RESUMEN
Upper extremity infections are frequently seen, especially in individuals with weakened immune system, posttraumatic events, and after surgery procedures. If not properly treated, such conditions can lead to serious consequences, such as movement impairment, amputation, and even mortality. These infections have the potential to spread extensively from their initial site of entry, traversing interconnected spaces either intra or extra-compartmental. Understanding the relevant anatomy is crucial to assess location and stage of infection, since surgical intervention and intravenous antibiotics are usually required. In this article, the authors provide a comprehensive review of the imaging findings of upper extremity infection, focusing on magnetic resonance imaging (MRI). Furthermore, this article sheds light on the pivotal role of radiology in managing hand, elbow, and shoulder infections offering an overview of available treatment options. KEY FINDINGS: Various types of infections affecting the upper extremity will be discussed, including infectious tenosynovitis, deep space infections, septic arthritis, and osteomyelitis. Authors also highlight anatomical spaces, common pathogens, spread routes, and key radiological features of these conditions.
Asunto(s)
Imagen por Resonancia Magnética , Extremidad Superior , Humanos , Imagen por Resonancia Magnética/métodos , Extremidad Superior/diagnóstico por imagen , Osteomielitis/diagnóstico por imagen , Artritis Infecciosa/diagnóstico por imagen , Tenosinovitis/diagnóstico por imagenRESUMEN
Imaging-guided tendon procedures aim to reduce pain and increase function by controlling inflammation and stimulating healing. Ultrasound is the preferable guiding modality due to its high resolution and real-time demonstration of the tendinous anatomy and needle positioning. The technique includes appropriate patient positioning, which varies depending on the targeted tendon, as well as sterile and proper draping. For most procedures, we prefer the "in-plane" approach, which demonstrates the entire needle as it advances through different tissue layers. Upper limb injections commonly use corticosteroids and anesthetics with different reported short- and long-term results depending on the tendon treated; better results are obtained in the treatment of tenosynovitis (sliding tendons such as trigger finger and De Quervain's tenosynovitis). Shoulder and elbow tendinopathies (anchor tendons) may also benefit from injections containing irritants or healing stimulants such as dextrose (prolotherapy) and platelet-rich plasma or by the stimulation of healing via tendon perforations (fenestration). The hyaluronic acid injection has also been used in the treatment of both tenosynovitis and tendinopathies. For tendons passing through osteofibrous tunnels, an additional release may be performed, and the techniques are discussed in this review. Therefore, this article provides practicing musculoskeletal radiologists and trainees with a comprehensive review of tendon injection musculoskeletal image-guided procedures.
Asunto(s)
Tendinopatía , Tenosinovitis , Humanos , Tenosinovitis/diagnóstico por imagen , Tenosinovitis/tratamiento farmacológico , Tendones/diagnóstico por imagen , Corticoesteroides , Tendinopatía/diagnóstico por imagen , Tendinopatía/tratamiento farmacológico , Extremidad SuperiorRESUMEN
BACKGROUND: Our objective was to investigate the value of ultrasound (US) detected synovitis and tenosynovitis as risk factors for short term flare in rheumatoid arthritis (RA) patients in clinical remission. METHODS: Consecutive RA patients in clinical remission (DAS28 ERS < 2.6) for at least 3 months underwent Power Doppler ultrasound (PDUS) examination of 1st to 6th extensor compartments at the wrist, 2nd to 5th finger flexor, posterior tibial tendon, and peroneal tendons. To assess synovitis, carpal joints, 1st to 5th metacarpophalangeal (MCP) joints, and 2nd to 5th interphalangeal proximal (IPP) joints were bilaterally examined. Synovitis and tenosynovitis were defined according to OMERACT. Patients were followed for 1 year. Disease flare was defined as an increase in disease activity generating the need for a change in therapy by the attending rheumatologist. RESULTS: Ninety patients were included. After 1 year of follow-up, 26 patients (29%) experienced a flare. At baseline 39%, 23% and 8% had US-detected synovitis, tenosynovitis or both, respectively. In the 1-year period after the baseline US examination, US-detected tenosynovitis (RR: 4.9; 95% CI: 2.2-10.8) was associated with an increased risk of exacerbation. This association was not shown with US-detected synovitis (RR: 1.3; 95% CI: 0.76-2.2). In the multivariate analysis, only subclinical tenosynovitis (OR: 9.8; 95% CI: 2.5-39.1; p = 0.001) and baseline DAS28 (OR: 5.7; 95% CI: 1.1-31.6; p = 0.047) were significantly associated with an increased risk of having a flare. CONCLUSION: In our study, subclinical tenosynovitis was associated with disease flare in patients with RA in clinical remission. KEY POINTS: ⢠Synovitis and tenosynovitis are risk factors for short term flare in RA patients in clinical remission. ⢠Subclinical tenosynovitis, but not synovitis, was associated with disease flare in patients with unstable remission. ⢠Ultrasound-detected tenosynovitis could be useful to predict relapses in RA patients in clinical remission.
Asunto(s)
Artritis Reumatoide , Sinovitis , Tenosinovitis , Artritis Reumatoide/complicaciones , Artritis Reumatoide/diagnóstico por imagen , Artritis Reumatoide/tratamiento farmacológico , Humanos , Articulación Metacarpofalángica , Factores de Riesgo , Índice de Severidad de la Enfermedad , Brote de los Síntomas , Sinovitis/complicaciones , Sinovitis/diagnóstico por imagen , Sinovitis/tratamiento farmacológico , Tenosinovitis/complicaciones , Tenosinovitis/diagnóstico por imagen , Ultrasonografía DopplerRESUMEN
OBJECTIVES: To compare musculoskeletal changes on a physical examination (PE), ultrasound (US) and magnetic resonance imaging (MRI) of the hands and wrists of patients with Chikungunya fever (CF). METHODS: The sample consisted of 30 patients in the chronic phase of CF. The sites analyzed were the interphalangeal (IP), metacarpophalangeal (MCP) and wrist/mediocarpal (WMC) joints and periarticular soft tissue. The interval between the PE and imaging tests was 7 days, and the interval between US and MRI was 2 days. The kappa coefficient was calculated to estimate the agreement between the PE and US and MRI findings and between the US and MRI findings. RESULTS: Significant agreement was observed between PE and US in the diagnosis of synovitis. The only statistically significant agreement between US and MRI was the finding of flexor tenosynovitis; the agreement was moderate. CONCLUSIONS: US has great potential for use in diagnosing synovitis suspected based on a PE. The limited agreement observed between US and MRI, in turn, may suggest a complementary role of these methods.
Asunto(s)
Artritis Reumatoide , Fiebre Chikungunya , Sinovitis , Tenosinovitis , Artritis Reumatoide/patología , Fiebre Chikungunya/complicaciones , Fiebre Chikungunya/diagnóstico por imagen , Humanos , Imagen por Resonancia Magnética/métodos , Examen Físico , Sinovitis/diagnóstico por imagen , Tenosinovitis/diagnóstico por imagen , Muñeca , Articulación de la MuñecaRESUMEN
Histoplasmosis is a disease endemic to several parts of the world, including South America. It progresses in a mostly asymptomatic and self-limiting manner but has the potential to cause disseminated pulmonary infection, especially in immunocompromised patients. Rare reports from the literature describe musculoskeletal manifestations related to the two varieties of the pathogen that cause histoplasmosis, namely, the capsulatum or duboissi variety. In this report, we describe the case of a previously healthy, middle-aged man, with slowly progressing pain in the right forearm, wrist, and fingers, diagnosed with a case of pathologically confirmed histoplasmosis tenosynovitis. We also describe the imaging, surgical, and histological findings and discuss the differential diagnoses for tenosynovitis, in case of atypical infections.
Asunto(s)
Histoplasmosis , Tenosinovitis , Antebrazo/diagnóstico por imagen , Histoplasmosis/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Tenosinovitis/diagnóstico por imagen , Muñeca/diagnóstico por imagen , Articulación de la Muñeca/diagnóstico por imagen , Articulación de la Muñeca/cirugíaRESUMEN
OBJECTIVES: This study aimed to investigate the predictive value of synovitis and tenosynovitis detected by grayscale (GS) and by power Doppler (PD) ultrasound (US) in relation to failure of tapering disease-modifying antirheumatic drugs (DMARD) in rheumatoid arthritis (RA) patients. METHODS: Long-standing RA patients who de-escalated treatment were included in this prospective cohort study. All patients underwent 3 ultrasonographic and clinical assessments, at baseline and every 3 or 4 months, over a period of 6-8 months. US investigation of 32 joints was performed. Synovitis was assessed by GS and PD semiquantitative scoring (0-3) and a global score was calculated for each individual by summing single joint scores. The presence of tenosynovitis was recorded whenever detected during ultrasound assessment. RESULTS: Thirty-three patients completed the follow-up period (29 women; 4 men). Eight patients (25%) relapsed. Using the optimal cutoff values determined by receiver operating characteristic curve, patients with a PD synovitis ≥1 at baseline had significantly greater chances to relapse than those without PD activity. During follow-up, GS tenosynovitis was detected in 6 patients (5 with PD) who failed and in 3 patients (1 with PD) who succeeded in tapering therapy. Having at least 1 joint with PD synovitis resulted in a relative risk of 3.14 and having GS tenosynovitis resulted in a relative risk of 11.4 (95% CI: 1.03-9.60 and 2.82-45.9, respectively) for relapse in the multivariate Poisson model. CONCLUSIONS: PD synovitis and GS tenosynovitis may be useful to identify RA patients in risk of relapse after DMARD tapering.
Asunto(s)
Antirreumáticos , Artritis Reumatoide , Sinovitis , Tenosinovitis , Antirreumáticos/uso terapéutico , Artritis Reumatoide/complicaciones , Artritis Reumatoide/diagnóstico por imagen , Artritis Reumatoide/tratamiento farmacológico , Femenino , Humanos , Masculino , Estudios Prospectivos , Índice de Severidad de la Enfermedad , Sinovitis/diagnóstico por imagen , Sinovitis/tratamiento farmacológico , Tenosinovitis/diagnóstico por imagen , Tenosinovitis/tratamiento farmacológico , Ultrasonografía DopplerRESUMEN
INTRODUCTION/OBJECTIVES: To evaluate the clinical relevance of high-resolution hand and wrist ultrasound (US) findings and their possible associations with anti-citrullinated peptide antibodies in primary Sjögren's syndrome (pSS). METHODS: Ninety-seven consecutive pSS patients (American-European Consensus Group, 2002) without meeting the American College of Rheumatology (ACR) criteria (1987) for rheumatoid arthritis (RA); 20 RA patients (ACR/European League Against Rheumatism (EULAR) criteria, 2010); and 80 healthy individuals with comparable age, gender, and ethnicity were enrolled in a case-control study. Disease activity was assessed by EULAR Sjögren's Syndrome Disease Activity Index (ESSDAI). US was performed by one expert blinded to anti-CCP, anti-MCV, and IgM rheumatoid factor tested by ELISA. RESULTS: Frequencies of grade 3 synovitis (9.3 vs. 0%, p = 0.004), tenosynovitis (36.1 vs. 3.8%, p < 0.001), and erosions (27.8 vs. 7.5%, p = 0.001) on US were higher in pSS patients than in healthy controls. ESSDAI presented a moderate correlation with the synovitis number (p = 0.001) and tenosynovitis (p < 0.001). Most pSS patients with erosions on US (81.5%) had negative anti-CCP. Nevertheless, anti-CCP ≥ 3× cut-off value was associated with the presence of erosions in pSS (p = 0.026). Erosions in pSS were mainly small size contrasting with moderate/large size in RA (p < 0.001), and positive power Doppler synovitis predominated in RA (p < 0.001). CONCLUSIONS: US identified significant frequencies of grade 3 synovitis, tenosynovitis, and erosions in pSS. Synovitis and tenosynovitis numbers were correlated with ESSDAI. Association between erosions on US and anti-CCP (high titers) in pSS possibly identifies a subgroup with severe arthritis. These findings suggest that US is a useful method for assessing joint involvement in pSS.Key Points⢠US identified significant frequencies of grade 3 synovitis, tenosynovitis, and erosions in pSS patients in comparison with age- and race-healthy individuals.⢠Numbers of synovitis and tenosynovitis on US were correlated with ESSDAI values.⢠Most pSS patients with erosions on US were negative for anti-CCP, but anti-CCP ≥ 3× cut-off value was associated with the presence of erosions in this disease.⢠Erosions in pSS were mainly small size contrasting with moderate/large size in RA, and positive power Doppler synovitis predominated in RA.
Asunto(s)
Mano/diagnóstico por imagen , Síndrome de Sjögren/diagnóstico por imagen , Sinovitis/diagnóstico por imagen , Tenosinovitis/diagnóstico por imagen , Muñeca/diagnóstico por imagen , Adulto , Autoanticuerpos/inmunología , Estudios de Casos y Controles , Femenino , Mano/patología , Humanos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Análisis de Regresión , Síndrome de Sjögren/complicaciones , Síndrome de Sjögren/patología , Sinovitis/complicaciones , Sinovitis/patología , Tenosinovitis/complicaciones , Tenosinovitis/patología , Ultrasonografía Doppler , Muñeca/patologíaRESUMEN
OBJECTIVES: Radiographic manifestations of synovitis (e.g., erosions) can be observed only in the late stage of rheumatoid arthritis. Ultrasound is a noninvasive, cheap, and widely available technique that enables the evaluation of inflammatory changes in the peripheral joint. In the same way, dynamic contrast-enhanced magnetic resonance imaging (MRI) enables qualitative and quantitative measurements. The objectives of the study were to compare the sensitivity and accuracy of ultrasound in detecting subclinical synovitis and tenosynovitis with those of contrast-enhanced MRI. METHODS: The ultrasonography and contrast-enhanced MRI findings of the wrist, metacarpophalangeal, and proximal interphalangeal joints (n=450) of 75 patients with a history of joint pain and morning stiffness between 6 weeks and 2 years were reviewed. The benefits score was evaluated for each modality. RESULTS: The ultrasonic findings showed inflammation in 346 (77%) joints, while contrast-enhanced MRI found signs of early rheumatoid arthritis in 372 (83%) joints. The sensitivities of ultrasound and contrast-enhanced MRI were 0.795 and 0.855, respectively, and the accuracies were 0.769 and 0.823, respectively. Contrast-enhanced MRI had a likelihood of 0-0.83 and ultrasound had a likelihood of 0-0.77 for detecting synovitis and tenosynovitis at one time. The two imaging modalities were equally competitive for detecting synovitis and tenosynovitis (p=0.055). CONCLUSION: Ultrasound could be as sensitive and specific as contrast-enhanced MRI for the diagnosis of subclinical synovitis and tenosynovitis.
Asunto(s)
Imagen por Resonancia Magnética/métodos , Sinovitis/diagnóstico por imagen , Tenosinovitis/diagnóstico por imagen , Ultrasonografía/métodos , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Articulación de la MuñecaRESUMEN
OBJECTIVES: Radiographic manifestations of synovitis (e.g., erosions) can be observed only in the late stage of rheumatoid arthritis. Ultrasound is a noninvasive, cheap, and widely available technique that enables the evaluation of inflammatory changes in the peripheral joint. In the same way, dynamic contrast-enhanced magnetic resonance imaging (MRI) enables qualitative and quantitative measurements. The objectives of the study were to compare the sensitivity and accuracy of ultrasound in detecting subclinical synovitis and tenosynovitis with those of contrast-enhanced MRI. METHODS: The ultrasonography and contrast-enhanced MRI findings of the wrist, metacarpophalangeal, and proximal interphalangeal joints (n=450) of 75 patients with a history of joint pain and morning stiffness between 6 weeks and 2 years were reviewed. The benefits score was evaluated for each modality. RESULTS: The ultrasonic findings showed inflammation in 346 (77%) joints, while contrast-enhanced MRI found signs of early rheumatoid arthritis in 372 (83%) joints. The sensitivities of ultrasound and contrast-enhanced MRI were 0.795 and 0.855, respectively, and the accuracies were 0.769 and 0.823, respectively. Contrast-enhanced MRI had a likelihood of 0-0.83 and ultrasound had a likelihood of 0-0.77 for detecting synovitis and tenosynovitis at one time. The two imaging modalities were equally competitive for detecting synovitis and tenosynovitis (p=0.055). CONCLUSION: Ultrasound could be as sensitive and specific as contrast-enhanced MRI for the diagnosis of subclinical synovitis and tenosynovitis.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Sinovitis/diagnóstico por imagen , Tenosinovitis/diagnóstico por imagen , Imagen por Resonancia Magnética/métodos , Ultrasonografía/métodos , Articulación de la MuñecaRESUMEN
Objectives The objective of this paper is to perform an ultrasonography (US) analysis of hands and wrists in two groups of patients with systemic lupus erythematosus (SLE), with and without Jaccoud's arthropathy, matched by age and disease duration and to correlate them with levels of CXCL13 clinical features, laboratory tests and disease activity score. Methods Sixty-four patients with SLE were enrolled, 32 with and 32 without Jaccoud's arthropathy. Each patient underwent physical examination, laboratory tests (including CXCL13 by ELISA) and bilateral US. Synovial hypertrophy, tenosynovitis and erosions were evaluated according to a semiquantitative grading system with a 0-3 rating. US findings were correlated with serum levels of CXCL13, other serological parameters and disease activity index. Results Synovitis was found in 25/64 patients (39%) and tenosynovitis in 14/64 (22%). These findings were more frequent in SLE patients with Jaccoud's arthropathy, particularly tenosynovitis ( p = 0.002) and synovitis ( p = 0.01). Median serum level of CXCL13 was 20.16 pg/ml in the whole population (23.21 pg/ml in the Jaccoud's arthropathy group and 11.48 pg/ml in the group without). There was an association between the presence of disease activity and high level of CXCL13 ( p = 0.004). However, no association was found between high levels of CXCL13 and "arthritis" in SLEDAI, swollen joints on physical examination or synovitis on US. Conclusions US findings in joints of SLE patients with Jaccoud's arthropathy confirm that synovitis and tenosynovitis are common in these patients. In addition, serum level of CXCL13 is associated with disease activity in SLE but does not seem to be a biomarker for arthritis in these patients.
Asunto(s)
Quimiocina CXCL13/sangre , Articulaciones de los Dedos/diagnóstico por imagen , Artropatías/diagnóstico por imagen , Lupus Eritematoso Sistémico/sangre , Articulación Metacarpofalángica/diagnóstico por imagen , Ultrasonografía , Adulto , Biomarcadores/sangre , Ensayo de Inmunoadsorción Enzimática , Femenino , Humanos , Artropatías/sangre , Artropatías/inmunología , Lupus Eritematoso Sistémico/diagnóstico , Lupus Eritematoso Sistémico/inmunología , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Pronóstico , Factores de Riesgo , Índice de Severidad de la Enfermedad , Sinovitis/sangre , Sinovitis/diagnóstico por imagen , Sinovitis/inmunología , Tenosinovitis/sangre , Tenosinovitis/diagnóstico por imagen , Tenosinovitis/inmunologíaRESUMEN
The purpose of this series was to describe the ultrasonographic and radiographic manifestations of changes to the hands and wrists in 50 patients with chronic musculoskeletal symptoms secondary to Chikungunya fever during the 2016 outbreak that occurred in Rio de Janeiro, Brazil. Most of the plain radiographs were normal (62%). The most common ultrasonographic findings were small joint synovitis (84%), wrist synovitis (74%), finger tenosynovitis (70%), and cellulitis (50%). In most cases, power Doppler did not show an increase in synovial vascular flow. The plain radiographs showed no specific findings, whereas the ultrasound images revealed synovial compromise and neural thickening.
Asunto(s)
Celulitis (Flemón)/diagnóstico por imagen , Fiebre Chikungunya/complicaciones , Fiebre Chikungunya/diagnóstico por imagen , Mano/diagnóstico por imagen , Tenosinovitis/diagnóstico por imagen , Brasil , Celulitis (Flemón)/etiología , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Tenosinovitis/etiología , Muñeca/diagnóstico por imagenRESUMEN
Diagnosis of synovitis/tenosynovitis by physical examination can be difficult. Ultrasound (US) can be an effective tool for the evaluation of joint involvement in systemic lupus erythematosus (SLE). This study will describe musculoskeletal findings by US in SLE patients and the evaluation of their correlation with physical examination. SLE patients underwent clinical/sonographic evaluation of hand/wrists. In total, 896 joints were evaluated: at least 1 change on physical examination was found in 136 joints and at least 1 US abnormality was found in 65 of 896 joints. Out of the 65 joints with US changes, only 13 had findings on physical examination. Conversely, 111 joints had tenderness on physical examination with no sonographic abnormalities. Tenosynovitis was statistically significant more frequently with joint edema (41%) (p = 0.0003). US can detect musculoskeletal changes in only a minority of symptomatic SLE patients. Clinical findings may be related to some reasons that cannot be explained using US.
Asunto(s)
Mano/diagnóstico por imagen , Lupus Eritematoso Sistémico/complicaciones , Examen Físico , Sinovitis/diagnóstico por imagen , Tenosinovitis/diagnóstico por imagen , Ultrasonografía/métodos , Adulto , Brasil , Estudios Transversales , Femenino , Humanos , Masculino , Sinovitis/complicaciones , Tenosinovitis/complicaciones , Muñeca/diagnóstico por imagenRESUMEN
The aim of this study is to investigate the prevalence of subclinical ankle involvement by ultrasound in patients with rheumatoid arthritis (RA). The study was conducted on 216 patients with RA and 200 healthy sex- and age-matched controls. Patients with no history or clinical evidence of ankle involvement underwent US examination. For each ankle, tibio-talar (TT) joint, tibialis anterior (TA) tendon, extensor halux (EH) and extensor common (EC) tendons, tibialis posterior (TP) tendon, flexor common (FC) tendon and flexor hallux (FH) tendon, peroneous brevis (PB) and longus (PL) tendons, Achilles tendon (AT) and plantar fascia (PF) were assessed. The following abnormalities were recorded: synovitis, tenosynovitis, bursitis, enthesopathy and rupture. BMI, DAS28, RF ESR and CRP were also obtained. A total of 432 ankles of patients with RA and 400 ankles of healthy controls were assessed. In 188 (87%) patients with RA, US showed ankle abnormalities whereas, in control group, US found abnormalities in 57 (28.5 %) subjects (p = 0.01). The most frequent US abnormality in RA patients was TP tenosynovits (69/216) (31.9 %), followed by PL tenosynovitis (58/216) (26.9 %), TT synovitis (54/216) (25 %), PB tenosynovitis (51/216) (23.6 %), AT enthesopathy (41/216) (19 %) and AT bursitis (22/216) (10.2 %). In 118 RA patients out of 216 (54.6%), a positive PD was found. No statistically significant correlation was found between the US findings and age, disease duration, BMI, DAS28, RF, ESR and CRP. The present study provides evidence of the higher prevalence of subclinical ankle involvement in RA patients than in age- and gender-matched healthy controls identified by US.
Asunto(s)
Articulación del Tobillo/diagnóstico por imagen , Artritis Reumatoide/diagnóstico por imagen , Bursitis/diagnóstico por imagen , Sinovitis/diagnóstico por imagen , Tenosinovitis/diagnóstico por imagen , Adulto , Artritis Reumatoide/epidemiología , Bursitis/epidemiología , Comorbilidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Sinovitis/epidemiología , Tenosinovitis/epidemiología , UltrasonografíaRESUMEN
OBJECTIVES: The aim of this systematic review is to describe the scientific evidence regarding sonographic findings of joints in SLE patients. METHODS: Seven databases were searched (PubMed, ScienceDirect, Scopus, Cochrane, EMBASE, LILACS, and SciELO) for articles from 1950 to January 2015. The keywords used for selecting articles include "lupus", "ultrasound imaging", "ultrasonography", "synovitis", "tenosynovitis", and "arthritis". RESULTS: A total of 12 articles were included in the final analysis. In total, 610 SLE patients and 1,091 joints were studied. Most patients underwent bilateral joint examination by US. A total of 888 hands and wrists, 154 ankles/feet, and 56 knees were examined. Effusion was identified in 602 joints, synovitis in 213, tenosynovitis in 210, synovial hypertrophy in 150, and bone erosions in 73 cases. The majority of the studies demonstrated higher frequency of musculoskeletal abnormalities on US than those observed on physical examination. CONCLUSION: US seems to be a valuable tool to identify subclinical joint manifestations in SLE. Prospective studies are necessary to determine if those patients with subclinical joint abnormalities have a higher risk for the development of chronic deformities as those seen in Jaccoud's Arthropathy. KEY POINTS: ⢠Musculoskeletal involvement occurs in more than 90% of SLE cases. ⢠Arthralgia or tender/swollen joints found on physical examination showed more US findings. ⢠Patients without joint symptoms or physical examinations changes showed musculoskeletal sonographic findings. ⢠US became a useful tool for rheumatologists. ⢠A substantial number of asymptomatic patients show abnormalities at musculoskeletal US.