Since the introduction of ultrasonography by Professor Ian Donald in Glasgow as a tool for imaging in medicine, it has become an important technology for imaging the musculoskeletal system. Musculoskeletal ultrasonography is a powerful adjunct to clinical examination that can detect subclinical abnormalities of soft tissues, tendons, and ligaments; it is also an important tool for the objective assessment of synovitis and bone erosion. Enthesitis, the hallmark of spondyloarthropathies, can be readily imaged using ultrasound. Furthermore, the characteristic soft tissue abnormalities and bone erosions seen in psoriatic arthritis, for example, are easily detected. The axial skeleton is a complex structure that currently is not very amenable to ultrasound imaging, but advances have been made in its use to image sacroiliac joints and semiquantify active sacroiliitis. Technological advances currently being made in ultrasonography will provide exciting new possibilities for the application of this imaging modality to the spondyloarthropathies.
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