Musculoskeletal Ultrasound in Rheumatic Diseases – A Case-based Review

The book is compact, comprising 170 pages divided into three parts. Part I is an extremely detailed and well referenced review of the historical and current use of ultrasound in MSK disease, not confined just to rheumatic disease. There are excellent chapters comparing the different modalities used, and the applications and requesting of ultrasound scans in particular.

There are comprehensive chapters giving guidelines and protocols for the grading and reporting of inflammatory arthritis, with extensively referenced information on the validity and reliability of ultrasound in research. This information would be really useful for those building an ultrasound service or using it in research. However, the lack of accompanying ultrasound images in the chapter about grading may make the theory very difficult to understand without significant previous experience.

The chapter concerning joint specific examinations is broad: many of the indications listed as appropriate for ultrasound imaging are surprisingly non-inflammatory and the diseases involved are often more commonly diagnosed in other ways, for example nerve conduction tests to confirm carpal tunnel syndrome, or x-ray or MRI for intra-articular pathologies such as osteoarthritis. In the wrist and hand section, it is suggested that ultrasound is appropriate for several relatively rare pathologies, which would challenge all but the most experienced sonographers, while inflammatory arthritis – the ‘bread and butter’ of rheumatology ultrasound – is way down the list. Of more concern is a small paragraph on soft tissue masses, not usually the realm of a rheumatologist/sonographer, with no reference to the fact that these masses can be extremely challenging to classify, can be malignant and must be handled with appropriate caution, following relevant pathways. 

The case review section, part II, has over 60 case studies, all well presented with accompanying ultrasound images. This would have been an opportunity to show the ultrasound appearances of rheumatic diseases with appropriate clinical history and consequent ‘diagnoses’. However, it concentrates even more on non-inflammatory pathologies, primarily osteoarthritis of the knee, with only approximately 25 per cent of the cases involving inflammatory disease. Many of these are very well described and the ultrasound images are of good quality. However, again I would suggest that most would normally be investigated with other imaging and, in my opinion, it would have been really helpful to show ultrasound images of the more common rheumatological conditions such as rheumatoid or psoriatic arthritis of the hands or feet.

Part III contains 50 multiple choice questions and answers, testing knowledge gained from the previous chapters, which is always popular. However, because of the points previously mentioned, there is a bias towards general MSK ultrasound rather than a focus on rheumatic diseases.

Because of the broad scope, the target audience of this book is a little unclear. It is certainly not a ‘how to’ book in any sense, with very little content that would help the beginner in a practical way. The concentration on theoretical rather than practical information would limit the reach of the book to those needing current evidence around the use of ultrasound in rheumatology rather than those wishing to learn scanning techniques and image interpretation. 

In conclusion, when asked to review this book I expected to be reading an overview of the use of ultrasound in rheumatoid, psoriatic and juvenile arthritis, crystal arthropathies and maybe some less common areas such as Sjögren’s syndrome and giant cell arteritis. I expected section II to concentrate on patients with inflammatory disease and part III to test my knowledge on that subject. 

What I actually read was an extremely detailed and well referenced theoretical first section; however, in the more practical sections II and III, there is a disappointing leaning towards other diseases less commonly seen in rheumatology patients, which I feel missed the opportunity to educate the reader in the ultrasound appearances of inflammatory disease.

To purchase this title at our discounted rate email: katherine@radmagazine.com.