EULAR recommendations for the use of imaging in the clinical management of peripheral joint osteoarthritis

Abstract

The increased information provided by modern imaging has led to its more extensive use. Our aim was to develop evidence-based recommendations for the use of imaging in the clinical management of the most common arthropathy, osteoarthritis (OA). A task force (including rheumatologists, radiologists, methodologists, primary care doctors and patients) from nine countries defined 10 questions on the role of imaging in OA to support a systematic literature review (SLR). Joints of interest were the knee, hip, hand and foot; imaging modalities included conventional radiography (CR), MRI, ultrasonography, CT and nuclear medicine. PubMed and EMBASE were searched. The evidence was presented to the task force who subsequently developed the recommendations. The strength of agreement for each recommendation was assessed. 17 011 references were identified from which 390 studies were included in the SLR. Seven recommendations were produced, covering the lack of need for diagnostic imaging in patients with typical symptoms; the role of imaging in differential diagnosis; the lack of benefit in monitoring when no therapeutic modification is related, though consideration is required when unexpected clinical deterioration occurs; CR as the first-choice imaging modality; consideration of how to correctly acquire images and the role of imaging in guiding local injections. Recommendations for future research were also developed based on gaps in evidence, such as the use of imaging in identifying therapeutic targets, and demonstrating the added value of imaging. These evidence-based recommendations and related research agenda provide the basis for sensible use of imaging in routine clinical assessment of people with OA.

Current State of Musculoskeletal Ultrasound Training and Implementation among Rheumatologists in Arab Countries

“…In addition to its advantages compared to other imaging tools, MSUS has provedits usefulness to help clinicians to specify diagnosis, prognosis and to monitorthe disease activity, indication and evaluation of therapeutic effects [5,[20][21][22].…”

Changes in Knee Joint Space Width in Treatment with a New Hyaluronic-Based Hydrogel

“…Moreover, in Romania, for economic reasons, the first X-ray examination is made this way in order to assess the type of prosthesis must be prepared in case of future surgery, a type that is influenced by the degree of instability. Also, according to EULAR recommendations, radiographic views are important for optimizing detection of OA features; in particular for the knee, weightbearing and patellofemoral views are recommended [13]. Lequesne's method of measurement was used to determine the joint space narrowing (JSN) [19].…”

“…It is also considered that viscosupplementation with hyaluronic acid based products may reduce the time to total knee arthroplasty for up to 8.7 months [10]. Cartilage loss assessment and joint space width (JSW) measurements using serial standardized radiographs are important instruments in the diagnosis, treatment and progression evaluation of knee OA [11][12][13]. Tibiofemoral JSW measurement is recommended by Osteoarthritis Research Society (OARSI) as the main measurement tool in assessing the biological progression in OA [14].…”

Could nail and joint alterations make the difference between psoriatic arthritis and osteoarthritis during the ultrasonographic evaluation of the distal interphalangeal joints?

“…To better differentiate DIP involvement in hand OA vs PsA, a recent review on the use of imaging in peripheral OA [12] reports that, in atypical presentations, imaging is recommended to help confirm the diagnosis (level of evidence IV). Conventional radiography should be used before other techniques.…”

“…Conventional radiography should be used before other techniques. In differential diagnosis involving soft tissues US or MRI should be performed and bone should be evaluated by CT or MRI (level of evidence III/ IV) [12].…”