Integrating point of care ultrasound into rheumatology practice.

A scenario-based probability approach integrating point of care rheumatology ultrasound (POCRUS) into rheumatology practice has recently been proposed as a teaching methodology to encourage greater awareness of US for practicing clinicians especially with respect to the management of overlapping clinical conditions. This article reviews the rheumatological areas where application of POCRUS substantially enhances clinical reasoning to confirm or exclude target conditions. It highlights the definitions of ultrasound-detected pathologies in rheumatoid arthritis (RA), spondylarthritis, gout and crystal arthritis, osteoarthritis, polymyalgia rheumatica and discusses the added value of POCRUS in diagnosing these conditions. It summarizes advances in predicting giant cell arteritis with sequential application of a probability score and ultrasonography. It discusses the potential for salivary gland ultrasound in the diagnostic workup of suspected Sjogren's syndrome. Other areas for POCRUS application such as in suspected nerve entrapment are reviewed.