EULAR recommendations for the use of imaging of the joints in the clinical management of rheumatoid arthritis

Abstract

Objective To develop evidence-based recommendations on the use of imaging of the joints in the clinical management of rheumatoid arthritis (RA). Methods The task force comprised an expert group of rheumatologists, radiologists, methodologists and experienced rheumatology practitioners from 13 countries. Thirteen key questions on the role of imaging in RA were generated using a process of discussion and consensus. Imaging modalities included were conventional radiography, ultrasound, MRI, CT, dualemission x-ray absorptiometry, digital x-ray radiogrammetry, scintigraphy and positron emission tomography. Research evidence was searched systematically for each question using MEDLINE, EMBASE and Cochrane CENTRAL. The experts used the evidence obtained from the relevant studies to develop a set of 10 recommendations. The strength of recommendation was assessed using a visual analogue scale. Results A total of 6888 references was identified from the search process, from which 199 studies were included in the systematic review. Ten recommendations were produced encompassing the role of imaging in making a diagnosis of RA, detecting inflammation and damage, predicting outcome and response to treatment, monitoring disease activity, progression and remission. The strength of recommendation for each proposition varied according to both the research evidence and expert opinion. Conclusions Ten key recommendations for the role of imaging in the management of RA were developed using research-based evidence and expert opinion.

Evaluation of Serum Interleukin‐6 Level as a Surrogate Marker of Synovial Inflammation and as a Factor of Structural Progression in Early Rheumatoid Arthritis: Results From a French National Multicenter Cohort

“…Ultrasound (US) and magnetic resonance imaging (MRI) evaluations are more sensitive techniques to identify synovitis than clinical examination and are better than conventional radiography to detect bone erosion (3). The exact position of US in RA management has been recently clarified (4). However, the benefit from these imaging procedures is hampered by their limited availability, which emphasizes the urgent need for widely available soluble biomarkers.…”

High-resolution18F-FDG PET/CT for assessing disease activity in rheumatoid and psoriatic arthritis: findings of a prospective pilot study

“…Current European League Against Rheumatism (EULAR) guidelines for the clinical management of RA are based on MRI and ultrasound scans, but do not include PET or CT scans. 40 While MRI and ultrasound provide outstanding information regarding RA status, these modalities cannot probe the molecular and cellular activity of oedema or synovitis. The strength of PET/CT scans in this area warrants further investigation.…”

Does Combined Clinical and Ultrasound Assessment Allow Selection of Individuals With Rheumatoid Arthritis for Sustained Reduction of Anti–Tumor Necrosis Factor Therapy?

“…Previous studies have demonstrated that ongoing synovitis can be detected by US in up to 62% of patients in clinical remission (19)(20)(21) and that synovitis demonstrated by power Doppler ultrasound (PDUS) correlates with both progression of structural damage (22) and risk of subsequent RA flare (23). As a result, the use of US assessment for patients in clinical remission has been proposed (24).…”