Ultrasound Beyond Joints: A Review of Extra-Articular Applications in Rheumatology

Overview

Journal Curr Rheumatol Rep

Publisher Current Science

Specialty Rheumatology

Date 2025 Mar 4

PMID 40035992

Authors

Emilio DIgnazio

Davide Corradini

Tomas Cazenave

Riccardo Bixio

Caterina Baldi

Harjit Kaur Ubhi

Kate Smith

Richard J Wakefield

Paul Emery

Andrea Di Matteo

Affiliations

Soon will be listed here.

Abstract

Purpose Of Review: This review highlights key ultrasound applications for evaluating extra-articular involvement in rheumatic diseases, including the lungs, vessels, salivary glands, muscles, nerves, skin, and nails. It explores recent advances, emerging areas of assessment, and future research directions. Additionally, the review examines current limitations in the routine use of ultrasound for these purposes and considers the potential of new technologies, such as shear-wave elastography, contrast-enhanced ultrasound, and artificial intelligence, to enhance the early detection and monitoring of extra-articular manifestations in rheumatic diseases.

Recent Findings: Extra-articular manifestations in patients with rheumatic diseases are crucial for diagnosis, management (including treatment strategies), and prognosis, making accurate assessment essential. Growing evidence supports the role of ultrasound in assessing these manifestations for diagnosis, monitoring, and gaining insights into disease pathogenesis. Recent studies emphasize the significant utility of ultrasound in evaluating extra-articular involvement across various organ systems, including the lungs, vessels, salivary glands, muscles, nerves, skin, and nails. Technological advances, such as shear-wave elastography, contrast-enhanced ultrasound, and artificial intelligence, are expanding the scope and precision of ultrasound applications. Despite its potential, challenges such as operator dependency, lack of standardized protocols, and the need for specialized training hinder its widespread adoption. Ultrasound is a non-invasive, cost-effective, and radiation-free imaging modality with high diagnostic accuracy, making it a valuable tool for assessing extra-articular manifestations in rheumatic diseases. Emerging technologies may further enhance its clinical utility. However, efforts to standardize techniques and improve accessibility are necessary to optimize its integration into routine practice.

References

Rozynek M, Kucybala I, Urbanik A, Wojciechowski W . Use of artificial intelligence in the imaging of sarcopenia: A narrative review of current status and perspectives. Nutrition. 2021; 89:111227. DOI: 10.1016/j.nut.2021.111227. View

Mossel E, Delli K, van Nimwegen J, Stel A, Kroese F, Spijkervet F . Ultrasonography of major salivary glands compared with parotid and labial gland biopsy and classification criteria in patients with clinically suspected primary Sjögren's syndrome. Ann Rheum Dis. 2017; 76(11):1883-1889. DOI: 10.1136/annrheumdis-2017-211250. View

Tang X, Yang Y, Zhong L, Zhang L, Tang Y, Wang Y . Shear wave elastography-derived scoring system: application in the detection, subdivision and evaluation of systemic sclerosis. Clin Exp Rheumatol. 2024; 42(8):1598-1605. DOI: 10.55563/clinexprheumatol/8gus7b. View

Chrysidis S, Lewinski M, Schmidt W . Temporal arteritis with ultrasound halo sign in eosinophilic granulomatosis with polyangiitis. Rheumatology (Oxford). 2019; 58(11):2069-2071. DOI: 10.1093/rheumatology/kez263. View

Hammenfors D, Brun J, Jonsson R, Jonsson M . Diagnostic utility of major salivary gland ultrasonography in primary Sjögren's syndrome. Clin Exp Rheumatol. 2014; 33(1):56-62. View

Sulli A, Ruaro B, Alessandri E, Pizzorni C, Cimmino M, Zampogna G . Correlations between nailfold microangiopathy severity, finger dermal thickness and fingertip blood perfusion in systemic sclerosis patients. Ann Rheum Dis. 2013; 73(1):247-51. DOI: 10.1136/annrheumdis-2012-202572. View

Fana V, Dohn U, Krabbe S, Terslev L . Application of the OMERACT Grey-scale Ultrasound Scoring System for salivary glands in a single-centre cohort of patients with suspected Sjögren's syndrome. RMD Open. 2021; 7(2). PMC: 8061801. DOI: 10.1136/rmdopen-2020-001516. View

Albano D, Messina C, Vitale J, Sconfienza L . Imaging of sarcopenia: old evidence and new insights. Eur Radiol. 2019; 30(4):2199-2208. DOI: 10.1007/s00330-019-06573-2. View

Sundholm J, Paetau A, Alback A, Pettersson T, Sarkola T . Non-Invasive Vascular Very-High Resolution Ultrasound to Quantify Artery Intima Layer Thickness: Validation of the Four-Line Pattern. Ultrasound Med Biol. 2019; 45(8):2010-2018. DOI: 10.1016/j.ultrasmedbio.2019.04.017. View

10.

Grayson P, Ponte C, Suppiah R, Robson J, Gribbons K, Judge A . 2022 American College of Rheumatology/EULAR classification criteria for Takayasu arteritis. Ann Rheum Dis. 2022; 81(12):1654-1660. DOI: 10.1136/ard-2022-223482. View

11.

Ford J, DiIorio M, Huang W, Sobiesczcyk P, Docken W, Tedeschi S . Follow-up vascular ultrasounds in patients with giant cell arteritis. Clin Exp Rheumatol. 2020; 38 Suppl 124(2):107-111. PMC: 7812681. View

12.

Garrote-Corral S, Silva-Fernandez L, Seoane-Mato D, Guerra-Rodriguez M, Aburto M, Castaneda S . Screening of interstitial lung disease in patients with rheumatoid arthritis: A systematic review. Reumatol Clin (Engl Ed). 2021; 18(10):587-596. DOI: 10.1016/j.reumae.2021.07.002. View

13.

Tagliafico A, Bignotti B, Torri L, Rossi F . Sarcopenia: how to measure, when and why. Radiol Med. 2022; 127(3):228-237. PMC: 8960583. DOI: 10.1007/s11547-022-01450-3. View

14.

Paramalingam S, Morgan K, Becce F, Diederichsen L, Ikeda K, Mandl P . Conventional ultrasound and elastography as imaging outcome tools in autoimmune myositis: A systematic review by the OMERACT ultrasound group. Semin Arthritis Rheum. 2021; 51(3):661-676. DOI: 10.1016/j.semarthrit.2020.11.001. View

15.

Burlina P, Billings S, Joshi N, Albayda J . Automated diagnosis of myositis from muscle ultrasound: Exploring the use of machine learning and deep learning methods. PLoS One. 2017; 12(8):e0184059. PMC: 5576677. DOI: 10.1371/journal.pone.0184059. View

16.

Berti A, Dejaco C . Update on the epidemiology, risk factors, and outcomes of systemic vasculitides. Best Pract Res Clin Rheumatol. 2018; 32(2):271-294. DOI: 10.1016/j.berh.2018.09.001. View

17.

Skoog J, Svensson C, Eriksson P, Sjowall C, Zachrisson H . The Diagnostic Performance of an Extended Ultrasound Protocol in Patients With Clinically Suspected Giant Cell Arteritis. Front Med (Lausanne). 2022; 8:807996. PMC: 8804250. DOI: 10.3389/fmed.2021.807996. View

18.

Schmidt W . Contrast-Enhanced Ultrasound for Monitoring Takayasu Arteritis. J Rheumatol. 2022; 49(11):1185-1187. DOI: 10.3899/jrheum.220726. View

19.

Di Matteo A, Dejaco C . Editorial: Ultrasound in rheumatology-A polyhedric imaging tool. Front Med (Lausanne). 2023; 10:1150111. PMC: 9941730. DOI: 10.3389/fmed.2023.1150111. View

20.

Albayda J, van Alfen N . Diagnostic Value of Muscle Ultrasound for Myopathies and Myositis. Curr Rheumatol Rep. 2020; 22(11):82. PMC: 7522112. DOI: 10.1007/s11926-020-00947-y. View