US-guided interventional joint procedures in patients with rheumatic diseases--when and how we do it?

Eur J Radiol. 2011 Sep;79(3):407-14. doi: 10.1016/j.ejrad.2010.04.001. Epub 2010 Jun 4.


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.

Materials and 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.

MeSH terms

  • Adrenal Cortex Hormones / therapeutic use
  • Biopsy
  • Drainage
  • Female
  • Humans
  • Injections, Intra-Articular / methods
  • Male
  • Rheumatic Diseases / therapy*
  • Synovectomy
  • Treatment Outcome
  • Ultrasonography, Interventional*
  • Yttrium Radioisotopes / therapeutic use


  • Adrenal Cortex Hormones
  • Yttrium Radioisotopes