Maj. Colin Edgerton, M.D., and the staff of Dwight D. Eisenhower Army Medical Center’s Rheumatology Clinic have implemented musculoskeletal ultrasound, to diagnose and treat the ever-expanding spectrum of joint disorders. Ultrasound, long used in the practice of obstetrics and cardiology, now offers rheumatologists the ability to image joints and related structures in real-time, during a routine office visit. Rheumatologists diagnose and treat medical diseases that frequently cause joint pain and swelling. These diseases include rheumatoid arthritis, gout, lupus and osteoarthritis, also known as “wear and tear” or “age related” arthritis. Rheumatologists prescribe medications to treat these diseases and perform procedures such as joint injections to alleviate pain and reduce disability. Rheumatologists are Internal Medicine physicians who complete an additional two or threeyear fellowship to become specialists.

Rheumatologists in the U.S. have been slow to adopt musculoskeletal ultrasound. Though the use of musculoskeletal ultrasound has become routine in the European practice of rheumatology in the last 5 years, most American rheumatologists do not use musculoskeletal ultrasound in their daily practice. European rheumatologists receive formal training with ultrasound as a matter-of-course during their fellowships. U.S. training has lagged behind, fueled in part by a medical culture unfamiliar with the application of ultrasound to joint examinations and also by reliance on scanning modalities such as Magnetic Resonance Imaging. The many benefits of musculoskeletal ultrasound are changing this.

The benefits to patients are many. In keeping with its name, ultrasound uses imperceptible sound waves to create images of the body. Ultrasound is painless and does not expose the body to harmful radiation. Patients welcome the ability to receive a comfortable and rapid diagnosis during their rheumatology visit and to initiate relieving therapy.Though ultrasound cannot always replace the need for advanced scanning such as MRI, it can reduce the need for MRI scanning, resulting in fewer delays imposed by MRI scheduling waits and fewer follow-up visits to review results with the physician prior to beginning treatment. Patients also enjoy the ability to view their ultrasound images, which are acquired as a real-time “movie” while the examination is occurring in the Rheumatology Office.

For physicians, musculoskeletal ultrasound serves as an extension of the physical examination. No longer are physicians limited to only external examination of a diseased joint. Ultrasound allows a rapid view deep into the bones, ligaments and tendons that comprise the joint—revealing information that previously remained hidden. Ultrasound also helps to guide injections into joints and related structures, resulting in reduced patient pain and improved patient satisfaction and outcomes. The cost savings of musculoskeletal ultrasound are the subject of ongoing study. The ultrasound equipment and time required for an examination incur costs that are a fraction of those associated with MRI scanning.

Eisenhower Rheumatology has been performing musculoskeletal ultrasound since 2008. Patients are not referred directly to the clinic for an ultrasound, as might occur with a radiology department. Rather, patients are referred to the Rheumatology Clinic by their primary care physicians for suspected Rheumatic diseases according to established referral guidelines. The Rheumatologists incorporate ultrasound into the course of the evaluation, as needed.

The Specialty Care Coordination Office at Eisenhower coordinates referrals for the Rheumatology Clinic and 28 other specialty clinics for all Department of Defense beneficiaries, regardless of age. Even if you have an external primary care physician, you are eligible to use the specialty clinics at Eisenhower with no co-pay. Your physician may refer you for care by calling the Specialty Care Coordination Office at (706) 787-0297 or toll free (877) 667-5828.