Ultrasound in rheumatology – beyond articular syndrome: analytical review of scientific literature

Abstract

Purpose: is to summarize data on the possibilities of ultrasound in rheumatology in patients outside the articular syndrome and to describe modern recommendations for the assessment of certain ultrasound changes. Materials and methods. In-depth analysis of scientific articles indexed in the databases SCOPUS, Web of Science, UpToDate, Google Scholar, MEDLINE, ResearchGate. The search in scientific metric databases was carried out using the keywords: “giant cell arteritis”, “nerve compression”, “polymyalgia rheumatica”, “tendon rupture”, “Sjögren’s syndrome”, “ultrasound”. A total of 36 scientific and information sources of foreign authors were analyzed. The following methods were used: bibliosemantic, structurallogical analysis. Results. An analysis of modern literature shows that ultrasound in the practice of a rheumatologist can be used in polymyalgia rheumatica or in the prediction of giant cell arteritis, in the examination of salivary glands in a patient with possible Sjögren’s syndrome or in the determination of such complications of inflammatory arthritis as nerve compression or tendon rupture. In polymyalgia rheumatica, bursitis and synovitis of the shoulder joint, biceps tenosynovitis, bursitis and synovitis of the hip joint can be determined. The “halo” sign is typical in giant cell arteritis. In ultrasound of the parotid and submandibular glands, the emphasis is on their homogeneity and echogenicity. Carpal nerve compression syndrome is characterized by typical changes in the thickness and echostructure of the nerve in the form of edema at the entrance and exit from the carpal canal and flattening inside, and measurement of the cross-sectional area of the median nerve at the entrance to the carpal tunnel corresponds to the degree of its compression. On ultrasound, a partially torn Achilles tendon, as the most common pathology, may appear thickened with a violation of the fibrillar echotexture and a gap between the fibers, and in the case of a complete rupture, the proximal and distal ends of the tendon will not appear continuous on ultrasound along the long axis and a violation of the fibrillar architectonics with a focal defect will be noted. The creation of national recommendations for ultrasound of the indicated pathologies can be a convenient and effective addition to the clinical examination of patients in the practice of a rheumatologist. Conclusions. Ultrasound in rheumatology has a wide application. This technique allows you to identify possible complications outside the joint cavity, identify specific signs of polymyalgia rheumatica and giant cell arteritis, as well as evaluate the parotid and submandibular glands in case of suspicion of Sjögren’s syndrome. Systematization and creation of clear algorithms for ultrasound of rheumatological patients allow optimizing their examination.