A patient with rheumatoid arthritis has managed her symptoms well over the past two years with medication, effectively controlling her pain and function. However, she experiences some lingering swelling in her right thumb, raising concerns about potential active disease.

Assessing the Clinical Scenario

Even in well-controlled RA cases, some residual pain or swelling can persist. The question for the rheumatologist becomes whether this swelling indicates active inflammation or a different issue.

Diagnostic Tools

A musculoskeletal ultrasound serves as a practical, in-office diagnostic tool for assessing inflammation, surpassing physical exams, X-rays, and even MRI in accessibility. Ultrasound provides a direct view of any inflammation under the skin, essential for evaluating disease activity.

Understanding Ultrasound Findings

In this patient’s case, the ultrasound of her right thumb’s first MCP joint reveals synovial hypertrophy (joint lining thickening), a chronic RA sign without active inflammation. Additionally, an erosion—bone damage from prior RA—indicates past disease activity, but no active inflammation.

Reassurance and Treatment Plan

The ultrasound findings reassure that there’s no active inflammation, and her current regimen remains effective. The thumb’s swelling reflects past disease, not ongoing damage. With no need to adjust her medication, the patient can continue her existing treatment with confidence that her RA is under control.

If functional limitations arise, occupational therapy could be beneficial, while supplements or platelet-rich plasma may address joint wear-and-tear pain. This case highlights how ultrasound aids in daily RA treatment, guiding care and reinforcing treatment stability.