Ultrasound findings as an element of diagnostic criteria in rheumatic diseases

Bhaskar Dasgupta, MB, BS, MD, is a consultant rheumatologist and head of rheumatology at Southend University Hospital, UK. He developed guidelines on polymyalgia rheumatica, giant cell arteritis, and the concept of point-of-care rheumatology ultrasound.

In which rheumatic diseases have ultrasound findings been already incorporated into the diagnostic criteria and help us reach a definitive diagnosis?

That is a very interesting question. Unfortunately, we still need more of the classification criteria to incorporate imaging criteria. But I’m very proud to state that the particular area that I have a specialist interest in, and that’s in large-vessel vasculitis, both in the polymyalgia rheumatica (PMR) criteria as well as the giant cell arteritis (GCA) criteria, we have imaging that has been incorporated.

In PMR ultrasound is incorporated as part of the scoring algorithm. For example, in patients who have typical PMR-type symptoms, we also look for PMR-specific ultrasound lesions in their shoulders such as subdeltoid-subacromial bursitis, or bicipital tenosynovitis, or hip involvement with ischial bursitis or hip effusion, etc. So, in PMR it’s been incorporated. And the recently published American College of Rheumatology (ACR) GCA criteria also incorporate ultrasound. They also incorporate other forms of imaging, including positron emission tomography (PET)/computed tomography (CT), etc. for large-vessel vasculitis.

We need to try and incorporate more of this imaging in other diseases, and certainly in gout. The gout criteria do incorporate imaging in the form of ultrasound or CT, but we need to try and make attempts to incorporate it in rheumatoid arthritis criteria, in psoriatic arthritis criteria, and that is what I have been lecturing about today at the McMaster International Review Course in Internal Medicine (MIRCIM) in Kraków.