Doctors Conclude Ultrasound Technology Should be used for Rheumatoid Arthritis More Often

The mantra of rheumatologists everywhere is “early interventions bring about better outcomes.” Ultrasound imaging for inflammatory arthritis has advantages in terms of cost and effectiveness but can also be used for earlier detection of arthritis in patients. The technology, however, is not being used as widely as it should be.

“If we diagnose something earlier, very often the patient will require a shorter course of treatment than if we allow the condition to become chronic — where longer treatment and many more visits to hospital will be needed,” said Dr. David Kane, Consultant Rheumatologist at AMNCH Tallaght Hospital.

Dr. Kane has led the use of ultrasound technology in Ireland. As he reported in Irish Medical Times: “I think we need more investment in this area. That would reduce waiting lists. The technology is extremely cost-effective. Patients who might otherwise be sent for a scan — and told to return for a second appointment — can be assessed on their first visits.”

Dr. Kane reported that by integrating ultrasound imaging into treatment, physicians can enhance the progress and outcomes of their patients. At the early inflammatory arthritis clinic in Tallaght Hospital, patients are scanned on the first visit and are informed during the same day if the diagnosis is inflammatory arthritis. “There’s a big advantage in that this frees up more of doctors’ time to see new patients.

“It really has made a huge difference to us,” Kane continued. “I would be in favour of making ultrasound a standard, integral part of rheumatology training in Ireland, so that patients would get the benefit of immediate diagnosis in the clinic,” said the consultant rheumatologist.

Dr Kane’s department established the Centre for Musculoskeletal Ultrasound at Tallaght, which is equipped with state-of-the-art ultrasound imaging capability.

Kane compared ultrasound imaging to that of magnetic resonance imaging, or MRI, saying that “[Ultrasound] offers a higher level of definition” which allows the “doctors and patients to focus on the area that is causing trouble. This is clearly preferable to imaging a wider area using MRI or a CAT scan.” Kane uses MRI and PET scans in his facility, but only when they are necessary.

Ultrasound is less costly than MRI scanning and in comparison to a vast amount medical equipment, the price is modest: A high-quality ultrasound scanner for a clinic can be purchased for an amount between $54,000 and $68,000. Large MRI scanners can cost over $1 million dollars, and dissimilar to MRI, ultrasound can be carried out on a patient immediately in a clinic setting.

“It’s portable and safe,” Kane explained. “There’s no radiation — ultrasound can be repeated at regular intervals without difficulty. It’s a real-time test that can monitor the patient when he or she is making a painful movement.”

The ability to image moving joints and tendon structures is a real advantage to clinicians. “You can place the probe on the tissue and actually see the movement of painful tissue in real time, which you cannot do with traditional CT scans and MRI — where a person lies motionless, in order to capture a still image,” said Dr Kane. While MRI at times requires injection of a contrast into a vein, ultrasound does not require contrasts in the early arthritis clinic.

Surveys show that merely one-third of clinicians actually carry out ultrasound examinations themselves in Ireland while two-thirds arrange for scans from radiology departments.

In Germany and Italy, it is obligatory for all doctors who specialize in musculoskeletal disease (including rheumatologists and orthopedic surgeons) to gain training experience in ultrasound. This idea has been gaining extensive recognition in the US as well, where similar training programs have begun over recent years.

The benefits of MRI and ultrasound must be cautiously evaluated when selecting imaging for patients, but both are now viable options and are available broadly. For rheumatologists, the major appliance of ultrasound lies in diagnosing and observing inflammatory arthritis, such as rheumatoid arthritis.

“Every time I do an ultrasound in the clinic, it avoids an alternative MRI scan and consequent delays in getting treatment,” Dr Kane said. “The longer you wait to treat someone, the worse the outcome.”