© The Ulster Medical Society, 2015. www.ums.ac.uk Ulster Med J 2015;84(2):139-140 Game Changers ULTRASOUND AS A DISEASE ASSESSMENT TOOL FOR INFLAMMATORY POLYARTHROPATHY

The evolution of musculoskeletal ultrasound as a tool in the daily practice of the rheumatologist has been astounding. Its benefits include relative lack of expense and the capability to carry out dynamic joint assessment 1. Whereas plain radiographs demonstrate established bony damage, ultrasound can highlight ongoing synovial inflammation, non-radiographic bony erosion and soft tissue pathology. This has augmented the assessment of inflammatory polyarthropathies and aided in clinical decision-making. Whilst limitations in intra-operator variability and reproducibility have been cited, education through both practical and on-line musculoskeletal ultrasound courses is helping to address these caveats2. With tailored standardised training, incorporated into the rheumatology curriculum, confidence in point of care scanning will increase. What does this mean for the future? Working groups such as the OMERACT ultrasound group are evaluating its role as an outcome measure3. Issues remain in cases where there is clinical disease remission but ongoing ultrasonographic evidence of active synovitis. Ultrasound based synovitis has been suggested to predict radiographic damage. Will this mean the need to escalate treatment in a case of clinical remission? Furthermore, will outcome measures such as the DAS28 joint score require enhancement or even replacement with ultrasound based scores? Some clinical trial data to date has shown no significant difference at primary outcome points but this is in need of further evaluation4. We guess time will tell. 1. Esperanza N. Ultrasound in Rheumatology: two decades of rapid development and evolving implementation. Medical Ultrasonograph