Joe Buggie is a master woodcarver, so it hurt when rheumatoid arthritis struck.

"All the woodcarving I did was by hand with mallets and gouges and I just couldn't do that anymore; it was too painful,” he said.

To diagnose RA, many patients have an MRI but Buggie has a heart defibrillator and pacemaker and needed a different imaging tool: ultrasound.

“We use it to assess inflamed or swollen joints, to tell whether the patient has rheumatoid arthritis or gout,” said rheumatologist Dr. Ralf Thiele.

Thiele says ultrasound is a must for arthritis care because X-rays can't tell the whole story.

"The X-ray only allows us to look at the bone itself, and we cannot really see the soft tissues around the bone, and we cannot see any active inflammation inside the joints,” said Thiele.

The ultrasound hand piece glides painlessly across gel, sending sounds waves into the tissue.

"And then the transducer picks up the reflection of the sound waves and creates an image on the computer screen and then you can see what is going on inside the joint,” said Thiele.

Many times physical exams and lab tests don't reveal hidden inflammation.

"When we use the ultrasound and the Doppler ultrasound, we find that these tissues are still highly inflamed and the patient is not on optimal treatment yet,” the doctor said.

For Buggie, the ultrasound helped the doctor guide a needle right into his shoulder for a pain-relieving injection.

“We were able to see just where the needle went into the shoulder and where it was relative to the inflammation from the arthritis,” said Buggie.

Typical ultrasound fees for an arthritis patient run about $120 per session, compared to an MRI at 10 times the cost.