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EULAR recommendations for the use of imaging in the clinical management of peripheral joint osteoarthritis
  1. Garifallia Sakellariou1,
  2. Philip G Conaghan2,
  3. Weiya Zhang3,
  4. Johannes W J Bijlsma4,
  5. Pernille Boyesen5,
  6. Maria Antonietta D'Agostino6,7,
  7. Michael Doherty3,
  8. Daniela Fodor8,
  9. Margreet Kloppenburg9,
  10. Falk Miese10,
  11. Esperanza Naredo11,
  12. Mark Porcheret12,
  13. Annamaria Iagnocco13
  1. 1 Division of Rheumatology, IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy
  2. 2 Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds and National Institute of Health Research Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK
  3. 3 Academic Rheumatology, Clinical Sciences Building, University of Nottingham, Nottingham City Hospital, Nottingham, UK
  4. 4 Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
  5. 5 Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
  6. 6 APHP, Hôpital Ambroise Paré, Service de Rhumatologie, Boulogne-Billancourt, France
  7. 7 INSERM U1173, Laboratoire d'Excellence INFLAMEX, Université Paris Ouest-Versailles St.-Quentin, Saint Quentin en Yvelines, France
  8. 8 2nd Internal Medicine Department, “Iuliu Hațieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
  9. 9 Department of Rheumatology, Leiden University Medical Center (LUMC), Leiden, The Netherlands
  10. 10 Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Dusseldorf, Germany
  11. 11 Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
  12. 12 Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK
  13. 13 Rheumatology Unit, Dipartimento di Scienze Cliniche e BIologiche, Università degli Studi di Torino, Turin, Italy
  1. Correspondence to Professor Philip G Conaghan, Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, Leeds  LS7  4SA, UK; p.conaghan{at}


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.

  • Osteoarthritis
  • Ultrasonography
  • Magnetic Resonance Imaging
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  • GS and PGC contributed equally.

  • Contributors GS and PGC contributed equally. GS performed the literature review, GS and PGC produced drafts of the manuscript with advice from AI and WZ. All authors were involved in the production of the recommendations and have reviewed the final manuscript.

  • Funding The authors would like to thank EULAR for financial support for this work. PGC is supported in part by the National Institute for Health Research (NIHR) Leeds Musculoskeletal Biomedical Research Unit.

  • Disclaimer The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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