Art is a treasure-house for understanding the natural progression of diseases. Artists have made clear portrayals of many rheumatic diseases including RA, OA, camptodactyly, and temporal arteritis in multiple eras including the Renaissance, the Baroque Period, and Post-Impressionism starting in the Middle Ages. Rheumatologists have begun observing the characteristics of this category of diseases anew through the eyes of artists.

The Last Supper

（Dieric Bouts the Elder）

Dieric Bouts the Elder was an early figure in the Netherlands school of painting, and the originator of the Gothic Revival. He carried forward the painting characteristics of northern Holland during the Renaissance. His works influenced all of Europe at the time.This painting of The Last Supper is not the one by DaVinci. It was painted decades before DaVinci’s. The word “camptodatyly” was first used in 1906 by Landouzy, and was used to describe the permanent flexion contracture which is congenital or occurs during development where one or two of a person’s fifth fingers are permanently bent.  

The Madonna with Chancellor Rolin

（Jan Van Eyck）

Jan Van Eyck (1385-1441) was a painter from the Netherlands who was known as the “Father of Oil Painting”. His Ghent Alterpiece is an great work of art of the early period of the Renaissance in the Netherlands. The image of the priest in his painting The Madonna with Chancellor Rolin is an emblematic representation of giant cell arteritis (temporal arteritis). Since the etiology of giant cell arteritis is unknown, it is the most commonly seen systemic vasculitis among adults.    

Portrait of a Young Man

（Sandro Botticelli）

Sandro Botticelli (1445-1510) was a famous painter from Florence at the end of the 15^th century, and a pioneer of Italian portrait painting. In Portrait of a Young Man he painted swelling of the wrist joints, metacarpophalangeal joints, and the proximal interphalangeal joints, which hints that the young man in the painting might have juvenile idiopathic arthritis.

Although works of art can provide evidence of ancient diseases, later generations might make an erroneous judgment due to following an artistic precedent or due to an artistic technique, making the correct interpretation difficult to come by, whereas modern imaging technology is able to make correct judgments with regard to rheumatic diseases.

Rheumatic diseases frequently involve bones and joints along with surrounding tissue. Imaging examinations are an important supplementary means of diagnosing and treating rheumatic diseases. For quite some time X-rays have been the most frequently used means of imaging detection. However, X-rays have poor sensitivity, and are unable to perform early diagnoses. MRI’s are expensive, making them difficult to use widely in a clinical setting to monitor rheumatic disease activity. 

In the past few years musculoskeletal system ultrasound has developed into a new field of ultrasound applications domestically and internationally due to the fact that ultrasound examinations are convenient, fast, real-time monitoring can be performed, there is no radiation, and costs are low, making it very popular among clinics and patients.

Since pathological musculoskeletal changes are commonly near the surface of the skin, ultrasound devices are required to perform very well at high frequencies. However,not all ultrasound device brands can perform this well. The world’s highest frequency probe that VINNO possesses can provide excellent image quality and abundant clinical functions. It can be of great importance in the diagnosis and treatment of many kinds of rheumatic diseases including diagnosis and differential diagnosis, assessing disease activity, follow up visits, and guided treatment.

Ultrasound images of rheumatic diseases

High frequency ultrasound examinations are the sensitive and precise way to diagnose the pathological changes of RA, and are most frequently used to detect the accumulation of fluid or assess the soft tissue within and surrounding the joint.

The former include synovitis, bursitis, and tenosynovitis. Ultrasound is able to display the relationship RA’s distribution and boundaries have with the surrounding tissue, whether or not the interior of the fluid is homogeneous, whether there has been compression locally, or changes in RA when the joint is in motion. Ultrasound can display inflammatory pathological changes, and can also help conduct boundary orientation, in-depth judgments, and even assist in guiding a needle biopsy or the injection of medication, assist in the judgment of the treatment outcome, and formulate a further treatment plan for the patient.

Ultrasound diagnoses for RV patients are usually done with two dimensional and Doppler ultrasound. The quality of the two-dimensional images is particularly important. VINNO’s unique tissue speckle noise reduction technology guarantees high quality images with feature tissue velocity imaging and composite ultrasound imaging technology. The super wide linear array probe technology supported with the RF platform can provide better resolution and contrast for two-dimensional images, and produce more sensitive blood flow image effects. 

The applications of ultrasound for rheumatoid arthritis:

(1) Arthroedema: Using high frequency ultrasound the sensitivity of discovering arthroedema approaches 100%. At the same time, the joint cavity can be punctured under the guidance of ultrasound, and direct the clinical doctor at the patient’s bedside in orienting the direction and depth of needle insertion, detect the entire puncturing process, and direct the injection of medicine into the joint cavity or next to the joint.

(2)Synovitis: An average X-ray cannot detect synovitis, whereas synovial hyperplasia can be displayed very well under ultrasound, and thereby indirectly reflect the degree of inflammation of the synovial membrane.

(3)Bone erosion: Bone erosion manifests as the bone cortex that is observed on two vertical planes being discontinuous in an ultrasound image. Ultrasound can discover bone erosion in the early stages of rheumatoid arthritis, much sooner than an average X-ray.  

Tips：

Rheumatoid arthritis (RA) is a systemic disease that has the chronic inflammation of joint tissue as its primary manifestation. The inflammation of synovial tissue and arthroedema are among its pathological characteristics. Data shows that RA can occur at any age. 80% of the people it occurs in are between the ages of 35-50. There are three times as many female sufferers of RA. RA has a variety of clinical manifestations. The onset of the disease is usually gradual and hidden. The likelihood of disability is very high if multiple symptoms occur within several days.