Table 1

EULAR Points to Consider (PtC) for the use of imaging to guide interventional procedures in patients with rheumatic and musculoskeletal diseases (RMD)

Overarching principlesLoELoA
A. The imaging technique should be optimised according to the procedure and the anatomical site taking into account potential side effects, radiation exposure, availability, expertise and costs.n.a.10.0 (0.2)
B. Imaging guided interventional procedures should be conducted under adequate aseptic conditions (as detailed in box 1).n.a.10.0 (0.2)
C. Complex imaging guided interventional procedures should be conducted with adequate assistance by technical personnel.n.a.9.5 (1.7)
Specific Points to Consider
1. Imaging should be preferred over palpation to guide targeted* interventional procedures at peripheral joints and periarticular structures in patients with RMDs.3†9.7 (0.5)
2. Ultrasound should be used as the first imaging modality for interventional procedures at peripheral joints. Fluoroscopy may be used as an alternative.3†9.1 (2.1)
3. Imaging should be preferred over palpation to guide targeted* injections at structures encompassing peripheral nerves. Ultrasound should be the preferred imaging modality.3†9.9 (0.3)
4. Imaging should be used to guide targeted* injections at the spine.59.9 (0.3)
5. Imaging should be preferred over palpation for targeted* injections of the sacroiliac joint(s).3†9.9 (0.3)
6. Healthcare professionals performing imaging guided interventional procedures must have adequate skills in the respective imaging technique and the interventional procedure.58.9 (2.9)
  • Numbers in column ‘LoA’ indicate the mean and SD (in parenthesis) of the LoA (range 0–10 with 0=‘completely disagree’ to 10=‘completely agree’), as well as the percentage of task force members with an agreement ≥8.

  • *Targeted interventions are defined as procedures requiring a high level of precision to reach a specific anatomical area such as injection of small ganglia, cysts or tenosynovitis, including aspiration of small amounts of fluid or synovial biopsy.

  • †Levels of evidence were downgraded (from level 2 to level 3) because of bias related to randomisation, outcome assessment (trials and non-randomised studies), the population of interest (cross-sectional studies) and inadequate adjustment of potential confounders.

  • EULAR, European Alliance of Associations for Rheumatology; LoA, level of agreement; LoE, level of evidence; n.a., not applicable; RMDs, rheumatic and musculoskeletal diseases.