Ultrasounds for Rheumatoid Arthritis, Part 3

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Ultrasounds as sensational tests for RA

Over the last couple of days, we have taken a look at musculoskeletal ultrasound tests for Rheumatoid Arthritis. We explored the value of ultrasounds (MSUS) compared to other tests for RA. We have seen that ultrasounds for Rheumatoid Arthritis are more precise and sensitive than x-ray tests for RA. The machines are less expensive and the procedure is less invasive than MRI’s which are of similar value to “see” the damage of Rheumatoid Arthritis.

Problems with obtaining a valid MUS for Rheumatoid Arthritis

Then, we examined some problems with obtaining a valid ultrasound for Rheumatoid Arthritis. MSUS is highly dependent upon the expertise of the operator. There is a need for standardization of training, standardization of interpretations of data, and skillful interpretation of a patient’s specific data. Consistency is difficult to obtain. In order to get a valid ultrasound for RA, you have to find just the right person to do the test. And it would seem that the stars must also be aligned…

Maybe we won’t really like having ultrasound tests for RA

Last week, I was reading a collection of radiological abstracts while doing research for a different project. I came across a study which shocked me. It was one of those “eureka” moments when I called out to whoever was home to come, “Look at this!”

The study reported that doctors changed plans for the treatment of Rheumatoid Arthritis patients after performing ultrasounds on the RA patients. Rheumatologists in this study were much less likely to prescribe disease modifying drugs for RA (DMARD’s) after the MSUS test. “A total of 88.7% of patients had DMARD as a proposed management option before US vs. 48.4% after US (p<0.001). In addition, 4.84% of patients had NSAID/ review as outpatients as a proposed management option before US vs. 45.26% after US (p<0.001).”

The doctors had planned to prescribe DMARD’s based upon clinical examination, lab tests, and reports from the patients about their conditions. The results of the ultrasound tests changed the minds of almost half of the doctors so that they prescribed NSAID’s (glorified aspirin) instead, for treatment of the disease. Listen to the conclusion of the original report: “Conclusion: Sonography of the hands and/or feet significantly influences the rheumatologists’ diagnostic confidence in specific clinical findings and management plans.”

That influence is significant indeed. And it is not a positive influence in my opinion. I wish that patients’ descriptions of their own disease states had such influence.

Let’s not get lost in the woods

Aren’t “early and aggressive” the watchwords for treating Rheumatoid Arthritis? I’ve met some RA’ers whose doctors have seen evidence of their Rheumatoid Arthritis using ultrasound, enabling them to obtain treatment for RA which was creating invisible damage. Ultrasound tests have been especially valuable for RA’ers who are seronegative. Obviously, what we see in that last study describes an opposite scenario. Patients who would have been treated for Rheumatoid Arthritis will not receive treatments because of an ultrasound result.

When I read that, I suddenly had no desire for an ultrasound test for my RA. Would the doctor cut off my disease treating DMARD’s if he could not detect my RA with his MSUS? Would he assume it was his own user error? How many docs do you know who usually see things that way?

Part 1 of this series, Ultrasounds for Rheumatoid Arthritis.

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Kelly Young. All rights reserved.

This entry was posted on Wednesday, November 25th, 2009 at 7:28 am and is filed under RA Education. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.

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