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Ultrasound is a widely implemented imaging modality in rheumatology practice that implies a great interaction between patient and professional. The COVID-19 pandemic requires a change in our clinical practice, through the adoption of new strategies that allow comprehensive care for our patients, guaranteeing the safety of both patients and healthcare professionals., Objetive: Our objective was to develop practical recommendations, agreed among a panel of experts, on the use and safety of rheumatological ultrasound during the COVID-19 pandemic., Methods: We performed a narrative review of the available literature. Based on the literature review, we produced preliminary recommendations that were subsequently agreed among a panel of experts using the Delphi methodology with a 1-5 Likert scale. Agreement for each recommendation was considered if 75% of the panel members scored the item ≥4 on the Likert scale., Results: 5 overarching principles and 28 recommendations were issued and agreed among the panel. Group consensus was achieved in 100% of items., Conclusions: The document provides useful information about preventive measures in the practice of ultrasound in rheumatology in times of a COVID-19 pandemic based on the experience and literature available to date., (© 2020 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.)

Ultrasound is a widely implemented imaging modality in rheumatology practice that implies a great interaction between patient and professional. The COVID-19 pandemic requires a change in our clinical practice, through the adoption of new strategies that allow comprehensive care for our patients, guaranteeing the safety of both patients and healthcare professionals., Objetive: Our objective was to develop practical recommendations, agreed among a panel of experts, on the use and safety of rheumatological ultrasound during the COVID-19 pandemic., Methods: We performed a narrative review of the available literature. Based on the literature review, we produced preliminary recommendations that were subsequently agreed among a panel of experts using the Delphi methodology with a 1-5 Likert scale. Agreement for each recommendation was considered if 75% of the panel members scored the item ≥4 on the Likert scale., Results: 5 overarching principles and 28 recommendations were issued and agreed among the panel. Group consensus was achieved in 100% of items., Conclusions: The document provides useful information about preventive measures in the practice of ultrasound in rheumatology in times of a COVID-19 pandemic based on the experience and literature available to date., (Copyright © 2020 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.)

Objectives: This study aims to evaluate the inter-observer reliability of the ultrasonographic examination of the wrist in RA patients between 3 examiners and 3 probe positions., Methods: Fifty-three RA patients were recruited at the University Clinical Hospital of Santiago de Compostela in Spain for ultrasonographic examination of the wrist. Ultrasonography (US) was performed on both wrists using a GE LOGIQ 9 machine, using three probe positions: Lister's Tubercle to digit II (position 1), Lister's Tubercle to digit III (position 2) and ulnocarpal (position 3), from the anatomic medial orientation. Three examiners (2 experienced ultrasonographers and 1 junior ultrasonographer) scored synovitis according to a 0-3 semiquantitative scoring system. Inter-observer reliability was expressed using the ICC (A,1)., Results: For grey-scale ultrasound (GSUS) the inter-observer reliability (ICC(A,1)) (single measure, agreement definition) ranged from 0.35 for the ulnocarpal joint, position 3, to 0.60 in both position 1 for the radiocarpal joint and position 2 for the inter-carpal joint. Using power Doppler ultrasound (PDUS) the inter-observer reliability (ICC(A,1)) ranged from 0.36 in position 3, to 0.52 both in position 1 and 2 for the radiocarpal joint., Conclusions: The reliability of the GSUS-examination of the wrist joints of RA patients with GSUS shows highest, moderate reliability using the anatomical landmarks Tubercle of Lister and digit III (position 2). The reliability of the PDUS examination was similar and moderate in both position 1 (Lister's Tubercle to digit II) and position 2 (Lister's Tubercle to digit III). The reliability was poorest for position 3 (the anatomic medial view of the ulnocarpal joint) in both the GSUS and PDUS examination. This study suggests that position 2 should be used in clinical trials and daily practice.

Management of an adult woman with a 3 years untractable low back pain, allowed us to discover the existence of hypophosphatemic osteomalacia, due to a benign mesenchymal tumor (vascular fibrous histiocytoma). The prognosis of this form of osteomalacia, as in the present case, is excellent after total removal of the tumor.