Musculoskeletal ultrasound for rheumatic diseases in low-resource settings: Current challenges and mitigating strategies

Musculoskeletal ultrasound (MSK-US) has been widely incorporated by clinical rheumatologists since its first description in inflammatory arthropathies in the late 1970s. Yet, the percentage of rheumatologists performing MSK-US remains low. Nevertheless, evidence shows it to be superior to clinical examination, comparable to MRI in many conditions, and far less expensive. Its convenience and ability to assess multiple joints make MSK-US particularly valuable in low-resource environments. Point-of-care US also reduces referrals and overall healthcare expenditure. In this narrative review, we aim to delineate current evidence of the role of MSK-US in the diagnosis and management of rheumatic diseases, with particular emphasis on its clinical utility, barriers to implementation, and potential strategies to overcome these challenges in resource-limited settings.