437hence the role of patient reported outcome measures. PROMs facilitate quantitative
assessment of the patient’s response to the US-guided procedure. Four main patient
reported parameters have been included in previous studies as primary or secondary
outcomes, namely: (1) pain; (2) functional ability; (3) quality of life, such as sleep
and ability to work; as well as (4) patient global assessment [ 88 , 89 ]. Results
revealed that the patients who underwent US-guided injections had statistically sig-
nifi cant greater improvement in joint pain and function at 6 weeks after injection,
and also had less adverse events in comparison to blinded injections. In a systematic
meta-analysis, which included 12 randomized controlled trials [ 90 ], assessing the
effectiveness of US guidance on intra- and periarticular joint injections, results
revealed that US-guided intra-articular and periarticular joint injections were more
accurate than the landmark-guided injections. Ultrasound-guided procedures sig-
nifi cantly decreased the visual analogue scale scores for pain, patient global assess-
ment, and functional ability, as well as quality of life at both 2 and 6 weeks after
injection. The meta-analysis conclusion recommended routine ultrasound guidance
for intra-articular and periarticular injections. Subsequently, PROMs is advised for
use in standard clinical practice as it would enable the treating doctor to quantitate
and record the response to management.
Conclusion
MSUS has emerged as a powerful adjunctive clinical imaging tool for assessment of
infl ammatory as well as noninfl ammatory arthritic conditions. It is more sensitive
than clinical assessment as it has the ability to detect synovial hypertrophy and effu-
sion through Grayscale ultrasonography as well as active infl ammation through
Doppler mode. Several studies depicted the relationship of patient reported out-
comes such as functional disability, patient reported tender and swollen joint counts,
pain score, patient global assessment, and morning stiffness with the MSUS, which
detected morphologic infl ammatory/structural changes. In addition, MSUS plays an
important role to improve patients’ adherence to therapy, identify the underlying
cause of joint pain, and helping to set up a treatment program tailored to the patient’s
needs as well as patient education. There is a potential role for linking PROMs and
MSUS outcomes in the setting of a minimal to low disease activity without erosive
changes.
References
- Keen HI, Wakefi eld R, Conaghan PG. Optimising ultrasonography in rheumatology. Clin Exp
Rheumatol. 2014;32(5 Suppl 85):S-13–6. - Naredo E. Ultrasound in rheumatology: two decades of rapid development and evolving
implementation. Med Ultrason. 2015;17(1):3–4.
18 PROMs and Musculoskeletal Ultrasonography