outcomes, the 2013 European League Against Rheumatism (EULAR) guidelines on imaging of the joints in RA recommends radiographs of the hand and feet as the initial imaging technique [13]. Assessment for synovitis and tenosynovitis is limited on radiography, although soft tissue swelling can be seen in the affected regions. Soft tissue and intraarticular crystal deposition as seen with gout or CPP deposition (CPPD); however, are readily apparent on radiographs in the form of tophi and chondrocalcinosis, respectively. US Area of Interest There is no relevant literature supporting the use of ultrasound (US) area of interest as the initial imaging modality in this clinical scenario. Variant 2: Chronic extremity joint pain. Suspect inflammatory arthritis (seropositive or seronegative arthritis). Radiographs normal or inconclusive. Next imaging study. Seropositive (rheumatoid) arthritis and seronegative spondyloarthritides including psoriatic arthritis, ankylosing spondylitis, reactive arthritis, and arthritis associated with inflammatory bowel disease share many clinical, pathologic, and imaging similarities. Thus, a uniform approach in the imaging workup of these entities is reasonable. Features of osseous erosions and soft tissue findings of synovitis and tenosynovitis may be seen in both seropositive and seronegative inflammatory arthritis, whereas enthesitis and dactylitis are typically seen only with the spondyloarthritis. The area of interest for this variant include: the ankle, elbow, foot, hand, hip, knee, shoulder, and wrist. Bone Scan Whole Body Tc-99m scintigraphy has been shown to be sensitive but not specific in the diagnosis of inflammatory arthritis, but it can detect inflammation and predict cortical erosions [9,14].
Chronic Extremity Joint Pain Suspected Inflammatory Arthritis Crystalline Arthritis or Erosive Osteoarthritis PCAs. outcomes, the 2013 European League Against Rheumatism (EULAR) guidelines on imaging of the joints in RA recommends radiographs of the hand and feet as the initial imaging technique [13]. Assessment for synovitis and tenosynovitis is limited on radiography, although soft tissue swelling can be seen in the affected regions. Soft tissue and intraarticular crystal deposition as seen with gout or CPP deposition (CPPD); however, are readily apparent on radiographs in the form of tophi and chondrocalcinosis, respectively. US Area of Interest There is no relevant literature supporting the use of ultrasound (US) area of interest as the initial imaging modality in this clinical scenario. Variant 2: Chronic extremity joint pain. Suspect inflammatory arthritis (seropositive or seronegative arthritis). Radiographs normal or inconclusive. Next imaging study. Seropositive (rheumatoid) arthritis and seronegative spondyloarthritides including psoriatic arthritis, ankylosing spondylitis, reactive arthritis, and arthritis associated with inflammatory bowel disease share many clinical, pathologic, and imaging similarities. Thus, a uniform approach in the imaging workup of these entities is reasonable. Features of osseous erosions and soft tissue findings of synovitis and tenosynovitis may be seen in both seropositive and seronegative inflammatory arthritis, whereas enthesitis and dactylitis are typically seen only with the spondyloarthritis. The area of interest for this variant include: the ankle, elbow, foot, hand, hip, knee, shoulder, and wrist. Bone Scan Whole Body Tc-99m scintigraphy has been shown to be sensitive but not specific in the diagnosis of inflammatory arthritis, but it can detect inflammation and predict cortical erosions [9,14].