Comments on: Ultrasounds for Rheumatoid Arthritis, Part 2

By: Ruby

Ruby — Wed, 01 Feb 2012 20:12:45 +0000

I think doctors who pass ultra sound off as a “ridiculous test” have just bought in to the “hopeless, no cure, what’s the point” mentality. They are also not putting themselves in the shoes of their patient and considering what it is like to have an “invisible” illness. Any opportunity I have to make my invisible illness more visible would be helpful! I think it would help doctors be more accurate with the meds they are prescribing. I agree with you Beth you made a lot of great points.

By: Beth

Beth — Thu, 03 Feb 2011 16:54:08 +0000

I hope so. It would help so many people!…To make an invisible and hard to quantify disease more “real.” As you say, we can have pain without swelling and without a high sed rate or be sereonegative. Wouldn’t it be nice to have a doctor say, “Look Beth, its here and here and lets have a good watch on those bad joints, and keep up on them. Maybe splint them especially.” Wouldn’t it be nice to come back to our spouses that are hard to reach mentally and say, look honey, its the Left PIP here and this knee, and this wrist. Or yes, your neck needs extra watching because it is degenerating (and we need to watch it). Of course, this should be the case anyway. But the more concrete the result, the better off we are as a group. Our disease can be studied better. We can see if our biologics are halting or reversing our disease. Its just a matter of time and eventually, some ultrasound company is working on a device just for us, portable and for the office. However, ultrasound techs are few and far between, it takes a lot of physics and A & P to get through those studies. Therefore an expensive person to have on call. Doctors do not usually do imaging, I’m sorry its not “House” where the doctors do everything (really, the show cracks me up!) Therefore, they must go to an imaging center.
I’m impressed with your steadfastness with updating us with facts and research. You have been an anchor in this new process for me. I hope you are doing well. And I appreciate your teaching me all that you know. Much hugs, Beth

By: Kelly Young

Kelly Young — Thu, 03 Feb 2011 16:26:36 +0000

Beth,
I do think that US will be able to become more widely used and even a money maker for some offices when it’s more accurately done. From what I’ve been able to determine interviewing doctors on the topic, we are just not “there yet” with the use of the technology. There is too much error still so it’s not reliable. I’m not sure if you read parts 1 and 3 of this series, but that was my conclusion to the issue. US is being used more to guide injections and hopefully eventually to “see” RA also.

By: Beth

Beth — Thu, 03 Feb 2011 05:07:36 +0000

Wow! A technology that could be done in a large medical center, and not invasive and cheaper. What is wrong here? The ultrasound tech would do the proceedure, and the radiologist or rheumy would interpret the images.
I think that this is a seriously underused “lab.” Its hard to get the medical profession doing things that are “new” and out of the comfort zone. Somehow it has got to be a money maker or easy and cheap. To get them excited. Isn’t that a shame.

By: Kelly Young

Kelly Young — Sun, 29 Nov 2009 12:33:53 +0000

I agree completely.

By: Kelly Young

Kelly Young — Sat, 28 Nov 2009 03:44:40 +0000

Yes, it was a couple of PIP’s only. Wanted to also do only one hand. Unfortunately (??) for me, hands were one of the last places that I got RA. And I had already been established on DMARDs several months by then. They do hurt when I am not on meds, but they are usually not classically “swollen.” My new doc can feel the “thickening” in them even without the ultrasound. A much better doctor. RA does not always present with “obvious swelling,” and can cause plenty of damage without externally visible synovitis…

By: Kelly Young

Kelly Young — Sat, 28 Nov 2009 03:39:24 +0000

The doing it over and over thing sounds like a good idea. Since it does no harm, it is another advantage.

Unfortunately, TIME to spend doing that is a problem for doctors – at least here in the US. We don’t have enough rheumatologists and they have to cram patients in, so they usually have to rush.

By: Dr. Akerkar

Dr. Akerkar — Tue, 24 Nov 2009 18:39:11 +0000

Ultrasound (USG) is one of the best diagnostic tool presently available for diagnosis of musculoskeletal conditions. It remains one of the best & most economical tool to pick up RA (inflammatory arthritis) early. It costs just a fraction of what a MRI would cost.
However, training in musculoskeletal ultrasound remains an area of concern even among the Radiologists. Awareness about the utility of USG in early diagnosis of RA/ musculoskeletal conditions, its subjective nature & lack of expertise among the Radiologists needs to be adressed.

By: Lisa Emrich

Lisa Emrich — Tue, 24 Nov 2009 14:23:13 +0000

“We only do this joint.”

What?! Completely not my experience with the one time my rheumatologist used the ultrasound to visualize as many joints as possible in my hands.

By: Dr. Kirsch

Dr. Kirsch — Tue, 24 Nov 2009 12:38:56 +0000

We had a sponsored training in ultrasound at our hospital by one of the experts in Germany. Ultrasound may depend on the experience of the user, but the advantage is: you can do the procedure over and over again. Someone with more experience could review critical findings.
Sometimes patients can’t bear lying in a vault-like MRT, though some peripheral joints could be done in open MRTs.
One advantage more: untrasound is less cost intensive.
Lothar/Rheumatologe