 Naredo E, Rodríguez M, Campos C. et al; Ultrasound Group of The Spanish Society of Rheumatology. Validity, reproducibility, and responsiveness of a twelve-joint simplified power Doppler ultrasonographic assessment of joint inflammation in rheumatoid arthritis. Arthritis Rheum 2008; 59 (04) 515-522
- 28 Filer A, de Pablo P, Allen G. et al. Utility of ultrasound joint counts in the prediction of rheumatoid arthritis in patients with very early synovitis. Ann Rheum Dis 2011; 70 (03) 500-507
- 29 Kaeley GS, Nishio MJ, Goyal JR. et al. Changes in ultrasonographic vascularity upon initiation of adalimumab combination therapy in rheumatoid arthritis patients with an inadequate response to methotrexate. Arthritis Rheumatol 2016; 68 (11) 2584-2592
- 30 Tămaş MM, Filippucci E, Becciolini A. et al. Bone erosions in rheumatoid arthritis: ultrasound findings in the early stage of the disease. Rheumatology (Oxford) 2014; 53 (06) 1100-1107
- 31 Filippucci E, Gabba A, Di Geso L, Girolimetti R, Salaffi F, Grassi W. Hand tendon involvement in rheumatoid arthritis: an ultrasound study. Semin Arthritis Rheum 2012; 41 (06) 752-760
- 32 Gutierrez M, Pineda C, Salaffi F. et al. Is ankle involvement underestimated in rheumatoid arthritis? Results of a multicenter ultrasound study. Clin Rheumatol 2016; 35 (11) 2669-2678
- 33 Ribbens C, André B, Marcelis S. et al. Rheumatoid hand joint synovitis: gray-scale and power Doppler US quantifications following anti-tumor necrosis factor-alpha treatment: pilot study. Radiology 2003; 229 (02) 562-569
- 34 Silvagni E, Zandonella Callegher S, Mauric E. et al. Musculoskeletal ultrasound for treating rheumatoid arthritis to target-a systematic literature review. Rheumatology (Oxford) 2022; 61 (12) 4590-4602
- 35 Aletaha D, Neogi T, Silman AJ. et al. 2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rheum 2010; 62 (09) 2569-2581
- 36 Hum RM, Barton A, Ho P. Utility of musculoskeletal ultrasound in psoriatic arthritis. Clin Ther 2023; 45 (09) 816-821
- 37 Ritchlin CT, Colbert RA, Gladman DD. Psoriatic arthritis. N Engl J Med 2017; 376 (10) 957-970
- 38 Bandinelli F, Prignano F, Bonciani D. et al. Ultrasound detects occult entheseal involvement in early psoriatic arthritis independently of clinical features and psoriasis severity. Clin Exp Rheumatol 2013; 31 (02) 219-224
- 39 Karmacharya P, Wright K, Achenbach SJ. et al. Diagnostic delay in psoriatic arthritis: a population-based study. J Rheumatol 2021; 48 (09) 1410-1416
- 40 Urruticoechea-Arana A, Moreno M, Pujol M, Clavaguera T. Ultrasound in the evaluation of dactylitis and enthesitis in psoriatic arthritis. Eur J Rheumatol 2024; 11 (03) S298-S304
- 41 Baeten D, Demetter P, Cuvelier C. et al. Comparative study of the synovial histology in rheumatoid arthritis, spondyloarthropathy, and osteoarthritis: influence of disease duration and activity. Ann Rheum Dis 2000; 59 (12) 945-953
- 42 Mondal S, Goswami RP, Sinha D. et al. Evaluation of subclinical hand joint synovitis by ultrasonography in patients with psoriatic arthritis and cutaneous psoriasis: a case-control study. Mediterr J Rheumatol 2022; 33 (04) 421-429
- 43 Zabotti A, Salvin S, Quartuccio L, De Vita S. Differentiation between early rheumatoid and early psoriatic arthritis by the ultrasonographic study of the synovio-entheseal complex of the small joints of the hands. Clin Exp Rheumatol 2016; 34 (03) 459-465
- 44 Agache M, Popescu CC, Enache L, Dumitrescu BM, Codreanu C. Nail ultrasound in psoriasis and psoriatic arthritis—a narrative review. Diagnostics (Basel) 2023; 13 (13) 2236
- 45 Ceccarelli F, Lucchetti R, Perricone C. et al. Musculoskeletal ultrasound in monitoring response to apremilast in psoriatic arthritis patients: results from a longitudinal study. Clin Rheumatol 2019; 38 (11) 3145-3151
- 46 Borocco C, Anselmi F, Rossi-Semerano L. Contribution of ultrasound in current practice for managing juvenile idiopathic arthritis. J Clin Med 2022; 12 (01) 91
- 47 Navarro-Compán V, Benavent D, Capelusnik D. et al. ASAS consensus definition of early axial spondyloarthritis. Ann Rheum Dis 2024; 83 (09) 1093-1099
- 48 de Winter JJ, van Mens LJ, van der Heijde D, Landewé R, Baeten DL. Prevalence of peripheral and extra-articular disease in ankylosing spondylitis versus non-radiographic axial spondyloarthritis: a meta-analysis. Arthritis Res Ther 2016; 18 (01) 196
- 49 Gutierrez M, Rodriguez S, Soto-Fajardo C. et al. Ultrasound of sacroiliac joints in spondyloarthritis: a systematic review. Rheumatol Int 2018; 38 (10) 1791-1805
- 50 Martini A, Lovell DJ, Albani S. et al. Juvenile idiopathic arthritis. Nat Rev Dis Primers 2022; 8 (01) 5
- 51 Petty RE, Southwood TR, Manners P. et al; International League of Associations for Rheumatology. International League of Associations for Rheumatology classification of juvenile idiopathic arthritis: second revision, Edmonton, 2001. J Rheumatol 2004; 31 (02) 390-392
- 52 Żuber Z. Oligoarticular onset juvenile idiopathic arthritis as the most common cause of disability of children and young adults. Reumatologia 2019; 57 (04) 189-191
- 53 Windschall D, Malattia C. Ultrasound imaging in paediatric rheumatology. Best Pract Res Clin Rheumatol 2020; 34 (06) 101570
- 54 Malattia C, Rinaldi M, Martini A. The role of imaging in juvenile idiopathic arthritis. Expert Rev Clin Immunol 2018; 14 (08) 681-694
- 55 Roth J, Jousse-Joulin S, Magni-Manzoni S. et al; Outcome Measures in Rheumatology Ultrasound Group. Definitions for the sonographic features of joints in healthy children. Arthritis Care Res (Hoboken) 2015; 67 (01) 136-142
- 56 Dalbeth N, Gosling AL, Gaffo A, Abhishek A. Gout. Lancet 2021; 397 (10287): 1843-1855
- 57 Mikuls TR. Gout. N Engl J Med 2022; 387 (20) 1877-1887
- 58 Neogi T, Jansen TL, Dalbeth N. et al. 2015 Gout classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Ann Rheum Dis 2015; 74 (10) 1789-1798
- 59 Rosenthal AK, Ryan LM. Calcium pyrophosphate deposition disease. N Engl J Med 2016; 374 (26) 2575-2584
- 60 Fisseler-Eckhoff A, Müller KM. Arthroscopy and chondrocalcinosis. Arthroscopy 1992; 8 (01) 98-104
- 61 Filippucci E, Riveros MG, Georgescu D, Salaffi F, Grassi W. Hyaline cartilage involvement in patients with gout and calcium pyrophosphate deposition disease. An ultrasound study. Osteoarthritis Cartilage 2009; 17 (02) 178-181
- 62 Hegazi T. Hydroxyapatite deposition disease: a comprehensive review of pathogenesis, radiological findings, and treatment strategies. Diagnostics (Basel) 2023; 13 (16) 2678
- 63 Lee JP, Kim DS, Han JY, Baik SH, Kwak JW, Kim SH. Clinical and radiological outcomes of ultrasound-guided barbotage using a spinal needle and subacromial steroid injection for calcific tendinitis of the shoulder. Clin Shoulder Elbow 2022; 25 (02) 140-144
- 64 Mathews CJ, Weston VC, Jones A, Field M, Coakley G. Bacterial septic arthritis in adults. Lancet 2010; 375 (9717) 846-855
- 65 Li SF, Henderson J, Dickman E, Darzynkiewicz R. Laboratory tests in adults with monoarticular arthritis: can they rule out a septic joint?. Acad Emerg Med 2004; 11 (03) 276-280
- 66 Chan BY, Crawford AM, Kobes PH. et al. Septic arthritis: an evidence-based review of diagnosis and image-guided aspiration. AJR Am J Roentgenol 2020; 215 (03) 568-581
- 67 Patel R. Periprosthetic joint infection. N Engl J Med 2023; 388 (03) 251-262
- 68 Kopec JA, Heath AJ, Sayre EC. et al. Prevalence of joint-specific osteoarthritis and joint pain in British Columbia, Canada. Rheumatol Int 2022; 42 (09) 1623-1628
- 69 Allen KD, Thoma LM, Golightly YM. Epidemiology of osteoarthritis. Osteoarthritis Cartilage 2022; 30 (02) 184-195
- 70 Iagnocco A. Ultrasound in osteoarthritis. Clin Exp Rheumatol 2014; 32 (1, Suppl 80): S48-S52
- 71 Vlychou M, Koutroumpas A, Malizos K, Sakkas LI. Ultrasonographic evidence of inflammation is frequent in hands of patients with erosive osteoarthritis. Osteoarthritis Cartilage 2009; 17 (10) 1283-1287
- 72 Aziz MU, Eisenbrey JR, Deganello A. et al. Microvascular flow imaging: a state-of-the-art review of clinical use and promise. Radiology 2022; 305 (02) 250-264
- 73 Diao XH, Shen Y, Chen L. et al. Superb microvascular imaging is as sensitive as contrast-enhanced ultrasound for detecting synovial vascularity in rheumatoid arthritis. Quant Imaging Med Surg 2022; 12 (05) 2866-2876
- 74 De Zordo T, Mlekusch SP, Feuchtner GM, Mur E, Schirmer M, Klauser AS. Value of contrast-enhanced ultrasound in rheumatoid arthritis. Eur J Radiol 2007; 64 (02) 222-230
- 75 Liu H, Huang C, Chen S. et al. Value of contrast-enhanced ultrasound for detection of synovial vascularity in experimental rheumatoid arthritis: an exploratory study. J Int Med Res 2019; 47 (11) 5740-5751
- 76 Liu H, Chen S, Huang C. et al. Longitudinal changes in knee joint synovial vascularity in a rabbit model of rheumatoid arthritis: quantification using power Doppler ultrasound and contrast-enhanced ultrasound. Ultrasound Med Biol 2021; 47 (08) 2430-2441
- 77 Padovano I, Costantino F, Breban M, D'Agostino MA. Prevalence of ultrasound synovial inflammatory findings in healthy subjects. Ann Rheum Dis 2016; 75 (10) 1819-1823
- 78 Kaeley GS, Bakewell C, Deodhar A. The importance of ultrasound in identifying and differentiating patients with early inflammatory arthritis: a narrative review. Arthritis Res Ther 2020; 22 (01) 1