The new frontiers of ultrasound in the complex world of vasculitides and scleroderma

Rheumatology (Impact Factor: 4.48). 12/2012; 51 Suppl 7(suppl 7):vii26-30. DOI: 10.1093/rheumatology/kes336


Modern US equipment allows rheumatologists to directly visualize vascular, musculoskeletal, dermal and internal organ structure.
In multisystemic and challenging diseases such as vasculitides and scleroderma, where new outcome measures are required in
both clinical practice and trials, US measures promise reproducible and objective scores of disease activity and extension.
US reveals early pathognonomic abnormalities and may help start early treatment.

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    ABSTRACT: Musculoskeletal ultrasonography is a routine diagnostic tool in rheumatological practice. The technique has only recently been used to evaluate articular and periarticular structures. In systemic sclerosis, different aspects of hand and wrist involvement have now been described, offering hope for the transfer of ultrasonography for this condition to the clinic.
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    ABSTRACT: Colour Doppler ultrasound displays a pathognomonic circumferential wall thickening in large-vessel vasculitis. Even rather small arteries like the temporal arteries can be easily examined with modern ultrasound equipment. In addition, ultrasound can detect stenoses and acute arterial occlusions. In large-vessel giant cell arteritis, the axillary arteries are most commonly involved. Takayasu arteritis affects particularly the left subclavian and the left common carotid arteries. As ultrasound diagnosis at the temporal arteries becomes more difficult already after a few days of glucocorticoid treatment in some patients, institutions are implementing fast-track clinics for which patients receive an appointment within 24 hours. An experienced rheumatologist is able to establish a definite diagnosis in most cases with standardised history, clinical examination and ultrasound of temporal and axillary arteries. Furthermore, early diagnosis and treatment may prevent blindness.
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    ABSTRACT: Rheumatologists have been using ultrasound (US) for the evaluation of patients affected by rheumatic disease for a long time. Actually this approach is becoming more and more diffuse and US is used for multiple purposes: diagnosis, disease activity assessment, prognosis, and therapy monitoring. The real 'new' step for the rheumatologist has been moving from the 'usual' musculoskeletal US to other fields of US, such as the assessment of vascular involvement (both macro and micro), skin, lung and even nails. In this paper we review the published literature related to the use of musculoskeletal, skin and lung US in patients affected by connective tissue diseases.
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