Welcome to the Rheumatology Resource Centre.
The Rheumatology Resource Centre is hosted by the journal Best Practice and Research Clinical Rheumatology. It aims to provide healthcare professionals with educational resources and the latest peer-reviewed research on rheumatoid arthritis. Funded by an educational grant, the Rheumatology Resource Centre is freely available. Content is selected by the editorial board; Dr. Thasia Woodworth, Dr. Sarah Mackie and Prof. Tony Woolf.
Healthcare professionals, will have access to articles and videos covering key topics in rheumatoid arthritis, focusing on targeted therapies, including the role of the IL-6 pathway in inflammation, as well as best practices in early diagnosis, treatment and patient care.
To keep up-to-date with the latest additions to the Resource Centre, you can sign up for our E-Alerts.
Here we focus on the use of imaging modalities such as ultrasound and magnetic resonance imaging (MRI) for the diagnosis and management of rheumatoid arthritis (RA). Video interviews with Professor Philip Conaghan of Leeds, UK and Veena Ranganath, Associate Clinical Professor, University of California Los Angeles, Division of Rheumatology, provide useful insights to apply these modalities in clinical practice. Each has advantages and disadvantages for the visualization of inflammation as well as structural damage, acknowledging that feasibility is influenced by availability, cost and patient burden. Both visualize synovitis and are more sensitive for detection of erosions. Osteitis, or bone marrow edema, which has been shown to predict joint damage is only visualized by MRI.
Ultrasound can be our “stethoscope” in managing RA patients; thus, learning to use this technique is an important opportunity for rheumatologists. Dr. Ingrid Moller of Instituto Poal de Reumatologia, Barcelona, Spain describes the EULAR Points to Consider for health professionals undertaking musculoskeletal ultrasound for rheumatic and musculoskeletal diseases.[Ann Rheum Dis. 2016 Dec 9. pii: annrheumdis-2016-210741. doi: 10.1136/annrheumdis-2016-210741] Ultrasound is a “hands on” technique to enable visualization of synovitis that may not be clinically apparent in a patient in clinical remission. This can influence decision-making, whether treatment should be maintained or tapered.
In contrast, MRI, although more costly with higher patient burden, is a valuable tool to identify both synovitis and osteitis, as well as erosions. Sensitively visualizing these features of joint inflammation and damage, Short Tau Inversion Recovery (STIR) images readily detect changes in inflammation and thus response to treatment. Using contrast, synovitis can be differentiated from joint effusion where synovitis enhances while joint effusion doesn’t. Contrast-enhanced studies are more sensitive and therefore the option to detect minimal synovitis to also influence treatment decisions.
Ultrasound and MRI are well- established tools in clinical practice and effectively complement clinical examination and conventional radiography. We hope that these videos provide you with helpful information to assist in your use of these modalities.
Tightening up? Impact of musculoskeletal ultrasound disease activity assessment on early rheumatoid arthritis patients treated using a treat to target strategy
Dale J, Purves D, McConnachie A, McInnes I, Porter D.Arthritis Care & Research, 66: 19–26
Haavardsholm EA, Aga AB, Olsen IC, Lillegraven S, Hammer HB, Uhlig T et al.Arthritis Care Res (Hoboken). 2014 Jan;66(1):19-26..
Targeting ultrasound remission in early rheumatoid arthritis: the results of the TaSER study, a randomised clinical trial
Dale J, Stirling A, Zhang R, Purves D, Foley J, Sambrook M, Conaghan PG, van der Heijde D, McConnachie A, McInnes IB, Porter D.Ann Rheum Dis. 2016 Jun;75(6):1043-50. doi: 10.1136/annrheumdis-2015-208941. Annals of the Rheumatic Diseases 2016;75:1043-1050.
Short-term changes on MRI predict long-term changes on radiography in rheumatoid arthritis: an analysis by an OMERACT Task Force of pooled data from four randomised controlled trials
Peterfy C, Strand V, Tian L, Østergaard M, Lu Y, DiCarlo J, Countryman P, Deodhar A, Landewé R, Ranganath VK, Troum O, Conaghan PG.Annals of the Rheumatic Diseases Published Online First: 14 December 2016
The EULAR points to consider for health professionals undertaking musculoskeletal ultrasound for rheumatic and musculoskeletal diseases.
Siddle HJ, Mandl P, Aletaha D, et al.Annals of the Rheumatic Diseases Published Online First: 09 December 2016.