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Novel algorithms for the pragmatic use of ultrasound in the management of patients with rheumatoid arthritis: from diagnosis to remission
  1. Maria Antonietta D'Agostino1,2,3,
  2. Lene Terslev4,5,
  3. Richard Wakefield3,6,
  4. Mikkel Østergaard4,5,
  5. Peter Balint7,
  6. Esperanza Naredo8,
  7. Annamaria Iagnocco9,
  8. Marina Backhaus10,
  9. Walter Grassi11,
  10. Paul Emery3,6
  1. 1Rheumatology Department, APHP, Hôpital Ambroise Paré, Boulogne-Billancourt, France
  2. 2INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University, Saint-Quentin en Yvelines, France
  3. 3Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, Leeds, UK
  4. 4Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark
  5. 5Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
  6. 6NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK
  7. 7Third Rheumatology Department, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary
  8. 8Department of Rheumatology, Hospital General Universitario Gregorio Marañón and Universidad Complutense, Madrid, Spain
  9. 9Ultrasound Unit, Rheumatology Department, Sapienza Università di Roma, Rome, Italy
  10. 10Department of Internal Medicine, Rheumatology and Clinical Immunology Academic Hospital of the Charité Berlin, Park-Klinik Weissensee Berlin, Berlin, Germany
  11. 11Clinica Reumatologica—Scuola di Specializzazione in Reumatologia Università Politecnica delle Marche, Ancona, Italy
  1. Correspondence to Professor Paul Emery, University of Leeds, Chapel Allerton Hospital, Chapeltown Road, Leeds, LS7 4SA, UK; p.emery{at}


The absence of specific guidance on how to use ultrasound (US) to diagnose and manage patients with inflammatory arthritis, especially with rheumatoid arthritis (RA) has hindered the optimal utilisation of US in clinical practice, potentially limiting its benefits for patient outcomes. In view of this, a group of musculoskeletal US experts formed a working group to consider how this unmet need could be satisfied and to produce guidance (additional to European League against Rheumatism (EULAR) imaging recommendations) to support clinicians in their daily clinical work. This paper describes this process and its outcome, namely five novel algorithms, which identify when US could be used. They are designed to aid diagnosis, to inform assessment of treatment response/disease monitoring and to evaluate stable disease state or remission in patients with suspected or established RA, by providing a pragmatic template for using US at certain time points of the RA management. A research agenda has also been defined for answering unmet clinical needs.

  • Rheumatoid Arthritis
  • Synovitis
  • Ultrasonography

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