Article Text

EULAR recommendations for the use of imaging of the joints in the clinical management of rheumatoid arthritis
  1. Alexandra N Colebatch1,2,
  2. Christopher John Edwards1,
  3. Mikkel Østergaard3,
  4. Désirée van der Heijde4,
  5. Peter V Balint5,
  6. Maria-Antonietta D'Agostino6,
  7. Kristina Forslind7,8,
  8. Walter Grassi9,
  9. Espen A Haavardsholm10,
  10. Glenn Haugeberg11,
  11. Anne-Grethe Jurik12,
  12. Robert BM Landewé13,
  13. Esperanza Naredo14,
  14. Philip J O'Connor15,
  15. Ben Ostendorf16,
  16. Kristina Potočki17,
  17. Wolfgang A Schmidt18,
  18. Josef S Smolen19,
  19. Sekib Sokolovic20,
  20. Iain Watt4,
  21. Philip G Conaghan21
  1. 1Department of Rheumatology, University Hospital Southampton, Southampton, UK
  2. 2Department of Rheumatology, Yeovil District Hospital, Yeovil, UK
  3. 3Copenhagen Center for Arthritis Research, Center of Rheumatology and Spine Diseases, Copenhagen University Hospital at Glostrup, Copenhagen, Denmark
  4. 4Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
  5. 53rd Department of Rheumatology, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary
  6. 6Department of Rheumatology, Ambroise Paré Hospital, Boulogne-Billancourt, France
  7. 7Department of Medicine, Section of Rheumatology, Helsingborg Hospital, Helsingborg, Sweden
  8. 8Section of Rheumatology, Institution of Clinical Science, University Hospital, Lund, Sweden
  9. 9Department of Rheumatology, Università Politecnica delle Marche, Ancona, Italy
  10. 10Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
  11. 11Department of Rheumatology, Hospital of Southern Norway, Kristiansand, Norway
  12. 12Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
  13. 13Department of Clinical immunology and Rheumatology, Academic Medical Centre, Amsterdam, The Netherlands
  14. 14Rheumatology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
  15. 15Department of Radiology, Leeds General Infirmary, Leeds, UK
  16. 16Centre for Rheumatology, Heinrich-Heine University of Düsseldorf, Düsseldorf, Germany
  17. 17Institute of Diagnostic and Interventional Radiology, University Hospital Center Zagreb, Zagreb, Croatia
  18. 18Immanuel Krankenhaus Berlin, Medical Centre for Rheumatology Berlin-Buch, Berlin, Germany
  19. 19Division of Rheumatology, Medical University of Vienna, Vienna, Austria
  20. 20Rheumatology Department, Clinic of Heart and Rheumatic Diseases, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
  21. 21Division of Musculoskeletal Disease, Section of Musculoskeletal Disease, University of Leeds & NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK
  1. Correspondence to Professor Philip G Conaghan, Division of Musculoskeletal Disease, Section of Musculoskeletal Disease, University of Leeds & NIHR Leeds Musculoskeletal Biomedical Research Unit, 2nd Floor Chapel Allerton Hospital, Chapeltown Road, Leeds LS7 4SA, UK; P.Conaghan{at}


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, dual-emission 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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