In the last few years the application of musculoskeletal imaging in rheumatology clinical practicehas become more widespread. However recommendations on its use in osteoarthritis (OA) are lacking.
Objective To develop evidence-based recommendations for the use of imaging in OA clinical practice
Methods After the project was approved by the EULAR Executive Committee, a task force of experts in the field of OA and imaging met in order to plan the strategy for a systematic literature review (SLR), subsequently conducted by a research fellow under the supervision of the conveners and the methodologist of the group. The task force identified areas of application of imaging in OA clinical practice and developed the research questions to drive the SLR. The imaging modalities (conventional radiography, ultrasound, magnetic resonance imaging, computed tomography, radioisotope scan) and joints (knee, hip, hand and foot) were first identified. Second, the role of imaging in the diagnosis of OA, identification of OA characteristics, detection of other diseases, managing OA, defining its prognosis, monitoring the disease progression as well asguiding treatment was addressed. A systematic search was performed separately for each question and site using PubMed and Embase.
Results From an initial SLR, 6858 references were found, 1317 papers were reviewed in detail and 380 of them were included. Furthermore, to investigate evidence not addressed by the first SLR,the task force required additional SLRs to evaluate the accuracy and efficacy of imaging-guided compared to blind injections and the comparison of different radiographic projections. For the first SLR, 25 papers out of 5379 abstracts were assessed and 8 included, while for the comparison of different projections 53 papers out of 4774 abstracts were reviewed, with the inclusion of 31 papers. After analysing the results of the SLRs and giving their expert opinion, the task force developed consensus recommendations. These covered different areas such as the lack of need for diagnostic imaging in patients with typical symptoms, the role of imaging in differential diagnosis, the use of imaging in monitoring OA when no significant therapeutic modification isrelated, the first choice imaging modality, how to acquire images, the influence of different joints on selecting the type and use of imaging modalities, and the role of imaging in guiding local injections. Future research recommendations were developed based on areas where there was a paucity of literature.
Conclusions EULAR recommendations for the use of imaging in osteoarthritis clinical practice have been developed thus filling a knowledge gap in the field.
– Recommendations on the use of imaging in OA clinical practice are lacking.
– Based on the results of a SLR and expert opinion, recommendations on the use of imaging in the clinical management of OA were developed.
Disclosure of Interest None declared