Studies have also found US to be helpful in differentiating RA and psoriatic arthritis [32,33]; for example, enthesitis is a finding often seen in spondyloarthritis but not seen in RA. Increased distance between the nail and distal phalanx in patients with psoriatic arthritis and cutaneous psoriasis is reported to have an 80% sensitivity and a 71% specificity [34]. US is also useful in the evaluation for synovitis and tenosynovitis, aided by the detection of hyperemia via color or Doppler signal [23]. Power Doppler US is more accurate for the diagnosis of synovitis and has a higher correlation with disease activity compared with grayscale US [35,36]. Synovitis on power Doppler US and grayscale US are both associated with the development of radiographic erosions in patients with RA compared with grayscale US [37,38]. Newer techniques for detecting microvascularization associated with joint inflammation like multimodal photoacoustic/US and ultra-microangiography have shown promise as indicators of disease activity [39,40]. US also provides prognostic information (such as detecting synovitis) that is linked to disease progression [13], although mild synovial hypertrophy as an isolated finding is not specific and has limited relevance [41]. In the evaluation of the finger joints with US, dorsal evaluation is recommended over palmar [42]. Abbreviated US scanning protocols of the hands, wrists, and feet to improve efficiency have been described [43-46]. Variant 3: Chronic extremity joint pain. Suspect gout. Radiographs normal or inconclusive. Next imaging study. The area of interest for this variant include: the ankle, elbow, foot, hand, hip, knee, shoulder, and wrist. Bone Scan Whole Body There is no relevant literature supporting the use of bone scan whole body for the evaluation of gout in the extremities following initial radiographs.
Chronic Extremity Joint Pain Suspected Inflammatory Arthritis Crystalline Arthritis or Erosive Osteoarthritis PCAs. Studies have also found US to be helpful in differentiating RA and psoriatic arthritis [32,33]; for example, enthesitis is a finding often seen in spondyloarthritis but not seen in RA. Increased distance between the nail and distal phalanx in patients with psoriatic arthritis and cutaneous psoriasis is reported to have an 80% sensitivity and a 71% specificity [34]. US is also useful in the evaluation for synovitis and tenosynovitis, aided by the detection of hyperemia via color or Doppler signal [23]. Power Doppler US is more accurate for the diagnosis of synovitis and has a higher correlation with disease activity compared with grayscale US [35,36]. Synovitis on power Doppler US and grayscale US are both associated with the development of radiographic erosions in patients with RA compared with grayscale US [37,38]. Newer techniques for detecting microvascularization associated with joint inflammation like multimodal photoacoustic/US and ultra-microangiography have shown promise as indicators of disease activity [39,40]. US also provides prognostic information (such as detecting synovitis) that is linked to disease progression [13], although mild synovial hypertrophy as an isolated finding is not specific and has limited relevance [41]. In the evaluation of the finger joints with US, dorsal evaluation is recommended over palmar [42]. Abbreviated US scanning protocols of the hands, wrists, and feet to improve efficiency have been described [43-46]. Variant 3: Chronic extremity joint pain. Suspect gout. Radiographs normal or inconclusive. Next imaging study. The area of interest for this variant include: the ankle, elbow, foot, hand, hip, knee, shoulder, and wrist. Bone Scan Whole Body There is no relevant literature supporting the use of bone scan whole body for the evaluation of gout in the extremities following initial radiographs.