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The 2017 EULAR standardised procedures for ultrasound imaging in rheumatology
  1. Ingrid Möller1,2,
  2. Iustina Janta3,
  3. Marina Backhaus4,
  4. Sarah Ohrndorf5,
  5. David A Bong1,2,
  6. Carlo Martinoli6,
  7. Emilio Filippucci7,
  8. Luca Maria Sconfienza8,9,
  9. Lene Terslev10,
  10. Nemanja Damjanov11,
  11. Hilde Berner Hammer12,
  12. Iwona Sudol-Szopinska13,14,
  13. Walter Grassi7,
  14. Peter Balint15,
  15. George A W Bruyn16,
  16. Maria Antonietta D’Agostino17,18,
  17. Diana Hollander19,
  18. Heidi J Siddle20,
  19. Gabriela Supp21,
  20. Wolfgang A Schmidt22,
  21. Annamaria Iagnocco23,
  22. Juhani Koski24,
  23. David Kane25,
  24. Daniela Fodor26,
  25. Alessandra Bruns27,
  26. Peter Mandl28,
  27. Gurjit S Kaeley29,
  28. Mihaela Micu30,
  29. Carmen Ho31,
  30. Violeta Vlad32,
  31. Mario Chávez-López33,
  32. Georgios Filippou34,
  33. Carmen Elena Cerón35,
  34. Rodina Nestorova36,
  35. Maritza Quintero37,
  36. Richard Wakefield20,
  37. Loreto Carmona38,
  38. Esperanza Naredo39
  1. 1Department of Rheumatology, Instituto Poal de Reumatología, Barcelona, Spain
  2. 2Barcelona University, Barcelona, Spain
  3. 3Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
  4. 4Department of Internal Medicine - Rheumatology and Clinical Immunology, Park-Klinik Weissensee, Berlin, Germany
  5. 5Department of Rheumatology and Clinical Immunology, Charité University Medicine, Berlin, Germany
  6. 6Department of Radiology-III, IRCCS AOU San Martino-IST, University of Genoa, Genoa, Italy
  7. 7Department of Rheumatology, Università Politecnica delle Marche, Ancona, Italy
  8. 8Unit of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Galeazzi, Milano, Italy
  9. 9Department of Biomedical Sciences for Health, University of Milano, Milano, Italy
  10. 10Centre for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark
  11. 11Institute of Rheumatology, University of Belgrade School of Medicine, Belgrade, Serbia
  12. 12Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
  13. 13Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
  14. 14Imaging Diagnostic Department, Warsaw Medical University, Warsaw, Poland
  15. 153rd Department of Rheumatology, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary
  16. 16Department of Rheumatology, MC Groep Hospitals, Lelystad, The Netherlands
  17. 17Rheumatology Department, Hôpital Ambroise Paré (APHP), Boulogne-Billancourt, France
  18. 18INSERM U1173, Laboratoire d’Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University, Saint-Quentin en Yvelines, France
  19. 19EULAR PARE Patient Research Partner, Amsterdam, The Netherlands
  20. 20Leeds Teaching Hospitals NHS Trust, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, Leeds, UK
  21. 21Joint and Bone Center for Diagnosis, Research, and Therapy of Musculoskeletal Disorders, Medical University of Vienna, Vienna, Austria
  22. 22Immanuel Krankenhaus Berlin, Medical Center for Rheumatology, Berlin, Germany
  23. 23Dipartimento Scienze Cliniche e Biologiche - Reumatologia, Università degli Studi di Torino, Turin, Italy
  24. 24Department of Internal Medicine, Mikkeli Central Hospital, Mikkeli, Finland
  25. 25Department of Medicine-Rheumatology, Trinity College, Dublin, Ireland
  26. 26Department of Internal Medicine, “Iuliu Hatieganu”, University of Medicine and Pharmacy, Cluj-Napoca, Romania
  27. 27Department of Rheumatology, University of Sherbrooke, Québec, Canada
  28. 28Division of Rheumatology, 3rd Department of Internal Medicine, Medical University of Vienna, Vienna, Austria
  29. 29Division of Rheumatology, University of Florida College of Medicine, Jacksonville, Florida, USA
  30. 30Rheumatology Division, 2nd Rehabilitation Department, Rehabilitation Clinical Hospital, Cluj-Napoca, Romania
  31. 31Rheumatology and Clinical Immunology Division, University of Hong Kong, Hong Kong SAR, China
  32. 32Department of Rheumatology, Sf. Maria Clinical Hospital, Bucharest, Romania
  33. 33Department of Biomedical Research, Universidad Autónoma de Aguascalientes, Aguascalientes, México
  34. 34Department of Medicine, Surgery and Neurosciences, Rheumatology Section, University of Siena, Siena, Italy
  35. 35Department of Rheumatology, Medicarte, Medellín, Colombia
  36. 36Rheumatology Centre ’St Irina', Sofia, Bulgaria
  37. 37Department of Rheumatology, Universidad de Los Andes, Mérida, Venezuela
  38. 38Instituto de Salud Musculoesquelética (InMusc), Madrid, Spain
  39. 39Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jiménez Díaz and Autónoma University, Madrid, Spain
  1. Correspondence to Dr Esperanza Naredo, Department of Rheumatology, Severo Ochoa Hospital, Madrid 28033, Spain; enaredo{at}


Background In 2001, the European League Against Rheumatism developed and disseminated the first guidelines for musculoskeletal (MS) ultrasound (US) in rheumatology. Fifteen years later, the dramatic expansion of new data on MSUS in the literature coupled with technological developments in US imaging has necessitated an update of these guidelines.

Objectives To update the existing MSUS guidelines in rheumatology as well as to extend their scope to other anatomic structures relevant for rheumatology.

Methods The project consisted of the following steps: (1) a systematic literature review of MSUS evaluable structures; (2) a Delphi survey among rheumatologist and radiologist experts in MSUS to select MS and non-MS anatomic structures evaluable by US that are relevant to rheumatology, to select abnormalities evaluable by US and to prioritise these pathologies for rheumatology and (3) a nominal group technique to achieve consensus on the US scanning procedures and to produce an electronic illustrated manual (ie, App of these procedures).

Results Structures from nine MS and non-MS areas (ie, shoulder, elbow, wrist and hand, hip, knee, ankle and foot, peripheral nerves, salivary glands and vessels) were selected for MSUS in rheumatic and musculoskeletal diseases (RMD) and their detailed scanning procedures (ie, patient position, probe placement, scanning method and bony/other landmarks) were used to produce the App. In addition, US evaluable abnormalities present in RMD for each anatomic structure and their relevance for rheumatology were agreed on by the MSUS experts.

Conclusions This task force has produced a consensus-based comprehensive and practical framework on standardised procedures for MSUS imaging in rheumatology.

  • ultrasound
  • scanning
  • standardization
  • rheumatology
  • rheumatic and musculoskeletal diseases
  • procedures

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  • Handling editor Francis Berenbaum

  • Funding This study was funded by a EULAR grant (The development of EULAR Standardised Procedures for Rheumatology Ultrasound Imaging has a EULAR grant invested in the payment of the fellows, the methodologist, the expenses for a 2-day meeting of a subgroup of the task force panel and the technical support for the App production. The app is available at no cost at the EULAR web page).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.