Role of musculoskeletal ultrasound in diagnosing and managing chronic inflammatory arthritis in overweight and obese patients: a narrative review

Obesity and metabolic syndrome play a significant role in the complexity of chronic inflammatory arthritis. By promoting systemic inflammation and altering immune responses, these conditions can amplify joint-related symptoms such as pain, synovitis and enthesitis. This inflammatory and mechanical burden complicates clinical evaluation, as traditional disease activity scores may be skewed by excess weight, leading to inaccurate assessments. Imaging techniques like musculoskeletal ultrasound (MSUS) offer a promising tool to detect subclinical inflammation, and to improve diagnostic accuracy. This review examines the role of MSUS in the management of obese patients with inflammatory arthritis. We explore how MSUS can be leveraged to detect subclinical inflammation, improve diagnostic accuracy, and guide more effective management strategies. We also discuss the limitations of MSUS in this patient population, including the impact of excessive adipose tissue on image quality and the need for standardized protocols.