However, use of musculoskeletal ultrasound is capable of changing this. This technology helps doctors visualize inflammation or fluid in joints and assist in determining if the condition is being caused by rheumatoid arthritis, gout, osteoarthritis, or other joint conditions and what type of treatment should be used.
The Columbia Arthritis Center at NewYork-Presbyterian/Columbia University Medical Center is one of the first rheumatology centers in the country to incorporate ultrasound in arthritis care. In an effort to offer cutting-edge patient services, the hospital has launched the Fast Arthritis Sonographic evaluation and Therapy (F.A.S.T.) clinic. The F.A.S.T. clinic, apart from using state-of-the-art ultrasound technology for diagnosis and therapy, also promises to evaluate patients within 72 hours of referral, which is “in record time compared with the average time needed for a rheumatology referral,” said Dimitrios Pappas, M.D., M.P.H., a rheumatologist at NewYork-Presbyterian.
Traditionally, doctors use MRIs or x-rays to evaluate joints which have some drawbacks. X-rays involve radiation; MRIs are expensive; and neither technique allows doctors to see how the joint performs in motion. In addition, the patient has to be referred to a radiologist for MRI or x-rays, while ultrasound is performed by the rheumatologist at the time of the visit, allowing the rheumatologist to review the images together with the patient at the time of the exam.
Ultrasound also allows doctors to place needles more accurately. “Sometimes we have to place a needle in the joint either to remove fluid for evaluation or to inject a medication,” Dr. Pappas explained. When the needle is placed blindly (without ultrasound guidance), the procedure is often unsuccessful or unnecessarily painful. “Ultrasound guidance of needle placement improves accuracy of diagnosis and is associated with better results after a procedure,” Dr. Pappas said.
Furthermore, the ability to take scans at each visit allows for better monitoring of response to treatment. “This improves patient compliance with their treatment because they can see that the treatment is working,” Dr. Pappas said.
In addition, doctors can detect rheumatoid arthritis earlier in the disease process, which is especially important because medications for rheumatoid arthritis have the best efficacy the sooner they are started. “If a patient starts medications in the first few weeks after the onset of symptoms, they will do much better in the long run with a lower likelihood of having disability or joint malformations and an improved degree of functionality,” Dr. Pappas said.