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Musculoskeletal ultrasound and ESPER

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ÓRgÃO OfICIAL DA SOCIEDADE PORTUgUESA DE REUMATOLOgIA

285 EDITORIAL

ACTA REUMATOL PORT. 2016;41:285-286

Musculoskeletal ultrasound and ESPER

Saraiva F1

goes far beyond the joint territory, affirming itself also in the diagnosis and follow up of patients with Sjögren s syndrome (salivary glands ultrasound), scleroderma (skin and lungs ultrasound) and vasculitis (vessels).

ESPER goals are education in MSUS, fomenting the practice and research in this field, and contribute to MSUS certification.

ESPER has promoted three internal courses to teach its teachers, inviting international recognized specia -lists - A. Iagnocco, C. Martinoli, E. de Miguel, I. Moller, C. Moragues, E. Naredo – and three inter and in -traobser ver actions. Aiming the education of residents and senior rheumatologists in MSUS, ESPER has per-formed four basic courses, two intermediate courses, two basic and two advanced workshops and three monothematic courses (hand/wrist, ankle/foot and shoulder), which were theoretical-practical courses, elaborated according to EULAR recommendations.

From the eleven teachers founders of ESPER, three left earlier – Pedro Gonçalves, Graça Sequeira, Mar-garida Cruz – and four ended their functions in last October – Guilherme de Figueiredo, Mónica Bogas, Paulo Monteiro and Sandra Falcão. Margarida Oliveira, ESPER coordinator from the beginning also ended those functions. We wish to express our appreciation for the dedication, competence and strength they all lent to this project. Besides the author, Margarida Oliveira, Margarida Silva and Ricardo Figueira, conti -nue to be part of ESPER and we will have now five new teachers – Dina Medeiros, Filipa Teixeira, Inês Silva, João Dias and Miguel Sousa – whom we welcome.

MSUS is devoid of adverse events or contraindica-tions and is a low cost, accessible and portable method. It is not invasive, it is easily repeated and it is well tole -rated and accepted by patients. It has a short execution time, which facilitates a multi-regional evaluation, it has a high spatial resolution and it allows dynamic stu -dies and real time examinations, as well as ultrasound guided procedures.

Ultrasound detects subclinical synovitis and entesi-tis, being most useful in early diagnosis and in moni-In the early 70’s ultrasonography was already

com-monly used by several medical specialties. It wasn’t the case for rheumatology. In fact, even the seminal publi-cations concerning the use of musculoskeletal ultra-sound (MSUS) that emerged then were led by radiolo-gists and were limited to the assessment of large joints. In the 90’s, with a new generation of high frequency probes and with the advent of Doppler ultrasound, there was a dramatic improvement in the method’s re -solution and in the evaluation of inflammatory activi-ty, widening horizons, unsuspected until then. Conse-quently, a growing amount of publications on MSUS emerged, concerning multiple pathologies, both in joints and in soft tissues, in adults and in children, and in ultrasound guided procedures.

In 1994, at the rheumatology department of Hospi-tal de Santa Maria, the first MSUS assessments were just starting. However, those examinations were still very conditioned by the available technology. Meanwhile, the accumulated experience allowed the elaboration of five courses on MSUS, between 2004 and 2008, orga-nized by portuguese rheumatologists (Fernando Sarai-va, Manuela Costa, Margarida Silva and Margarida Cruz), for further dissemination of the method among senior rheumatologists and residents, under the pa-tronage of the Portuguese Society of Rheumatology (PSR).

In 2009 the musculoskeletal ultrasound school of the PSR (ESPER) was founded, after Margarida Oliveira’s proposition to the PSR board, whose chair-man at the time was Rui André Santos. ESPER creation was the result of the awareness of the importance of MSUS, sometimes referred to as the rheumatologist’s stethoscope, on our daily clinical practice, both in its diagnostic and therapeutic dimensions, in monitoring treatment response, particularly in inflammatory rheumatic diseases and in biotechnological era, given the significant sensitivity to change evidenced by this method. Ultrasonography in rheumatology nowadays

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ÓRgÃO OfICIAL DA SOCIEDADE PORTUgUESA DE REUMATOLOgIA

286 editorial

toring disease activity and outcome. In fact the avai -lable instruments to identify disease remission are in-exact, since inflammation is frequently found by ul-trasound in joints thought to be in clinical remission. Furthermore, Doppler signal is associated with an in-creased risk of structural lesion.

Ultrasonography is more sensitive than X-Ray in identifying osteophytes, erosions and crystals in carti-lage and fibrocarticarti-lage, and ultrasound guided proce-dures are more accurate and better tolerated and ac-cepted by patients, providing superior results than non-guided techniques.

In a time of emerging technology such as tridimsional ultrasonography, elastography and contrast en-hanced ultrasound, in which a formal training in MSUS is provided within EULAR and ACR courses and where several national rheumatology societies already

include MSUS in the skills required for their residents, efforts are being made to respond to the main chal-lenges that face the technique – suppress standardiza-tion gaps through the elaborastandardiza-tion of pathological change definitions, validation of systems of quantifi-cation of main elementary lesions, distinction between normal activity and minimal pathological changes and validation of an appropriate number of joints or ente-sis to be scanned, according to the exam’s purpose, diag nostic or follow-up.

CorrespondenCe to

Fernando Saraiva ESPER coordinator

CHLN – Hospital de Santa Maria Av. Prof Egas Moniz

1649-035 Lisbon

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