Rheumatoid arthritis is a chronic, systemic inflammatory disease, with certain evidence of multiple factors involved, but also with the strong autoimmune component, leading to a high potential for disability, through synovial inflammation and joint destruction. Diagnostic methods and management possibilities have recently improved, thus leading to a better outcome, based on the treat to target recommendation. Although biologic agents represent efficient therapeutic agents, in the last few years, the advances in understanding the mediators involved in rheumatoid arthritis pathogenesis have provided new targeted therapies, represented by small molecule inhibitors against the Janus kinases that contribute in the signaling pathways of various cytokine receptors.
Part of the book: Rheumatoid Arthritis
Musculoskeletal ultrasound had gained more and more importance lately and there is no doubt now about its role in the diagnosis and management of rheumatic diseases such as rheumatoid arthritis, spondyloarthritis, osteoarthritis and crystal related arthropathies. We can say that now, US is a widely available, non-invasive, and cost-effective technique suitable for the evaluation of the articular and periarticular structures, such as joints, tendons, muscles, ligaments, and bursa. The real-time capabilities of the US allow continuous observation of those structures during movement and of the needle placement during musculoskeletal interventions. More than this, recently, ultrasonography (US) has gained its rights in the evaluation of Sjogren syndrome and giant cell arteritis. Thus, US can detect changes secondary to both inflammatory joint diseases, like synovitis, tenosynovitis or enthesitis, and to degenerative disease, like osteophytes or tendinosis. US can identify calcium pyrophosphate and urate deposits at the level of the cartilage and tendons and to recognize the changes at the level of the salivary glands in the context of the Sjogren’s syndrome and the ones at the level of the temporal artery, secondary to giant cell arteritis.
Part of the book: Ultrasound Imaging