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Ultrasonography in rheumatology: an evolving technique
  1. Department of Rheumatology, University of Ancona, Italy
  1. Professor Grassi, Clinica Reumatologica, Universit degli Studi di Ancona, Ospedale A Murri, Via dei Colli 52, I-60035 Jesi (Ancona), Italy.

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Ultrasonography (US) has proved to be an excellent technique for a quick, efficient, and accurate evaluation of soft tissues involvement in rheumatic diseases. US is a powerful tool to look around or inside joints, or both, tendons, muscles, bursae, and nerves. Skin, salivary glands, parathyroids, and small and large vessels are other interesting targets of US in rheumatology. The main advantages of US, with respect to other imaging techniques, include absence of radiation, good visualisation of the joint cavity, low running costs, multiplanar imaging capability, quantification of soft tissue abnormalities. Moreover, US is rapidly performed and readily accepted by patients.

US is not a new technique, but it has undergone relatively little clinical evaluation in rheumatology (compared with other imaging techniques) because of the paucity of sonographic units in rheumatology departments and of rheumatologists capable of performing a sonographic examination.

Most ultrasound equipment is available in radiology departments and musculoskeletal ultrasonography is mainly performed by radiologists even if few of them have a specific interest in rheumatic diseases.

Over the past few years, an increasing number of rheumatologists has started to utilise ultrasounds in their daily clinical practice. Although there is great potential for US in rheumatological clinical activity, most rheumatologists are not familiar with US and many are hesitant to attempt a direct approach. This reluctance may be related to several factors including lack of adequate anatomical knowledge (anatomophobia is a common syndrome among many rheumatologists), the lack of interest and of expertise in pathoanatomy, the discouraging impact of untrained attempts to have a first direct sonographic experience, and the initial cost of a high quality sonographic equipment (not less than $65 000).

At present, US is still a tool in search of a job in rheumatology, but it seems to have many of the features of a big bargain. …

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