Robert Michael Fairchild
Assistant Professor of Medicine (Immunology and Rheumatology)
Medicine - Immunology & Rheumatology
Bio
Dr. Robert Fairchild is Clinical Chief of the Division of Immunology and Rheumatology and an Assistant Professor of Medicine at Stanford University. He specializes in the diagnosis and management of rheumatologic diseases with a clinical and research focus on musculoskeletal ultrasound (MSKUS), systemic autoimmune disease, and advanced imaging techniques.
Dr. Fairchild is the founding Director of Stanford’s Rheumatology Ultrasound Diagnostic and Interventional Clinic, established in 2017. Under his leadership, MSK ultrasound has become a core component of Stanford Rheumatology’s clinical practice, supporting diagnostic evaluations, procedural guidance, and disease monitoring. He also developed and directs Stanford’s comprehensive rheumatology ultrasound fellowship curriculum, which trains fellows and faculty in diagnostic and interventional ultrasound techniques. In addition, Dr. Fairchild serves as Medical Director for Stanford’s Value-Based Care Program, where he leads initiatives aimed at delivering high-quality, cost-effective care across specialties.
Dr. Fairchild’s research spans a broad range of clinical and translational topics, including lung ultrasound in interstitial lung disease (ILD), ultrasound detection of vascular disease and calcinosis in systemic sclerosis (SSc), and the use of ultrasound to assess joint and soft tissue pathology in inflammatory and connective tissue diseases. He has led observational cohort studies evaluating the clinical significance of ultrasound-detected pathology in SSc, including the association between ulnar artery occlusion and calcinosis burden, and the contribution of tendon and joint abnormalities to musculoskeletal symptoms.
He is also actively engaged in research at the intersection of imaging and artificial intelligence. His ongoing work includes the development of deep learning and explainable AI (XAI) models to support automated interpretation of MSK ultrasound images in arthritis and connective tissue disease, with the goal of improving diagnostic precision and standardization across diverse clinical settings. He is a co-investigator on multiple interdisciplinary projects applying AI to the detection and subtyping of inflammatory arthritis, calcinosis, and other rheumatologic conditions.
Dr. Fairchild performs ultrasound-guided synovial biopsies as part of Stanford’s translational rheumatology research program and has contributed to the development of ultrasound-based outcome measures for clinical trials in diseases such as IgG4-related disease, Sjögren’s syndrome, and systemic sclerosis.
He received his PhD in Immunology from Georgetown University and his MD from Columbia University Vagelos College of Physicians and Surgeons. He completed internal medicine residency and rheumatology fellowship at Stanford. He trained in rheumatologic ultrasonography through the USSONAR program and holds RhMSUS certification from the American College of Rheumatology.
Clinical Focus
- Diagnostic and Interventional Rheumatologic Ultrasonography
- Rheumatoid Arthritis
- Rheumatology
Academic Appointments
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Assistant Professor - University Medical Line, Medicine - Immunology & Rheumatology
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Member, Wu Tsai Neurosciences Institute
Administrative Appointments
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Clinic Chief, Immunology and Rheumatology Clinic, Stanford Health Care (2024 - Present)
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Medical Director, Rheumatology POCUS program, Stanford Health Care (2024 - Present)
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Director, Rheumatology Ultrasound Program, Stanford University (2017 - Present)
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Director of Value Based Care for the Department of Medicine, Stanford University/Stanford Hospital (2023 - 2024)
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Medical Director, Value Based Care Program, Stanford Hospital and Clinics (2021 - 2023)
Professional Education
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Board Certification: American Board of Internal Medicine, Rheumatology (2017)
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Board Certification: American Board of Internal Medicine, Internal Medicine (2015)
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Fellowship: Stanford University Immunology and Rheumatology Fellowship (2017) CA
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Residency: Stanford University Internal Medicine Residency (2015) CA
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Internship: Stanford University Internal Medicine Residency (2013) CA
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Medical Education: Columbia University College of Physicians and Surgeons (2012) NY
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PhD, Georgetown University, Host-Guest and Organometallic Chemistry (2008)
Current Research and Scholarly Interests
Dr. Fairchild’s research focuses on advancing musculoskeletal and organ-based ultrasound applications in rheumatology, with the goal of improving diagnostic precision, monitoring, and treatment stratification in systemic autoimmune disease. His work bridges clinical imaging, translational research, and applied machine learning.
He has led multiple studies applying ultrasound to systemic sclerosis (SSc), including the assessment of arthritis, tendinopathy, skin involvement, and vascular pathology. His research has demonstrated that vascular ultrasound can sensitively detect ulnar artery occlusion and that this is strongly associated with the burden of calcinosis in SSc. He has also shown that ultrasound is more sensitive than radiographs in detecting calcinosis and has explored the relationship between joint pathology and musculoskeletal symptoms in connective tissue disease.
Dr. Fairchild has an extensive research portfolio in lung ultrasound for rheumatologic interstitial lung disease (ILD), including the development and validation of lung ultrasound scoring criteria for systemic sclerosis and pediatric ILD. His work has shown high concordance between ultrasound and CT findings and has established lung ultrasound as a practical and reliable modality for detecting ILD in both adult and pediatric populations.
He is also actively involved in the development of ultrasound-based outcome measures for clinical trials and disease monitoring. These efforts include salivary gland ultrasound for IgG4-related disease and Sjögren’s syndrome, lung ultrasound for systemic sclerosis–associated ILD, and calcinosis scoring tools for SSc clinical research.
In parallel, Dr. Fairchild conducts interdisciplinary research in artificial intelligence and explainable machine learning. He leads projects applying deep learning and XAI techniques to musculoskeletal ultrasound for the detection and classification of inflammatory arthritis, including rheumatoid arthritis, spondyloarthritis, osteoarthritis, and crystalline arthritis. His work integrates imaging and structured clinical data to build interpretable diagnostic models and improve real-world usability of AI tools in rheumatology.
Dr. Fairchild also performs ultrasound-guided synovial biopsies, which serve as a key platform for translational research in arthritis and support biomarker discovery, mechanistic studies, and integration with advanced imaging data.
Clinical Trials
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Ultrasound Therapy Effects to Modulate the Inflammatory Reflex
Not Recruiting
This two treatment group study, including sham treatment, attempts to measure how ultrasound frequency, duration, intensity, and duty cycle impact its acute anti-inflammatory effect in healthy volunteers. It also attempts to contribute to the evidence regarding the comfort and safety of using therapeutic ultrasound. This pilot dose-finding study will be the basis for a larger Phase 2 trial in Rheumatoid Arthritis (RA) patients.
Stanford is currently not accepting patients for this trial. For more information, please contact Alexander Sackeim, MD, 914-523-7345.
Graduate and Fellowship Programs
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Immunology/Rheumatology (Fellowship Program)
All Publications
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Validation of Lung Ultrasound Interpretation Criteria for Interstitial Lung Disease in Systemic Sclerosis and Inflammatory Myopathy.
Arthritis care & research
2025
Abstract
Interstitial lung disease (ILD) has a high prevalence in systemic sclerosis (SSc) and inflammatory myopathy (IM) and early identification reduces associated morbidity and mortality. We previously developed LUS interpretation criteria for ILD detection in 2020 (LUS-ILD-20) showing excellent sensitivity and specificity in SSc-ILD; herein, we sought to validate revised LUS-ILD-24 in a large SSc and IM cohort.Patients meeting criteria for SSc and IM, with planned CT chest imaging underwent LUS imaging interpreted with LUS-ILD-24 by 3 blinded readers. The sensitivity and specificity for LUS-ILD detection as noted on CT was analyzed for SSc, IM, and possible incident ILD subgroups. Inter- and intra-rater agreement was calculated. Correlations between LUS-ILD-24 severity, CT imaging severity, and pulmonary function tests (PFTs) were assessed.Ninety-five patients were included in the analyses. Sensitivity and specificity for ILD detection ranged from 92.4% to 95.5% and 82.8% to 86.2% across readers with similar accuracy in all subgroups. Inter- and intra-reader reliability showed near perfect agreement (κ = 0.92 and κ = 0.90 to 1, respectively). LUS severity correlated with CT imaging severity and inversely correlated with diffusion capacity for carbon monoxide (%DLCO) and forced vital capacity.We validated our revised LUS-ILD-24 in SSc and IM cohorts and found excellent sensitivity, specificity, and reliability for detection of ILD identified on CT. LUS severity correlated with CT and PFT markers of ILD severity. Validation of the revised LUS-ILD-24 supports the implementation of LUS in screening algorithms for ILD in SSc and IM patients.
View details for DOI 10.1002/acr.25567
View details for PubMedID 40320831
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Evolution and impact of a dedicated ultrasound clinic on clinical rheumatology practice at an academic medical center.
Seminars in arthritis and rheumatism
2023; 63: 152276
Abstract
Rheumatologic ultrasonography (RhUS) has grown in scope and application over the past 20 years. While many studies have shown the benefits of RhUS, few have investigated the efficacy of a dedicated clinic. This study explores the impact of a dedicated ultrasound clinic on patients and rheumatologists at an academic medical center (AMC).We analyzed claims data for patient visits, X-rays (XR), magnetic resonance imaging (MRI), and RhUS from an AMC with an established RhUS clinic, alongside two affiliated community medical practices (CMPs) without RhUS. We also analyzed RhUS clinic records on referral indication, procedures, results, and follow-up treatment changes. Pre- and post-RhUS visit patient surveys and referring physician (RP) surveys assessed experience and impact of the RhUS clinic.From 2018 to 2021, referrals to the RhUS clinic substantially increased. In parallel, XR and MRI orders changed by -76 % and -43 % respectively, compared with 163 % and -24 % at CMPs. Discordance between RP pre-RhUS assessments and RhUS results were common. Patient surveys showed RhUS led to increased disease understanding and impacted thoughts and decisions about their therapy. RPs found utility in RhUS across a range of indications and were confident with RhUS results.These findings suggest a dedicated RhUS clinic can be a valuable resource in clinical rheumatology practice. Implementation of a RhUS clinic at this AMC spurred rapid adoption of RhUS into clinical decision-making with notable benefits for patients and physicians alike. This may serve as a model for implementation of similar clinics at other institutions.
View details for DOI 10.1016/j.semarthrit.2023.152276
View details for PubMedID 37857047
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Biologics Initiation in Rheumatoid Arthritis by Race and Ethnicity: Results From a Randomized Survey Study.
ACR open rheumatology
2023
Abstract
To investigate whether the race and ethnicity of a patient with rheumatoid arthritis (RA) influences rheumatologists' likelihood of choosing to initiate biologic disease-modifying antirheumatic drug (bDMARD) treatment.We conducted a randomized survey experiment in which identical brief case vignettes of hypothetical patients with RA were sent to US rheumatologists (respondents). Three of the four cases included some level of treatment decision ambiguity whereas the fourth case strongly favored bDMARD initiation. Each respondent was shown the four case vignettes, with the race and ethnicity (Black, Hispanic, White) randomly assigned for each case. Each vignette offered multiple choices for next therapeutic step, which we summarized using frequencies and proportions by race and ethnicity version.Among 159 US rheumatologists, we found that for the three cases with some level of treatment decision ambiguity, there was little to no variability in the proportions of respondents who chose to start a biologic for the Black and Hispanic variants (cases 1, 2, and 3). For case 4, respondents generally agreed to start a biologic with some minimal variability across the variants (92.6% for the Black version, 98.1% for the Hispanic version, and 96.2% for the White version).There are conflicting data regarding bDMARD use and initiation in patients with RA based on the sex and race of the patient. This work adds to this conversation by examining how the next therapeutic step chosen by rheumatologists varied by the race and ethnicity of the hypothetical patient.
View details for DOI 10.1002/acr2.11573
View details for PubMedID 37312437
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Lung Ultrasound in Children with Systemic Juvenile Idiopathic Arthritis Associated Interstitial Lung Disease.
Arthritis care & research
2022
Abstract
OBJECTIVE: Lung disease associated with Systemic Juvenile Idiopathic Arthritis (sJIA-LD) is a potentially life threating complication in children with sJIA. Although high resolution computed tomography (HRCT) is considered the gold standard imaging modality for evaluating interstitial lung disease (ILD), lung ultrasound (LUS) has shown utility for ILD screening in adults with connective tissue diseases (CTD) at lower cost and without utilizing ionizing radiation. The goals of this pilot study were to describe LUS features in children with known SJIA-LD and to assess the feasibility of LUS in this population.METHODS: Children <18years with sJIA-LD and healthy controls were enrolled. LUS acquisition was performed at 14 lung positions. Demographic, clinical, and HRCT data were collected and reviewed. Feasibility was assessed through patient surveys. LUS findings were qualitatively and semi-quantitatively assessed and compared to HRCT findings.RESULTS: LUS was performed in 9 children with sJIA-LD and 6 healthy controls and took 12 minutes on average to perform. LUS findings in sJIA-LD included focal to diffuse pleural irregularity, granularity, and thickening, with associated scattered or coalesced B-lines, and subpleural consolidations. LUS findings appeared to correspond to HRCT findings.CONCLUSION: LUS in sJIA-LD reveals highly conspicuous abnormalities in the pleura and sub-pleura that appear to correlate with peripheral lung findings on HRCT. LUS is a feasible imaging tool in children even from an early age. This study suggests a potential role of LUS in sJIA-LD screening, diagnosis, and/or prognostication.
View details for DOI 10.1002/acr.24957
View details for PubMedID 35604884
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Ultrasound evaluation of the hands and wrists in patients with systemic sclerosis: Osteophytosis is a major contributor to tender joints.
Seminars in arthritis and rheumatism
2021; 51 (4): 735-740
Abstract
OBJECTIVE: To evaluate the prevalence and clinical associations of ultrasound (US) findings of inflammatory arthritis and joint and soft tissue pathology in patients with systemic sclerosis (SSc).METHODS: The hands and wrists of 43 SSc patients and 35 age-balanced controls were evaluated by clinical exam and musculoskeletal US. Synovial and tenosynovial pathology were assessed using semi-quantitative Gray Scale (GS) and Power Doppler (PD) scoring. US evaluation for osteophytes, erosions, ulnar artery occlusion, and median nerve cross-sectional areas was performed. Tender joints (TJ), swollen joints (SJ), modified Rodnan skin score (mRSS), digital ulcers, contractures, and calcinosis were evaluated. Concordance between US and physical exam findings at each joint region were assessed, and associations between their severity were analyzed.RESULTS: TJs and SJs were present in 44.2% and 62.8% of SSc patients, respectively. Inflammatory arthritis, defined as having both GS>0 and PD>0, was observed in 18.6% of SSc patients and no controls. There was a high concordance by joint region between GS synovial hypertrophy and osteophytes (kappa=0.88) as well as TJs (kappa=0.72). SSc patients had more osteophytes compared to controls (48.8% vs 22.9%, p=0.018) as well as higher osteophyte severity (p=0.033).CONCLUSIONS: Despite a high percentage of tender and swollen joints, less than 20% of SSc patients met criteria for inflammatory arthritis on US. The high concordance of osteophytes with GS synovial hypertrophy and tender joints suggest that osteophytosis may be a significant contributor to joint pain in SSc patients.
View details for DOI 10.1016/j.semarthrit.2021.04.020
View details for PubMedID 34144383
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Prevalence and significance of pulmonary disease on lung ultrasonography in outpatients with SARS-CoV-2 infection.
BMJ open respiratory research
2021; 8 (1)
Abstract
The majority of patients with SARS-CoV-2 infection are diagnosed and managed as outpatients; however, little is known about the burden of pulmonary disease in this setting. Lung ultrasound (LUS) is a convenient tool for detection of COVID-19 pneumonia. Identifying SARS-CoV-2 infected outpatients with pulmonary disease may be important for early risk stratification.To investigate the prevalence, natural history and clinical significance of pulmonary disease in outpatients with SARS-CoV-2.SARS-CoV-2 PCR positive outpatients (CV(+)) were assessed with LUS to identify the presence of interstitial pneumonia. Studies were considered positive based on the presence of B-lines, pleural irregularity and consolidations. A subset of patients underwent longitudinal examinations. Correlations between LUS findings and patient symptoms, demographics, comorbidities and clinical outcomes over 8 weeks were evaluated.102 CV(+) patients underwent LUS with 42 (41%) demonstrating pulmonary involvement. Baseline LUS severity scores correlated with shortness of breath on multivariate analysis. Of the CV(+) patients followed longitudinally, a majority showed improvement or resolution in LUS findings after 1-2 weeks. Only one patient in the CV(+) cohort was briefly hospitalised, and no patient died or required mechanical ventilation.We found a high prevalence of LUS findings in outpatients with SARS-CoV-2 infection. Given the pervasiveness of pulmonary disease across a broad spectrum of LUS severity scores and lack of adverse outcomes, our findings suggest that LUS may not be a useful as a risk stratification tool in SARS-CoV-2 in the general outpatient population.
View details for DOI 10.1136/bmjresp-2021-000947
View details for PubMedID 34385149
View details for PubMedCentralID PMC8361701
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Ultrasound Detection of Calcinosis and Association with Ulnar Artery Occlusion in Patients with Systemic Sclerosis.
Arthritis care & research
2020
Abstract
To investigate the ability of ultrasound (US) compared to radiographs in detecting calcinosis in hands/wrists of systemic sclerosis (SSc) patients, and assess US markers of pathologic perfusion.SSc patients were evaluated for calcinosis in the hands/wrists by X-ray and US. Presence or absence of calcinosis was recorded by patient, hand, and anatomical zone; sensitivity and specificity for calcinosis detection by US versus X-ray was determined. Bilateral US vascular measurements of ulnar artery occlusion (UAO) and finger pulp blood flow (FPBF) were obtained. For each hand, associations between markers of pathologic blood flow (UAO, FPBF, and a composite severity score of UAO and FPBF) and presence of calcinosis were assessed using generalized estimating equations.Of 43 SSc patients (19 diffuse, 24 limited), 39.5% had calcinosis on X-ray compared to 30.2% on US. Sensitivity and specificity for US was 61% and 95% by zone, 78% and 98% by hand, and 76% and 100% by patient, respectively. UAO was seen in 30% and 28% of left and right hands, respectively; FPBF was absent in ≥1 digit of the left and right hands in 49% and 44%, respectively. UAO was associated with X-ray identified calcinosis by hand (OR 8.08, 95% CI 2.45-26.60, p<0.001), whereas FPBF and the composite severity score were not significant. UAO was associated with calcinosis even in the absence of digital ulcers (OR 33.00, 95% CI 3.39-321.09, p=0.003).US was sensitive and highly specific in detecting calcinosis in SSc. UAO was strongly associated with X-ray identified calcinosis.
View details for DOI 10.1002/acr.24327
View details for PubMedID 32475057
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Development and Assessment of a Novel Lung Ultrasound Interpretation Criteria for the Detection of Interstitial Lung Disease in Systemic Sclerosis.
Arthritis care & research
2020
Abstract
Interstitial lung disease (ILD) is a frequent complication of systemic sclerosis (SSc), and ILD screening, characterization, and monitoring are important for therapeutic decision-making and prognostication. Lung ultrasonography (LUS) is a potential alternative imaging modality for ILD detection. In this study, we develop and test a novel LUS examination technique and interpretation criteria for detecting SSc-ILD.LUS acquisition was performed by collecting short ultrasound movies at 14 lung positions. LUS interpretation criteria for SSc-ILD detection focused on visualized pleural changes. To assess the performance of our methodology for SSc-ILD detection, we prospectively enrolled SSc patients with high resolution computed tomography (HRCT) imaging within 3 months of LUS. LUS exams were scored independently by two blinded readers (one ultrasonographer and one non-ultrasonographer). The sensitivity and specificity for SSc-ILD detection was assessed and agreement was measured with Cohen's Kappa statistic.To test the performance of our LUS acquisition technique and interpretation criteria, 20 SSc patients were evaluated by LUS (278 lung zones) and HRCT. HRCT confirmed ILD in 9 patients (45%). LUS was positive for SSc-ILD in 11 patients (55%) with a sensitivity of 100% and specificity of 82% versus HRCT, with perfect agreement between the two readers (κ=1). Analysis by individual lung zones found excellent agreement between readers with 93.8% concordance and κ=0.82.We developed a novel LUS examination technique and interpretation criteria that are highly sensitive and specific for SSc-ILD detection in an SSc cohort, affording perfect agreement between ultrasonographer and non-ultrasonographer readers.
View details for DOI 10.1002/acr.24338
View details for PubMedID 32475026
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Reply to Letter to the Editor: Validation of Lung Ultrasound Interpretation Criteria for Interstitial Lung Disease in Systemic Sclerosis and Inflammatory Myopathy.
Arthritis care & research
2025
View details for DOI 10.1002/acr.25607
View details for PubMedID 40654102
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Imaging of the Major Salivary Glands in Rheumatic Disease.
Rheumatic diseases clinics of North America
2024; 50 (4): 701-720
Abstract
Salivary gland involvement is a common feature of rheumatologic disease. The authors review the anatomy of the major salivary glands and the uses of imaging modalities such as ultrasound, MRI, computed tomography, sialography, and scintigraphy in evaluating the major salivary glands in rheumatologic disease.
View details for DOI 10.1016/j.rdc.2024.07.008
View details for PubMedID 39415375
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Imaging Revolutions in Modern Rheumatology.
Rheumatic diseases clinics of North America
2024; 50 (4): xiii-xiv
View details for DOI 10.1016/j.rdc.2024.08.001
View details for PubMedID 39415379
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Artificial Intelligence Assisted Interpretation of Lung Ultrasound Imaging for the Detection of Interstitial Lung Disease
WILEY. 2024: 3994-3996
View details for Web of Science ID 001331419106073
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Validation of a Lung Ultrasound Interpretation Criteria for Interstitial Lung Disease Screening in Systemic Sclerosis and Inflammatory Myopathy
WILEY. 2024: 3250-3252
View details for Web of Science ID 001331419105019
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A double-blind, placebo-controlled, randomized withdrawal trial of sarilumab for the treatment of glucocorticoid-dependent sarcoidosis.
Rheumatology (Oxford, England)
2023
Abstract
Effective steroid-sparing therapies for the treatment of sarcoidosis are lacking; interleukin-6 (IL-6) antagonists may reduce sarcoidosis disease activity. This study assessed the safety and efficacy of the IL-6 receptor antagonist, sarilumab, in subjects with glucocorticoid-dependent sarcoidosis.This phase II, double-blind, placebo-controlled, randomized withdrawal trial enrolled 15 subjects with biopsy-proven sarcoidosis at Stanford University from November 2019 to September 2022. In Period 1, subjects were treated with open-label sarilumab 200mg subcutaneously every two weeks for 16 weeks, with predefined tapering of prednisone. Subjects who completed Period 1 without a sarcoidosis flare entered Period 2 and were randomized to continue sarilumab or to receive matching placebo for 12 weeks. Endpoints included flare-free survival, as well as changes in pulmonary function tests, chest imaging, patient reported outcomes, and laboratory values.Fifteen subjects were enrolled in the study (median age 57 years, 80% male, 73.3% White), and 10 subjects successfully completed Period 1. During Period 1, 4 of 15 subjects (26.7%) discontinued due to worsening of their sarcoidosis, and CT chest imaging worsened in 5 of 15 subjects (35.7%). During Period 2, 0 of 2 subjects in the sarilumab group and 1 of 8 subjects (12.5%) in the placebo group had a flare. Treatment with sarilumab 200 mg was generally well tolerated in subjects with sarcoidosis.In this double-blind, placebo-controlled, randomized withdrawal trial, a meaningful signal for improvement in subjects with sarcoidosis treated with sarilumab was not observed. Given the small numbers in this study, no definitive conclusions can be drawn.ClinicalTrials.gov Identifier: NCT04008069.
View details for DOI 10.1093/rheumatology/kead373
View details for PubMedID 37471590
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North American musculoskeletal ultrasound scanning protocol of the shoulder, elbow, wrist, and hand: update of a Delphi Consensus Study.
Clinical rheumatology
2022
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 focalsymptoms 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.
View details for DOI 10.1007/s10067-022-06337-2
View details for PubMedID 36008579
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Strongyloides Hyperinfection After Immunosuppression in an Immigrant From El Salvador A Case for Early Diagnosis and Treatment
JCR-JOURNAL OF CLINICAL RHEUMATOLOGY
2021; 27 (4): E128-+
View details for Web of Science ID 000657235500003
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Comparison of Adverse Events Among Home- vs Facility-Administered Biologic Infusions, 2007-2017.
JAMA network open
2021; 4 (6): e2110268
Abstract
Importance: Infusion reactions occur in 7% to 20% of patients receiving biologics. Home infusions are convenient and incur lower costs but may be associated with more adverse events; the safety of receiving biologic infusions for immune-mediated diseases at home remains unclear.Objective: To assess whether patients receiving home biologic infusions have increased adverse events requiring emergency department (ED) or hospital admission compared with patients receiving facility infusions.Design, Setting, and Participants: This retrospective cohort study used administrative claims data from a large national insurer for adult patients who received biologic infusions for immune-mediated disease between January 2007 and December 2017. Patients with hematologic malignant neoplasms or bone marrow transplantation were excluded. Data were analyzed from August 2019 to October 2020.Main Outcomes and Measures: ED or hospital admission on the same or next day after administration of a biologic infusion at home vs at a facility; secondary outcomes included discontinuation of the biologic after an ED or hospital admission and postinfusion mortality.Results: Of a total of 57 220 patients (mean [SD] age, 50.1 [14.8] years; 512 314 [68.1%] women) who received 752 150 biologic infusions (34 078 home infusions [4.5%] to 3954 patients and 718 072 facility infusions [95.5%] to 54 770 patients), patients who received home infusions were younger (mean [SD] age, 43.2 [13.2] vs 51.3 [14.8] years), more likely to be men (14 031 [41.2%] vs 225 668 [31.4%]), and had a lower Charlson comorbidity score compared with patients who received facility infusions (mean [SD] score, 0.5 [1.0] vs 1.1 [1.3]). Home infusions were associated with 25% increased odds of ED or hospital admission on the same or next day after the infusion (odds ratio [OR], 1.25; 95% CI, 1.09-1.44; P=.002) and 28% increased odds of discontinuation of the biologic after the ED or hospital admission (OR, 1.28; 95% CI, 1.08-1.51; P=.005). There was no difference in postinfusion mortality between home or facility infusions. The rates of adverse events were highest with home infusions of tocilizumab (48 of 481 infusions [10.0%]), vedolizumab (150 of 2681 infusions [5.6%]), and infliximab (1085 of 20 653 infusions [5.3%]), although the number of tocilizumab and vedolizumab infusions was low.Conclusions and Relevance: In this study, biologic infusions administered at home, compared with those administered at a facility, were associated with increased adverse events requiring escalation of care. Because the number of home infusions has increased and is expected to continue to rise, the safety implications of administering biologic infusions at home needs to be further assessed.
View details for DOI 10.1001/jamanetworkopen.2021.10268
View details for PubMedID 34081140
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North American musculoskeletal ultrasound scanning protocol of the hip, knee, ankle, and foot: update of a Delphi consensus study.
Clinical rheumatology
2021
Abstract
BACKGROUND/OBJECTIVE: A North American rheumatology consensus on tiered-mastery designation for anatomic views was developed in 2011 for course and fellowship teaching. This study updates the lower extremity joint scanning protocols aiming to inform musculoskeletal ultrasound curriculum development for the American College of Rheumatology affiliated Fellowship Programs.METHODS: Three Delphi rounds were conducted to reach consensus for tiered-level mastery designation for hip, knee, ankle, and foot scanning views. The survey was disseminated (Qualtrics) to 101 potential participants with ultrasound teaching experience. High agreement was defined as ≥ 85% consensus and final tier designation as having >50% agreement for the preferred tier. Response changes were evaluated by McNemar's chi-square test.RESULTS: Consensus regarding tier designations was reached for 80% of the views. Three knee views (anterior transverse suprapatellar, medial, and lateral longitudinal) and 2 ankle views (anterior and posterior transverse) achieved upgrades to tier 1 from 2. The transverse sacroiliac hip joint was downgraded from tier 2 to 3. The lateral longitudinal hip view was added with a tier 1 designation.CONCLUSION: Updated scanning protocols support modifications reflecting current scanning methods delivered by North American rheumatologists performing point of care ultrasound that may inform educators involved in rheumatology ultrasound. Key Points The anterior transverse suprapatellar, medial, and lateral longitudinal knee views; the anterior and posterior transverse ankle views; and the lateral longitudinal view hip view were perceived as important to master and perform routinely. The transverse sacroiliac joint view was suggested to be performed based on practice focus.
View details for DOI 10.1007/s10067-021-05716-5
View details for PubMedID 33821367
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A narrative review of imaging in calcinosis associated with systemic sclerosis.
Clinical rheumatology
2021
Abstract
Calcinosis is dystrophic calcification of the soft tissue which can lead to painful and debilitating disease. It is commonly seen in patients with systemic sclerosis (SSc). Imaging can assist in diagnosis, quantification of disease, and better pathophysiologic understanding of calcinosis. Traditionally, X-rays have been the most frequently used imaging modality for diagnosis; however, advances in ultrasound (US), computed tomography (CT), positron emission tomography (PET), and magnetic resonance imaging (MRI) have led to greater ability to characterize these lesions and surrounding structures. This narrative review aims to describe the use of imaging for calcinosis in patients with SSc. Key Points Imaging is useful in the diagnosis of calcinosis, assessment of disease severity, and disease monitoring. X-ray is commonly used and offers high sensitivity and specificity, but both ultrasound and CT-scans are alternatives when greater anatomic detail is sought regarding surrounding structures. Investigational imaging modalities include dual energy CT-scans, cinematic rendering CT-scans, and PET- CT scans. Conventional MRI scans have less sensitivity and specificity for detection of calcinosis.
View details for DOI 10.1007/s10067-021-05696-6
View details for PubMedID 33755836
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Painful Panniculitis and Polyarthritis in Pancreatic Adenocarcinoma: A Case Report.
Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases
2020
View details for DOI 10.1097/RHU.0000000000001408
View details for PubMedID 32496359
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Ultrasound Doppler and tenosynovial fluid analysis in tenosynovitis.
Annals of the rheumatic diseases
2020
Abstract
To assess Doppler ultrasound (US) and tenosynovial fluid (TSF) characteristics in tenosynovitis within common rheumatic conditions, as well as their diagnostic utility.Subjects with tenosynovitis underwent Doppler US and US-guided TSF aspiration for white cell count (WCC) and crystal analysis. Tenosynovial Doppler scores (DS) were semiquantitatively graded. TSF WCC and DS were compared using Kruskal-Wallis tests and logistic regression between non-inflammatory conditions (NIC), inflammatory conditions (IC) and crystal-related conditions (CRC). Receiver operating curves, sensitivity and specificity assessed the ability of WCC and DS to discriminate IC from NIC.We analysed 100 subjects from 14 sites. The mean age was 62 years, 65% were female, and the mean TSF volume was 1.2 mL. Doppler signal was present in 93.7% of the IC group and was more frequent in IC than in NIC group (OR 6.82, 95% CI 1.41 to 32.97). The TSF median WCC per 109/L was significantly higher in the IC (2.58, p<0.001) and CRC (1.07, p<0.01) groups versus the NIC group (0.38). A TSF cut-off of ≥0.67 WCC per 109/L optimally discriminated IC versus NIC with a sensitivity and specificity each of 81.3%. In the IC group, 20 of 48 (41.7%) subjects had a TSF WCC <2.00 per 109/L.A negative DS helps rule out IC in tenosynovitis, but a positive DS is non-specific and merits TSF testing. Unlike synovial fluid, a lower TSF WCC better discriminates IC from NIC. US guidance facilitates aspiration of minute TSF volume, which is critical for diagnosing tenosynovial CRC.
View details for DOI 10.1136/annrheumdis-2020-216927
View details for PubMedID 32213497
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Development and Preliminary Validation of a Novel Lung Ultrasound Interpretation Criteria for the Detection of Interstitial Lung Disease in Patients with Systemic Sclerosis
WILEY. 2019
View details for Web of Science ID 000507466904514
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Tenosynovial Aspiration by Ultrasound Guidance: Correlation and Diagnostic Implications of Tenosynovial Analysis and Ultrasound Doppler Signal
WILEY. 2019
View details for Web of Science ID 000507466903201
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Ultrasound Evaluation of the Hands in Patients with Systemic Sclerosis: Osteophytosis Is a Major Contributor to Tender Joints
WILEY. 2019
View details for Web of Science ID 000507466901134
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Ultrasound Detection of Calcinosis and Correlation with Ulnar Artery Occlusion in Patients with Systemic Sclerosis
WILEY. 2019
View details for Web of Science ID 000507466904371
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Musculoskeletal Ultrasound Scanning Protocol Consensus Statements on Scanning Conventions and Documentation in the U.S.
Arthritis care & research
2019
Abstract
There has been increased engagement with ultrasound in rheumatology (RhUS) in the United States with more physicians being trained and certified, its inclusion in fellowship training curricula, and as criteria in the evaluation of rheumatic disease patients. European rheumatology and Radiology-determined standards have largely driven the execution of RhUS; how this translates to American rheumatology practice has not been examined. A 2011 rheumatology-driven consensus on documentation, scanning conventions, and tiered-mastery designation for anatomic region views was developed, which served as the framework for training, and clinical research validation. This study aims to update this consensus to reflect current utilization of musculoskeletal RhUS evaluation in the United States.A 3-round Delphi method study was conducted using a 96-item questionnaire sent via Qualtrics® to 101 respondents experienced in RhUS education and scholarship. The target participant number was 38. High agreement was defined as ≥ 85% agreement on each item. McNemar's chi-square statistic tested for changes in agreement in responses. Comments were reviewed for content analysis.46 respondents completed all three rounds. 80% and 100% of documentation and scanning convention statements, respectively, reached high agreement. Comments reflected the need for rheumatology-defined and disease-specific "complete scan" and "limited scan" definitions, separate from radiology-defined definitions.Many scanning conventions from 2011 remain relevant in current practice. There is a need to determine rheumatology-defined descriptions for common procedural terminology codes for "complete" and "limited" scans that accurately reflect the current state of RhUS. This article is protected by copyright. All rights reserved.
View details for DOI 10.1002/acr.24005
View details for PubMedID 31199596
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Consensus Statements on Scanning Conventions and Documentation in Musculoskeletal Ultrasound
WILEY. 2018
View details for Web of Science ID 000447268902292
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Strongyloides Hyperinfection After Immunosuppression in an Immigrant From El Salvador: A Case for Early Diagnosis and Treatment.
Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases
2018
View details for PubMedID 30074914
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Consensus-Building on a Rheumatology Musculoskeletal Ultrasound Scanning Protocol for Rheumatology Fellowship Programs
WILEY. 2017
View details for Web of Science ID 000411824100110
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Utility of B-type natriuretic peptides in the assessment of patients with systemic sclerosis-associated pulmonary hypertension in the PHAROS registry
CLINICAL AND EXPERIMENTAL RHEUMATOLOGY
2017; 35 (4): S106–S113
View details for Web of Science ID 000418419000015