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A New Framework for Musculoskeletal Ultrasound in Rheumatology

A New Framework for Musculoskeletal Ultrasound in Rheumatology

A consensus-based comprehensive but practical update describing standardized procedures for musculoskeletal ultrasound in rheumatologic practice was developed by the European League Against Rheumatism (EULAR).

Increasing numbers of rheumatologists are using musculoskeletal ultrasound in their practices to make diagnoses and monitor response to treatment as well as to direct local injections and take biopsies, the guideline authors noted. Ingrid Möller and colleagues representing EULAR pointed out that ultrasound has many benefits over other imaging techniques, the most important being safety and point-of-care convenience. The portability of smaller ultrasound machines has contributed to their widespread availability in the rheumatologist’s office.

Based on these facts and the remote nature of EULAR’s 2001 guidelines for musculoskeletal ultrasound, the authors presented an update to those guidelines in a recent Annals of the Rheumatic Diseases article.

Task force objectives

EULAR created a task force with the following objectives:

(1) To update the standardized scanning techniques for musculoskeletal ultrasound assessment of the joint areas accessible to ultrasound evaluation in rheumatologic musculoskeletal diseases.

(2) To produce standardized imaging procedures for ultrasound assessment of other structures important to rheumatology.

(3) To select and prioritize the abnormalities found with musculoskeletal ultrasound.

(4) To create an electronic illustrated manual (an App) of images and techniques accessible to everyone who has interest in performing musculoskeletal ultrasound in their clinical practice.


A comprehensive literature review was performed to look at 7706 articles; 176 were selected for detailed review. Surveys were completed by 227 international musculoskeletal ultrasound experts; the response rate was 49.8%.


Following are general recommended procedures for musculoskeletal ultrasound assessment in rheumatologic musculoskeletal disease:

• Musculoskeletal ultrasound includes 2 principal modes: B-mode (or grey scale) that provides morphological information of the anatomic structures and Doppler mode (color Doppler or power Doppler) that allows for evaluation of blood flow.


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