Editor’s Pick: Why Point of Care Ultrasound Is More than the Modern Rheumatologist’s Stethoscope

Point of care ultrasound (POCUS) imaging is a valuable tool in assisting clinicians to assess and manage patients in the acute and elective care environment. In modern rheumatology practice, POCUS has been increasingly used due to its effective role in identifying signs of acute inflammation, particularly with the use of power Doppler signals. There is growing evidence to support the utility of ultrasound (US) in the early and accurate diagnosis of inflammatory arthritis. This can prompt early initiation or escalation of disease-modifying treatment. It can also help to explain non-response to ongoing treatment and rule out other causes of joint symptoms. The role of US in diagnosing giant cell arteritis, particularly with the ‘halo sign’, is well-recognised as the first-line investigation modality due its non-invasive and quick-access features in comparison to temporal artery biopsy. US can also enhance the precision of intra-articular steroid injections. Acknowledging that there can be discrepancies in the use of US in real-life clinical practice, due to reliance on operator dependence and interpretation of findings, the Outcome Measures in Rheumatology (OMERACT) Ultrasound Working Group have agreed on standardised definitions and scoring symptoms for pathophysiological manifestations in rheumatic diseases. Further research is needed to improve understanding of the predictive role of US assessment in treat-to-target strategies and in the follow-up of patients, particularly in psoriatic arthritis. It is the authors’ hope that modern rheumatologists will increasingly integrate POCUS as a complementary diagnostic and interventional tool in clinical practice to improve patient outcomes.