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mended for use to describe the changes in osteoarthritis as these changes appear to
be less infl ammatory. The role of the enthesis organ in bone erosion formation in
rheumatoid arthritis has recently been described [ 48 ]. Specifi cally, early rheumatoid
arthritis erosion formation occurs immediately adjacent to the small joint collateral
ligament insertions as a result of enthesis-associated compression of bone at these
sites. These fi ndings moved enthesitis, from being a “second-class citizen” in SpA,
to the center stage as a structure responsible for morphologic changes in both
infl ammatory and degenerative arthritic diseases.
Table 18.1 depicts the joint sonopathologic defi nitions together with its corre-
sponding MSUS images (Figs. 18.1 , 18.2 , 18.3 , 18.4 , 18.5 , 18.6 , 18.7 , 18.8 , 18.9 ,
18.10 , 18.11 , and 18.12 ).
Musculoskeletal Ultrasound and Patient Reported Outcome
Measures
The new concept redefi ning health outcomes has gone beyond disease activity con-
trol and status of remission to include other parameters that are also vital in the
disease management process. This includes patient-reported as well as structural
outcomes. The correlation of joint ultrasonographic fi ndings and clinical assess-
ment has been studied thoroughly over the past years and US was reported to be a
more reliable measure of disease activity than clinical evaluation in patients with
infl ammatory arthritis. Furthermore, sonographic outcomes have shown a better
discriminatory capacity in both early and late stages of the disease process [ 49 , 50 ].
In contrast, both US and patient reported outcomes demonstrated similar predictive
validity with regard to disease progression as well as joint damage. Taking into
account the differences in quantifi cation schemes used to assess both tools (visual
analogue scale in patient reported outcome measures versus graded semiquantita-
tive synovitis assessment in joint ultrasonography), the persistence of such relation
early in the disease course, during disease activity, as well as in remission, has
added a potential value for patient reported outcome measures in standard clinical
practice. Though there was no direct studies linking sonographic fi ndings to indi-
vidual patient reported disease activity parameters, such correlations were evident
as secondary outcomes in different studies.
Ultrasound Versus Functional Disability
The outcome of infl ammatory arthritis relies mainly on the severity of joint damage,
the patient’s physical ability status, psychological health, and the presence of asso-
ciated comorbid illness such as cardiovascular disease or infection. Functional dis-
ability has been reported to be a biomarker for infl ammatory arthritis [ 51 ]. Its
J. Uson and Y. El Miedany