US-guided interventional joint procedures in patients with rheumatic diseases--when and how we do it?
OBJECTIVE
To describe the main indications and the technical steps to perform ultrasound guided procedures in patients with rheumatic diseases. To access procedures accuracy, safety and effectiveness.


METHODS
27 patients with pain related to articular complications of rheumatic diseases and according to previous radiographic or US exam were submitted to several US-guided procedures. 42% of patients (n=11) had rheumatoid arthritis, 11% (n=3) spondyloarthropathies, 18% (n=5) psoriatic arthritis, 15% (n=4) undifferentiated arthritis, 3% (n=1) Sjögren syndrome and 11% (n=3) had gout. Described procedures are synovial biopsies, intra-articular injections of corticosteroids, radiation synovectomy and synovial cysts drainage procedures. When a therapeutical procedure was made, patients were evaluated by 2 rheumatologists. Corticosteroids used were Prednisolone and Triamcinolone. Yttrium-90 was used for synovectomy.


RESULTS
In all cases success was achieved with correct needle placement inside the joint. After injection/aspiration symptoms successfully solved with all patients improving their health status. No complications were recorded during follow-up period.


CONCLUSIONS
US-guidance is very reliable to afford a safety procedure always checking the injection, biopsy or aspiration. Guided-biopsy has high success rates obtaining several samples. Thus is also possible to use more powerful/long acting therapeutic drugs aggressive to extra-articular structures avoiding complications.
Gonçalves
B
B
Department of Radiology, Hospitais da Universidade de Coimbra - HUC, Coimbra, Portugal. belarmino.goncalves@gmail.com
Ambrosio
C
C
Serra
S
S
Alves
F
F
Gil-Agostinho
A
A
Caseiro-Alves
F
F
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D001706:Biopsy; D004322:Drainage; D005260:Female; D006801:Humans; D007270:Injections, Intra-Articular / Q000379:methods; D008297:Male; D012216:Rheumatic Diseases / Q000628:therapy*; D000074402:Synovectomy; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional; D015021:Yttrium Radioisotopes / Q000627:therapeutic use
D000305:Adrenal Cortex Hormones; D015021:Yttrium Radioisotopes