Ultrasound of the hands and feet for rheumatological disorders: influence on clinical diagnostic confidence and patient management

Matsos, Mark; Harish, Srinivasan; Zia, Peter; Ho, Y J; Chow, Andrew; Ioannidis, George; Khalidi, Nader

doi:10.1007/s00256-009-0738-2

Cited by 32 publications

(25 citation statements)

References 13 publications

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“…Three of these studies examined the hand joints (wrist, metacarpophalangeal and proximal interphalangeal joints), but none compared sites 7 – 11. One study showed that ultrasound synovitis improved the certainty of RA diagnosis from 42.0% to 53.2% (p 0.17),7 and another described how synovitis seen with ultrasound helped confirm (65.2%) or change the diagnosis (11.1%); ultrasound was superior to clinical examination in 75% of patients 8.…”

Section: Resultsmentioning

confidence: 99%

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

et al. 2013

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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.

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Section: Resultsmentioning

confidence: 99%

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

et al. 2013

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“…When US was added to clinical findings, the diagnostic confidence in differentiating OA from inflammatory arthritis significantly increased 2. Due to the absence of strong evidence supporting the use of different imaging modalities at different anatomical sites, the systematic use of imaging in the diagnostic process was not recommended in cases with typical clinical presentation.…”

Section: Resultsmentioning

confidence: 99%

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

et al. 2017

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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.

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“…In a prospective controlled observational study, Matsos et al reported a significant increase in confidence by rheumatologists using US to diagnose synovitis, tenosynovitis, erosions and enthesitis within the feet of 62 patients [45]. The inferences from these findings suggest good clinical utility for the use of US in assisting the diagnosis of foot pathology and ensuring appropriate foot structures are injected/treated.…”

Section: Current Evidence For Use Of Us To Detect Foot Pathology In Ramentioning

confidence: 88%

“…The inferences from these findings suggest good clinical utility for the use of US in assisting the diagnosis of foot pathology and ensuring appropriate foot structures are injected/treated. However, it should be noted that with only two study rheumatologists, the external validity of their findings may be limited [45].…”

Section: Current Evidence For Use Of Us To Detect Foot Pathology In Ramentioning

confidence: 99%

Using ultrasound to image the foot in rheumatoid arthritis: current understanding, challenges and future scope

Bowen¹,

Hooper²,

Edwards³

et al. 2013

Imaging in Medicine

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Ultrasound of the hands and feet for rheumatological disorders: influence on clinical diagnostic confidence and patient management

Abstract: Ultrasound of the hands and/or feet significantly influenced the rheumatologists' diagnostic confidence in specific clinical findings and management plans.

Cited by 32 publications

References 13 publications

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

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

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

Using ultrasound to image the foot in rheumatoid arthritis: current understanding, challenges and future scope

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