Comments on: Ultrasounds for Rheumatoid Arthritis, Part 3

By: Susan Galyon

Susan Galyon — Fri, 03 Feb 2012 10:35:47 +0000

Rheumatologists are not trained to correlate the US with the clinical. An orthopedic radiologists told me once that he was 500% better at interpretation of spinal issues after a flexed MRI than a regular radiologist. This ortho guy pointed out he looked at 100′s of these spinal films a month and that the smallest disparity jumped out at him. Could a rheumatologist take on such a challenge? Would many of them do it? We all hear of rheumy complacency. What would happen if they had a huge commitment with each patient for in-depth review of MSUS? One more personal experience. My rheumy had been injecting a shoulder joint for a couple of years-usually twice, sometimes three or four times annually. In frustration, I went to my orthopedic doc. Before he even saw an x-ray, the ortho described three major conditions occurring. After the x-rays in his office, he explained how the synovitis had ruptured the bursa, caused tendon shredding and pointed out the extreme bone spurs present. He wished for a good shoulder replacement and said he would overhaul the shoulder and try to get several more years from it. On the next rheumy appointment, I took the pics from the surgery. My rheumy expertly explained how my RA had affected the shoulder. When I asked him why he didn’t recommend the surgery, his only reply was no one knows when you are ready for surgery except you. I have faith in both my rheumy and my ortho (four TJRs). I just wish they would have a dialog about me. They are not at polar opposites; they just think so. My opinion on education and medicine in this country are the same: they both need an overhaul in humanity and commitment and money won’t fix either.

By: Kelly Young

Kelly Young — Sat, 15 Oct 2011 20:20:43 +0000

If you really need the MSUS, she may need to send you to an expert – it’s hard to find someone who can do this reliably – but you are in a good part of the country – good luck.

By: Patty

Patty — Sat, 15 Oct 2011 13:47:48 +0000

Thank you so much for this info Kelly. I just printed the article you have linked to above; I also have my next rheum appointment next week and I am going to ask about US for my hands. My Doc is usually very connected to and informed about new research, which is why I have stayed with her for my entire term of care (just under 20 years now). This past year has seen my first hand involvement(as far as MY symptoms go) but she has always checked my hands visually and is always surprised that they don’t hurt. I had to come off Enbrel for 6 weeks earlier this year in order to have surgery on my toe, and my response to it since going back on has not been as well as before.
I live in Massachusetts, so I’m hoping that if she is not set up or comfortable doing US that she can have me go into Boston….will keep you updated!

By: Kelly Young

Kelly Young — Mon, 08 Aug 2011 15:29:35 +0000

Suz, this is an article that was just posted on US that I found very helpful. It’s a great tool, but extremely user dependent. Also, I like how the article explains that different joints or tissues show better on one test than another. http://www.musculoskeletalnetwork.com/display/article/1145622/1916613

There is a pretty large portion of patients who don’t respond to Enbrel, so I hate to hear of doctors using lack of response to Enbrel as a diagnostic indicator.

By: Suz

Suz — Mon, 08 Aug 2011 13:59:35 +0000

I had US on my fingers and wrists at last rheumatology appointment. My RA diagnosis was in question because I had not responded to Enbrel and I am seronegative. My joints continue to ache symmetrically, my fatigue disables me… but no observation of inflammation on ultrasound lead the MD to suggest a diagnosis of Fibromyalgia rather than RA and prescribe Cymbalta. To be fair, she did not dismiss the possibility of RA completely.

By: Daiga

Daiga — Wed, 26 Jan 2011 19:57:38 +0000

Came across this article as I’m having my USG tomorrow. This will be the first one for my hands, but fifth in five years of disease overall. I’ve had a very nice experience of using ultrasound on my joints as I see it as a fun thing and the last time I had a usg the man turned the screen to my side and explained every single detail on the screen and I got some pretty pictures.
My docs have never taken me off medication just because the arthritis has not left a mark visible on an X-ray or USG, or MRI. Probably because I’ve had Full Body Scan that lit up like a Christmas tree.

By: Kelly Young

Kelly Young — Sun, 29 Nov 2009 12:31:35 +0000

YES! We have big job ahead of us to educate about RA; unfortunately that includes some doctors. :curse:

By: Kelly Young

Kelly Young — Sun, 29 Nov 2009 12:29:40 +0000

I have never heard of that approach, but it sounds smart. That doc sounds like a keeper; I’d probably send her muffins!

By: chelsea

chelsea — Thu, 26 Nov 2009 18:40:46 +0000

Interesting. I’ve wondered about that in addition to use of MRI to detect MRI damage or activity that isn’t clinically obvious to the doctor. I did read something on an ER blog where the doc discussed how ultrasounds would and are useful in some ER situations but not used nearly as often as they should be.

By: Kelly Young

Kelly Young — Thu, 26 Nov 2009 18:36:07 +0000

Thank you, Heather. So much work to make it sound simple but also present some evidence…