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Article: Periosteal Manifestations of Osteomyelitis and Arthritis on Ultrasound: A Systematic Review.

Waitayangkoon, Palapun / Weilg-Espejo, Pablo / Kissin, Eugene Y

Journal of medical ultrasound

2023 Volume 32, Issue 1, Page(s) 25–31

Abstract: Ultrasound (US) can visualize the periosteal changes in the early stage compared to radiography. In this review, we studied periosteal manifestations on US and assessed their diagnostic utility for osteomyelitis (OM) and arthritis. We included articles ... ...

Abstract	Ultrasound (US) can visualize the periosteal changes in the early stage compared to radiography. In this review, we studied periosteal manifestations on US and assessed their diagnostic utility for osteomyelitis (OM) and arthritis. We included articles that studied ultrasonographic findings of periosteal changes in OM and arthropathies with aims to systematically review periosteal manifestations of each condition and summarize diagnostic values of each finding. A total of 13 articles were included in the systematic review. Of these, 10 articles are on OM, 3 articles are on psoriatic arthritis (PsA), 1 article is on rheumatoid arthritis (RA), and 1 article is on gouty arthritis (GA). In OM, subperiosteal fluid/subperiosteal collection (SF/SC) was detected in 32%-76% within 72 h after presentation. Periosteal reaction (PR) was seen after day 4 and the sensitivity on US ranges from 33% to 100%. In PsA, PR was seen near 16%-59% in active PsA joints. Periosteal changes are rarely detected in RA joints. Small hyperechoic spots were seen in 87.5% of GA. SF/SC may be seen on US as the earliest sign followed by PR for OM. PR is more specific in PsA than RA. Further investigations on periosteal abnormalities on US are warranted to confirm our findings.
Language	English
Publishing date	2023-09-02
Publishing country	India
Document type	Journal Article ; Review
ISSN	0929-6441
ISSN	0929-6441
DOI	10.4103/jmu.jmu_16_23
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Article: Scruples over Speckles.

Persons, Benjamin / Kissin, Eugene Y

Journal of medical ultrasound

2020 Volume 28, Issue 3, Page(s) 179–180

Abstract: The "snowstorm" sign refers to the ultrasound appearance of motile hyperechoic specks within synovial fluid and has been reported to have a high specificity for gout. We describe three additional etiologies commonly encountered in the rheumatology clinic ...

Abstract	The "snowstorm" sign refers to the ultrasound appearance of motile hyperechoic specks within synovial fluid and has been reported to have a high specificity for gout. We describe three additional etiologies commonly encountered in the rheumatology clinic that can produce a snowstorm: calcium pyrophosphate deposition disease, fibrin collections/rice bodies, and gas bubbles in viscous synovial fluid.
Language	English
Publishing date	2020-05-25
Publishing country	India
Document type	Journal Article
ISSN	0929-6441
ISSN	0929-6441
DOI	10.4103/JMU.JMU_122_19
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Article: Ultrasound evaluation of the Achilles enthesis in inflammatory and non-inflammatory processes: a systematic review and meta-analysis.

Desai, Nancy / Baker, Joshua F / Bucci, Justin / Kissin, Eugene Y

Clinical and experimental rheumatology

2022 Volume 41, Issue 1, Page(s) 24–31

Abstract: Objectives: Ultrasound evaluation of the Achilles tendon has been utilised to assess involvement at the entheses in the setting of various inflammatory, metabolic, and mechanical processes. The purpose of this systematic review was to evaluate the ... ...

Abstract	Objectives: Ultrasound evaluation of the Achilles tendon has been utilised to assess involvement at the entheses in the setting of various inflammatory, metabolic, and mechanical processes. The purpose of this systematic review was to evaluate the differences in ultrasound findings at the Achilles enthesis between inflammatory tendinopathy (IT) versus non-inflammatory tendinopathy (NIT). Methods: A review of all studies involving ultrasound evaluation of IT or NIT (mechanical or metabolic) affecting the Achilles enthesis was performed by searching the Embase, PubMed and Medline databases from start until October 2020. We assessed study quality and extracted summary data from each individual study. We used random-effects meta-analysis to determine the average proportion of affected anatomic sites across all studies for each abnormality, weighting the analysis based on the size of each individual study. Results: Achilles enthesis thickening was more frequent in the symptomatic IT (sIT) group (37.8%) compared to the unspecified IT (25%), NIT (11.2%) and healthy control (2.7%) groups. Increased vascularity at the enthesis was more common in the NIT (23.4%) group compared to the IT (9%), sIT (8.6%) and healthy control (0.1%) groups. Erosions were more common among the IT (17.3%) and sIT (14%) groups compared to the NIT (2.2%) and healthy controls (0.3%) groups. Conclusions: While Achilles enthesis thickening, Doppler signal and calcaneal erosions discriminate IT from healthy subjects, erosions are more likely to distinguish IT from NIT than thickening or Doppler signal. Additional study is needed to quantify the diagnostic performance of ultrasound at this location given the frequency of abnormalities in NIT.
MeSH term(s)	Humans ; Achilles Tendon/diagnostic imaging ; Ultrasonography ; Ultrasonography, Doppler ; Tendinopathy
Language	English
Publishing date	2022-03-01
Publishing country	Italy
Document type	Meta-Analysis ; Systematic Review ; Journal Article
ZDB-ID	605886-3
ISSN	1593-098X ; 0392-856X
ISSN (online)	1593-098X
ISSN	0392-856X
DOI	10.55563/clinexprheumatol/6vg24c
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Article ; Online: Sonographic Features of Salivary Glands in Sjögren's Syndrome and its Mimics.

James-Goulbourne, Tracian / Murugesan, Vagishwari / Kissin, Eugene Y

Current rheumatology reports

2020 Volume 22, Issue 8, Page(s) 36

Abstract: Purpose of review: For 30 years, ultrasound has been investigated as a means to evaluate salivary gland abnormalities in patients with autoimmune disease. We aim to review the test characteristics of ultrasound for diagnosing Sjögren's syndrome, the ... ...

Abstract	Purpose of review: For 30 years, ultrasound has been investigated as a means to evaluate salivary gland abnormalities in patients with autoimmune disease. We aim to review the test characteristics of ultrasound for diagnosing Sjögren's syndrome, the scoring systems used for this purpose, and the ultrasound similarities and differences between Sjögren's syndrome and some of its potential salivary gland mimics. Recent findings: Hypo/anechoic glandular lesions are the major ultrasound characteristic found in Sjögren's syndrome. Most studies have reported such ultrasound abnormalities to have a sensitivity and specificity in the range of 65-85% and 85-95%, respectively, as well as a positive likelihood ratio between 4 and 12. However, similar findings can also be seen in sarcoidosis, amyloidosis, IgG4-related disease, HIV, and lymphoma. A "nodal" pattern of involvement or the ultrasound artifact of "through transmission" can help distinguish some of these mimics from Sjogren's syndrome. Ultrasound can substantially influence the diagnosis of Sjögren's syndrome.
MeSH term(s)	Diagnosis, Differential ; Humans ; Salivary Glands/diagnostic imaging ; Salivary Glands/pathology ; Sensitivity and Specificity ; Sjogren's Syndrome/diagnostic imaging ; Ultrasonography
Language	English
Publishing date	2020-06-19
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2057357-1
ISSN	1534-6307 ; 1523-3774
ISSN (online)	1534-6307
ISSN	1523-3774
DOI	10.1007/s11926-020-00914-7
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Article ; Online: The "dirty little secret" exposed in the 2013 EULAR recommendations for rheumatoid arthritis therapy.

Kissin, Eugene Y

Clinical therapeutics

2014 Volume 36, Issue 7, Page(s) 1114–1116

Abstract: The European League Against Rheumatism (EULAR) recently updated its recommendations on the management of rheumatoid arthritis (RA) with synthetic and disease-modifying antirheumatic drugs (DMARDs), motivated by the availability of new treatment options ... ...

Abstract	The European League Against Rheumatism (EULAR) recently updated its recommendations on the management of rheumatoid arthritis (RA) with synthetic and disease-modifying antirheumatic drugs (DMARDs), motivated by the availability of new treatment options over the past 3 or 4 years. Modifications since 2010 include the removal of the recommendation of the use of azathioprine, cyclosporine A, or cyclophosphamide for the treatment of RA. Furthermore, there is no longer an expressed preference for tumor necrosis factor inhibitors, including the approved biosimilar tumor necrosis factor inhibitors, over abatacept (a co-stimulatory blocker), tocilizumab (an interleukin-6 inhibitor), or rituximab (a B-cell antibody) when conventional DMARDs are not sufficiently effective. However, the use of tofacitinib (a Janus-associated kinase inhibitor) should come after initial biologic treatment has failed, due to uncertainty about the long-term safety and cost considerations of tofacitinib in comparison to biologic DMARDs. It was recommended that DMARD-naive patients be treated with either conventional DMARD monotherapy or DMARD combination therapy up front, and that low-dose glucocorticoids "should be considered" as a part of the initial treatment strategy, with glucocorticoids tapered within 6 months. Because glucocorticoids have been reported to retard joint damage and have been associated with negligible adverse events at low doses, perhaps the 2013 EULAR recommendation did not go far enough in its support of low-dose glucocorticoid use. Almost 60 years have passed since the initial discovery of glucocorticoid efficacy in the treatment of RA, and despite the flurry of new and exciting medications for the treatment of RA, we still have not come to a consensus on how the first effective, and now the least expensive, RA therapy should be used.
MeSH term(s)	Antirheumatic Agents/therapeutic use ; Arthritis, Rheumatoid/drug therapy ; Biological Products/therapeutic use ; Europe ; Glucocorticoids/economics ; Glucocorticoids/therapeutic use ; Humans ; Practice Guidelines as Topic
Chemical Substances	Antirheumatic Agents ; Biological Products ; Glucocorticoids
Language	English
Publishing date	2014-07-01
Publishing country	United States
Document type	Journal Article
ZDB-ID	603113-4
ISSN	1879-114X ; 0149-2918
ISSN (online)	1879-114X
ISSN	0149-2918
DOI	10.1016/j.clinthera.2014.06.012
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Article ; Online: Editorial: The Sound and the Fury: Musculoskeletal Ultrasound in the Diagnosis of Gout.

Kissin, Eugene Y / Pillinger, Michael H

Arthritis & rheumatology (Hoboken, N.J.)

2016 Volume 69, Issue 2, Page(s) 249–252

MeSH term(s)	Gout ; Humans ; Ultrasonography ; Uric Acid
Chemical Substances	Uric Acid (268B43MJ25)
Language	English
Publishing date	2016-10-13
Publishing country	United States
Document type	Editorial ; Research Support, N.I.H., Extramural ; Comment
ZDB-ID	2756371-6
ISSN	2326-5205 ; 2326-5191
ISSN (online)	2326-5205
ISSN	2326-5191
DOI	10.1002/art.39958
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Article ; Online: Modern Landscapes and Strategies for Learning Ultrasound in Rheumatology.

Widener, Benjamin B / Cannella, Amy / Martirossian, Linett / Kissin, Eugene Y

Rheumatic diseases clinics of North America

2019 Volume 46, Issue 1, Page(s) 61–71

Abstract: Ultrasound in rheumatology is gaining increasing acceptance in the field, with its use expanding beyond the musculoskeletal system to image rheumatic disease pathology of the vasculature, salivary glands, and lungs. Fellows in training and practicing ... ...

Abstract	Ultrasound in rheumatology is gaining increasing acceptance in the field, with its use expanding beyond the musculoskeletal system to image rheumatic disease pathology of the vasculature, salivary glands, and lungs. Fellows in training and practicing clinicians are seeking ways to attain training and competency assessment. These standards are evolving, but no uniform mechanism for training exists. Although clinicians in practice find a wide array of resources available for self-directed education in ultrasound in rheumatology, a consensus-based and publicly available training curriculum can further enhance and standardize learning. This article discusses ultrasound in rheumatology education opportunities, competency assessment, and certification pathways.
MeSH term(s)	Certification ; Clinical Competence/standards ; Education, Medical, Graduate/methods ; Education, Medical, Graduate/standards ; Educational Measurement/standards ; Humans ; Musculoskeletal Diseases/diagnostic imaging ; Point-of-Care Testing/standards ; Rheumatic Diseases/diagnostic imaging ; Rheumatology/education ; Rheumatology/standards ; Ultrasonography/standards
Language	English
Publishing date	2019-11-20
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	92118-x
ISSN	1558-3163 ; 0889-857X
ISSN (online)	1558-3163
ISSN	0889-857X
DOI	10.1016/j.rdc.2019.09.002
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Article: A Vascular Obstacle in Ultrasound-Guided Hip Joint Injection.

Zhang, MaryAnn / Pessina, Monica A / Higgs, Jay B / Kissin, Eugene Y

Journal of medical ultrasound

2018 Volume 26, Issue 2, Page(s) 77–80

Abstract: Background: We evaluated the risk of lateral circumflex femoral artery (LCFA) injury during ultrasound-guided intra-articular hip injections.: Methods: This study was divided into three parts. (1) Four ultrasound-guided hip injections were performed ... ...

Abstract	Background: We evaluated the risk of lateral circumflex femoral artery (LCFA) injury during ultrasound-guided intra-articular hip injections. Methods: This study was divided into three parts. (1) Four ultrasound-guided hip injections were performed on human cadavers. With needles in place, tissues were dissected to expose the LCFA. (2) Ultrasound-trained rheumatologists marked a planned needle trajectory from skin to hip joint on live human ultrasound images during an Observed Structured Clinical Examination (OSCE). Doppler was subsequently activated to locate the LCFA, and the distance between trajectory and arterial signal was recorded. (3) Rheumatologists certified in musculoskeletal ultrasound were surveyed about joint injection vascular complications. Results: (1) In one of the four cadaveric dissections, the needle made direct contact with the LCFA. (2) Of 27 OSCE participants, only two activated Doppler before marking simulated hip injection trajectories. Trajectories passed through LCFA Doppler signal in six (22%) cases. Mean minimal distance from trajectory to arterial signal was 4 mm (range, 0-11 mm). (3) Of 62 survey respondents, 24% stated that they did not use Doppler routinely. While none reported bleeding injuries with their patients, 16% knew of a hip injection-related vascular complication performed by another provider. Conclusion: There is a risk of LCFA injury during ultrasound-guided hip joint injection. Routine use of Doppler should be considered in standard hip injection protocols.
Language	English
Publishing date	2018-06-12
Publishing country	India
Document type	Journal Article
ISSN	0929-6441
ISSN	0929-6441
DOI	10.4103/JMU.JMU_8_17
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Article ; Online: Comparison of Ultrasound Features of Major Salivary Glands in Sarcoidosis, Amyloidosis, and Sjögren's Syndrome.

Law, Shing T / Jafarzadeh, S Reza / Govender, Praveen / Sun, Xianbang / Sanchorawala, Vaishali / Kissin, Eugene Y

Arthritis care & research

2019 Volume 72, Issue 10, Page(s) 1466–1473

Abstract: Objective: While salivary gland ultrasound (SGU) has gained prominence for evaluating Sjögren's syndrome, little information exists on SGU appearance of sarcoidosis and amyloidosis, potential mimics of Sjögren's syndrome. Our goal in this study was to ... ...

Abstract	Objective: While salivary gland ultrasound (SGU) has gained prominence for evaluating Sjögren's syndrome, little information exists on SGU appearance of sarcoidosis and amyloidosis, potential mimics of Sjögren's syndrome. Our goal in this study was to estimate the diagnostic accuracy of major SGU features in differentiating Sjögren's syndrome from sarcoidosis, amyloidosis, and controls. Methods: We enrolled consecutive adult ambulatory patients with a clinical diagnosis of Sjögren's syndrome fulfilling the 2016 American College of Rheumatology (ACR) classification criteria; we also enrolled patients with a clinical diagnosis of sarcoidosis or systemic immunoglobulin light chain (AL) amyloidosis, with histologic confirmation from any tissue, and rheumatology outpatients without diagnoses affecting salivary glands. Subjects underwent major SGU using the Hočevar protocol, with resulting video clips reviewed blind to clinical diagnosis. Results: Sjögren's syndrome SGU scores were greater than in patients from the other groups, but there were no distinguishing salivary gland features from AL amyloidosis or sarcoidosis. None of the patients in the control group scored higher than 17, a cutoff previously suggested for Sjögren's syndrome, but 27% of patients with AL amyloidosis and 19% with sarcoidosis scored higher than 17. Adding Hočevar SGU scores of ≥17 to the 2016 ACR/European League Against Rheumatism criteria in a parallel scheme increased the sensitivity for Sjögren's syndrome from 87% to 98%, while combining the 2 criteria in series increased specificity from 81% to 98%. Conclusion: Sjögren's syndrome, sarcoidosis, and AL amyloidosis share common SGU features that can help distinguish these conditions from patients without systemic rheumatologic disease. Clinicians should carefully consider these potential mimics when interpreting salivary gland US results.
MeSH term(s)	Aged ; Amyloidosis/diagnostic imaging ; Case-Control Studies ; Diagnosis, Differential ; Female ; Humans ; Male ; Middle Aged ; Salivary Glands/diagnostic imaging ; Sarcoidosis/diagnostic imaging ; Sjogren's Syndrome/diagnostic imaging ; Ultrasonography
Language	English
Publishing date	2019-07-13
Publishing country	United States
Document type	Comparative Study ; Journal Article
ZDB-ID	645059-3
ISSN	2151-4658 ; 0893-7524 ; 2151-464X
ISSN (online)	2151-4658
ISSN	0893-7524 ; 2151-464X
DOI	10.1002/acr.24029
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Article ; Online: North American musculoskeletal ultrasound scanning protocol of the shoulder, elbow, wrist, and hand: update of a Delphi Consensus Study.

Bethina, Narandra K / Torralba, Karina D / Choi, Kristal S / Fairchild, Robert M / Cannella, Amy C / Salto, Lorena / Kissin, Eugene Y / Yinh, Janeth / Aggarwal, Manushi / Thiele, Ralf / Nishio, Midori J

Clinical rheumatology

2022 Volume 41, Issue 12, Page(s) 3825–3835

Abstract: Introduction/objectives: There has been an increase in the proficiency and utilization of ultrasound among North American rheumatologists over the past decade. This study aims to create an updated upper extremity scanning protocol to inform ultrasound ... ...

Abstract	Introduction/objectives: There has been an increase in the proficiency and utilization of ultrasound among North American rheumatologists over the past decade. This study aims to create an updated upper extremity scanning protocol to inform ultrasound curriculum development for the American College of Rheumatology affiliated fellowship programs and guide clinical practice patterns in North America. Method: Three Delphi survey rounds were used to reach consensus on tiered-mastery designations for scan views of the shoulder, elbow, wrist, and hand joints. The survey was disseminated by Qualtrics™ to 101 potential participants with ultrasound experience. High agreement was defined as having ≥ 85% consensus and final tier designation as > 50% agreement for a preferred tier. Changes in responses were evaluated by McNemar's chi-square test. Results: Consensus was achieved for 70% of scan views of the upper extremity joints. Two views-ulnar transverse view of the wrist and the radial/ulnar orthogonal views over metacarpophalangeal joints 2 and 5 of the hand-were upgraded from tier 2 to tier 1. The suprascapular transverse and the axillary longitudinal views of the shoulder were downgraded from tier 2 to tier 3. A new anterior transverse view of the elbow was added to the protocol with tier 1 designation. Conclusions: This study reflects the current opinions of North American rheumatologists for scanning upper extremity joints and provides support for the updated protocol and guidance for educators in rheumatology ultrasound. Key Points • Ultrasound scan views of the metacarpophalangeal, wrist, elbow, and glenohumeral joint recesses and views of the biceps and rotator cuff tendons at the shoulder were perceived as essential views of the upper extremity scanning protocol for rheumatologists to master and perform routinely. • A targeted scanning approach of the upper extremity joints may be considered when focal symptoms are present. • The North American Musculoskeletal Ultrasound Scanning Protocol shares some similarities with existing musculoskeletal ultrasound protocols of other specialties and worldwide rheumatology societies but varies in the extent of examination and emphasis on certain specialty-specific focuses.
MeSH term(s)	Humans ; Elbow ; Shoulder ; Wrist ; Delphi Technique ; Upper Extremity ; Shoulder Joint
Language	English
Publishing date	2022-08-26
Publishing country	Germany
Document type	Journal Article
ZDB-ID	604755-5
ISSN	1434-9949 ; 0770-3198
ISSN (online)	1434-9949
ISSN	0770-3198
DOI	10.1007/s10067-022-06337-2
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