Controversies in rheumatology: ultrasound for monitoring of RA-do we need it?

Clinical joint examination is the cornerstone for evaluation of patients with RA. However, since large discrepancies have been shown even between experienced rheumatologists in evaluation of joint inflammation, and tender joints may have limited value in reflecting inflammation, US has in recent decades been introduced in the clinical assessments of RA patients. US has high accordance with other imaging modalities and enables detection of clinically difficult pathologies and contributes to assessments of joints difficult to evaluate clinically. However, there is no general agreement on the optimal use of US in rheumatology, and the prevalence of machines as well as the level of experience differs greatly between countries. In addition, standardized use of US in treat-to-target follow-up of RA patients was found not to have any added value. Thus, how to use US in monitoring of RA patients is open for debate. The present article will discuss the pros and cons for using US in the clinical setting.