The Role of Contrast-Enhanced Ultrasonography in Early Rheumatoid Arthritis

The diagnosis of rheumatoid arthritis (RA) is, most often, challenging, due to the variety of clinical features and to the absence of gold standard tests for diagnosing this disease. Early diagnosis as well as the identification of poor prognostic markers will lead to an early, appropriate treatment that will prevent the evolution towards a severe disease, offering the chance for a complete remission. Ultrasonography (US), used as an extension of clinical examination, helps in the early classification of the disease. Power Doppler is important for quantification of synovial inflammation, both at diagnosis and during therapy monitoring, but has limits in detecting blood flow in small vessels. Ultrasound contrast-agents improve visualization of vascularity and allow a better characterization and quantification of synovial pannus inflammation. We aim to discuss the role of contrast-enhanced ultrasonography (CEUS) in the diagnosis and follow-up of early RA.