The Value of Magnetic Resonance Imaging and Ultrasound in Undifferentiated Arthritis: A Systematic Review

Machado, Pedro; Koevoets, Rosanne; Bombardier, Claire; Heijde, Désirée M van der

doi:10.3899/jrheum.101072

Cited by 36 publications

(24 citation statements)

References 37 publications

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“…REACH was used as a background cohort in which the new diagnostic tests were simulated. (17)(18)(19)(20). MRI also adds information on bone marrow edema (21) and tenosynovitis (21)(22)(23).…”

Section: Methodsmentioning

confidence: 99%

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Cost‐Effectiveness Model for Evaluating New Diagnostic Tests in the Evaluation of Patients With Inflammatory Arthritis at Risk of Having Rheumatoid Arthritis

Luime

Buisman

Oppe

et al. 2016

Arthritis Care & Research

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Objective. New opportunities have emerged for early diagnosis with the arrival of new technologies that assess the impact of genomics, proteomics, metabolomics, and cytomics on rheumatoid arthritis (RA) risk. This early health technology assessment study assesses the short-term cost effectiveness of 4 add-on diagnostic tests in early inflammatory arthritis patients at risk of RA. Methods. We modeled 4 diagnostic add-on tests to the American College of Rheumatology/European League Against Rheumatism 2010 RA classification criteria, covering the first year after diagnosis, using Rotterdam Early Arthritis Cohort data. Sensitivity, specificity, and costs were assigned to the magnetic resonance imaging of hands and feet (sensitivity 0.90, specificity 0.60, cost e756), interleukin-6 (IL-6) serum level test (sensitivity 0.70, specificity 0.53, cost e50), B cell-related gene expression (sensitivity 0.60, specificity 0.90, cost e150), and gene assay for RA (sensitivity 0.40, specificity 0.85, cost e750), based on literature and expert opinion. Outcomes were evaluated using the unweighted diagnostic net benefit (UDNB) and the incremental costeffectiveness ratio (ICER) in all patients (n 5 552), intermediate-risk patients (n 5 263), and seronegative patients (n 5 329). Results. The highest UDNB was found when using the B cell assay in intermediate-risk patients (43%, ICER e5,314), while the IL-6 test in seronegative patients resulted in the lowest UDNB (211.4%, ICER e7,650). If a threshold of e20,000 is applied, the B cell assay would be preferred over the other alternatives, with a 78% probability of being cost effective for intermediate-risk patients, 57% for all patients, and 73% for seronegative patients. Conclusion. Diagnostic add-on tests favoring specificity over sensitivity with a headroom less than e370 per test are cost effective, with the largest diagnostic benefit occurring in intermediate-risk patients.

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Section: Methodsmentioning

confidence: 99%

“…MTX is the cornerstone of treatment in RA (18,19). On average, 50-70% of patients respond well to this drug (24,25).…”

Section: Methodsmentioning

confidence: 99%

Cost‐Effectiveness Model for Evaluating New Diagnostic Tests in the Evaluation of Patients With Inflammatory Arthritis at Risk of Having Rheumatoid Arthritis

Luime

Buisman

Oppe

et al. 2016

Arthritis Care & Research

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“…A systematic literature review by Machado et al concludes that BME and combined synovitis and erosion pattern seem useful in predicting development of RA from undifferentiated peripheral arthritis. The difference in conclusions seems partly explained by whether poor-quality studies are included [124] or not included [125] in the systematic literature review.…”

Section: Diagnostic Utility Of Mri In Undifferentiated Peripheral Artmentioning

confidence: 98%

“…Two systematic literature reviews have been published recently [124,125], but too early to include the study by Duer-Jensen et al [123]. The former study states that widespread use of MRI for diagnosing RA is scientifically not justified, because the sensitivity and specificity of MRI findings for RA differ substantially among studies, depending upon the criteria applied.…”

Section: Diagnostic Utility Of Mri In Undifferentiated Peripheral Artmentioning

confidence: 99%

The impact of MRI on the clinical management of inflammatory arthritides

et al. 2011

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In the past two decades, MRI has gained a major role in research and clinical management of patients with inflammatory arthritides, particularly in spondyloarthritis (SpA), rheumatoid arthritis (RA), and osteoarthritis (OA). MRI is regarded as the most sensitive imaging modality for detecting early SpA in young patients with inflammatory back pain and normal radiographs of the sacroiliac joints. The recently published Assessment of SpondyloArthritis International Society classification criteria for axial SpA include for the first time a positive MRI demonstrating sacroiliitis as an imaging criterion indicative of SpA together with at least one clinical feature of SpA. Recent data show that systematic assessment of sacroiliitis displayed on MRI has much greater diagnostic utility than previously reported and highlight the diagnostic relevance of structural lesions. In RA, MRI has predictive value for the development of disease in new onset undifferentiated arthritis, and MR pathology at disease onset is a highly significant predictor of radiographic erosions. Consequently MRI has been credited with an important role in the new ACR/EULAR 2010 classification criteria for RA. In OA, bone marrow edema (BME) and synovitis may serve as biomarkers in interventional trials. Treatment interventions targeting BME and synovitis observed on MRI in inflammatory arthritides may have a disease-modifying effect as these lesions are potentially reversible and have been shown to be associated with structural progression. Research should focus on the prognostic significance of MRI lesions in larger cohorts and whether adding MRI to routine care improves clinical and radiographic outcome in patients with inflammatory arthritides.

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“…Our study did not specifically look at different imaging modalities; however, the value of different forms of imaging has been reported to be useful in predicting development of RA from undifferentiated peripheral arthritis. 22 Magnetic resonance imaging and power Doppler ultrasound are increasingly being used to detect inflammation and bone injury, and allow management of RA before progression becomes detectable on X-ray. [23][24][25] They may also have prognostic value in aggressive disease, 23 but at this stage their predictive utility value is modest at best, and their lack of availability means their applicability in clinical practice is limited at this time.…”

Section: 13-15mentioning

confidence: 99%

Longitudinal study of clinical prognostic factors in patients with early rheumatoid arthritis: the PREDICT study

Bird

Nicholls²,

Barrett³

et al. 2017

Int J of Rheum Dis

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Aim: To assess the association between baseline clinical prognostic factors and subsequent Disease Activity Score of 28 joints (DAS28) remission in early rheumatoid arthritis (RA).Methods: Data were collected using point of care clinical software from participating rheumatology centres. Patients aged 18 years or over whose date of clinical onset of RA was within the previous 12-24 months, who had at least 6 months of follow-up data and a DAS28-ESR (erythrocyte sedimentation rate) score recorded between 12 and 24 months from first being seen for RA were included. Data collected included baseline demographics, mode of disease onset, pattern of joint involvement at onset, smoking status, DAS28, rheumatoid factor (RF), anti-citrullinated peptide antibodies (ACPA), time from symptom onset to presentation and disease activity at baseline. Univariate and multivariate logistic regression of DAS28-ESR remission between 12 and 24 months after first assessment were performed.Results: Data from 1017 patients were analyzed: 70% female; mean age 60 years (SD: 14.7); 70% RF-positive, 58% ACPA-positive. The strongest age and sex adjusted baseline predictors of DAS28-ESR remission at 12-24 months were remission at baseline (odds ratio [OR]: 4.49, 95% CI: 2.17-9.29, P < 0.001), being male (OR: 2.42, 95% CI: 1.46-4.01, P < 0.001), abstaining from alcohol (P < 0.001) and being lower weight (OR: 0.98, 95% CI: 0.97-1.00, P = 0.015). There was no statistically significant association between joint onset patterns, mode of onset, RF, ACPA or smoking status.Conclusion: In this observational study, patients with early RA at risk of not achieving remission include those with high disease activity at baseline, women, those who drink alcohol and those with higher body weight.

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The Value of Magnetic Resonance Imaging and Ultrasound in Undifferentiated Arthritis: A Systematic Review

Cited by 36 publications

References 37 publications

Cost‐Effectiveness Model for Evaluating New Diagnostic Tests in the Evaluation of Patients With Inflammatory Arthritis at Risk of Having Rheumatoid Arthritis

Cost‐Effectiveness Model for Evaluating New Diagnostic Tests in the Evaluation of Patients With Inflammatory Arthritis at Risk of Having Rheumatoid Arthritis

The impact of MRI on the clinical management of inflammatory arthritides

Longitudinal study of clinical prognostic factors in patients with early rheumatoid arthritis: the PREDICT study

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