Background Musculoskeletal ultrasound (MSUS) is increasingly used for diagnostic and monitoring purposes by rheumatologists in daily clinical care.
Objectives Gain structured insight into the use of MSUS in routine rheumatology practice in Central and Eastern European (CEE) countries.
Methods In a cross-sectional, observational, multi-centre, international survey, a questionnaire was sent to 44 investigational sites in 9 CEE countries: Bulgaria, Croatia, Czech Republic, Estonia, Hungary, Lithuania, Romania, Serbia and Slovakia. Data was collected on all subsequent routine MSUS examinations from site inclusion into the survey for up to 6 months/100 examinations. Data on site characteristics, US equipment and investigators were also recorded. Endpoints: frequency of MSUS use at site, ratio and purpose of MSUS in various diagnoses, impact of MSUS examination's outcome on clinical decision-making and education and impact of investigation. Simple descriptive and summary statistics were calculated.
Results Twenty-five (56.8%) sites were university hospitals and 11 (25%) were general hospitals. Ninety-five physicians responded to the survey, with a median number of 3 physicians trained in MSUS/site, who having attended an average number of 2.9 (1-14) MSUS courses and reported a total of 2,810 MSUS examinations. The mean number of weekly MSUS examinations over all sites was 4.6 (from 1.5 in Bulgaria to 9.0 in Lithuania). The mean number of MSUS investigations per investigator was 29.6 (from 8.7 in Bulgaria to 60.0 in Serbia). In 51.9% of examinations MSUS was performed as part of the routine work-up, and was pre-scheduled in 43.4%. Most frequent diagnoses were rheumatoid arthritis (RA) in 978 (35%), and undifferentiated arthritis (uA) in 305 (10.9%) of cases; mean number of joints examined was 6.8. MSUS was most frequently performed for diagnostic purposes (58%), particularly in patients with uA, soft-tissue disorders or osteoarthritis (range of 73%>85.3%). Other reasons include monitoring of disease activity (33.2%) or treatment efficacy (15%), and help with an interventional procedure (11.6%). In RA patients, 56.3% of examinations were conducted to monitor disease activity. Nearly all (99%) investigations had clinical impact, with 58.6% confirming the findings of clinical investigation, 24.9% clarifying unclear pathology, 23.6% yielding more intensive treatment, and 10.1% establishing a new diagnosis. The results of 78.6% (51.6-99.0%) of examinations were deemed useful for patient education.
Conclusions This first systematic study focusing on the use of MSUS in CEE countries revealed considerable variation in the training and frequency of MSUS use among the included countries. The majority of MSUS examinations were performed for a diagnostic purpose while a third were conducted to monitor disease activity in RA. The overwhelming majority of examinations had an impact on clinical decision-making and were also found to be useful for patient education.
Acknowledgements Design, study conduct, and financial support were provided by AbbVie. AbbVie participated in the interpretation of data, review, and approval of the abstract.
Disclosure of Interest P. Mandl Grant/research support: AbbVie, Pfizer., Consultant for: AbbVie, Pfizer, GE, Speakers bureau: AbbVie, Pfizer, GE, A. Baranauskaite Grant/research support: AbbVie, Roche, Consultant for: MSD, N. Damjanov Grant/research support: Roche, AbbVie, Pfizer, Consultant for: Pfizer, Vertex, Speakers bureau: Boehringer Ingelheim, Roche, Pfizer, MSD, R. Kurucz: None declared, O. Nagy Shareholder of: AbbVie, Employee of: AbbVie, P. Nemec Grant/research support: AbbVie, MSD, Consultant for: AbbVie, Berlin-Chemie/A. Menarini, Pfizer, MSD, Speakers bureau: AbbVie, Berlin-Chemie/A. Menarini, Pfizer, MSD, P. Peric Speakers bureau: Boehringer Ingelheim, MSD, AbbVie, T. Petranova Grant/research support: AbbVie, MSD, UCB, Roche, Consultant for: AbbVie, MSD, Roche, UCB, Speakers bureau: AbbVie, Roche, UCB, MSD, A. Pille Speakers bureau: MSD, S. Rednic Consultant for: AbbVie, Bristol-Myers Squibb, MSD, Pfizer, Roche, UCB, Speakers bureau: AbbVie, Astra Zeneca, Bristol-Myers Squibb, Pfizer, Roche, UCB, MSD, V. Vlad Speakers bureau: AbbVie, M. Zlnay Speakers bureau: AbbVie, P. Balint Grant/research support: AbbVie, ESAOTE, Roche, Consultant for: AbbVie, Egis, MSD, Philips, Pfizer, Richter, Speakers bureau: AbbVie, Bristol-Myers Squibb, GE, MSD, Philips, Pfizer, Richter, UCB
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