How Aussie Rheumatologists are using Ultrasound

By Dr Irwin Lim, Rheumatologist

Another sunny, glorious Sydney weekend.

I spent it indoors. Being upskilled.

With a bunch of 20+ rheumatologists from around Australia discussing how ultrasound is used to enhance our practices. We also brought in many helpful patients who were happy to allow us to scan their various body parts to educate and teach each other.

This cohort of Aussie rheumatologists are increasingly using an ultrasound machine at point-of-care.

By point-of-care, I mean that we use the technology to enhance our patients experience at our rooms and during our consultations.

The rheumatologist will be there as the ultrasound is performed. In many circumstances, this has a clear advantage over sending a patient away for the scan to be performed at St.Elsewheres.

The rheumatologist already has an in depth knowledge of the complaint, has already physically examined the patient, and has a clear clinical question to hopefully be answered using the ultrasound scan.

I have written about the reasons I think ultrasound is useful in my hands (read it here).

And, it’s a win for patients and a win for us, rheumatologists.

The range of clinical situations my colleagues are finding this technology helpful for them and their patients is large, and include:

• Assessing the degree of disease involvement. For eg, in rheumatoid arthritis, working out the extent of disease.
• Assessing the degree of damage that has already occurred in inflammatory arthritis. For eg, we may look for erosions as these predict more aggressive disease.
• Trying to help make a diagnosis in cases where it’s not otherwise clear. For eg, trying to differentiate between osteoarthritis and a seronegative inflammatory arthritis, trying to help make the diagnosis of psoriatic arthritis, looking for classic changes of gout.
• Helping to make clinical decisions. For eg, attempting to judge how active the disease still is before modifying medication therapy.
• Assessing sporting injury or mechanical problems. Commonly, we look at the rotator cuff or the gluteal (buttock) tendons or the wrist or ankle or elbow tendinopathy.
• Assessing various lumps, bumps and a variety of swelling. Is it fluid-filled? Is it solid? Should we worry?
• Guiding cortisone injections to various parts of the body (watch my shoulder injection video)
• Assessing vasculitis (autoimmune inflammation of blood vessels). I’ve not learned to do this yet but a nice case of temporal arteritis was presented.
• Assessing nerve problems, commonly carpal tunnel syndrome with the median nerve at the wrist.
• Helping patients understand their disease better. Some patients do seem to appreciate their problem more if they can watch on a screen what is happening to their joints, tendons or other tissues, rather than just accepting what their doctor may have told them after the usual physical examination.

It’s still early days for ultrasound use in the Australian rheumatology clinic but the tide seems to be turning. It’s a skill that more and more of us are developing.

Could you share your experience of this?

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