| 1. Zhang W, Doherty M, Leeb BF, et al. EULAR evidence-based recommendations for the diagnosis of hand osteoarthritis: report of a task force of ESCISIT. [Review] [100 refs]. Ann Rheum Dis. 68(1):8-17, 2009 Jan. |
Review/Other-Dx |
N/A |
To develop evidence-based recommendations for the diagnosis of hand osteoarthritis (OA). |
Ten key recommendations for diagnosis of hand OA were developed using research evidence and expert consensus. Diagnosis of hand OA should be based on assessment of a composite of features. |
4 |
| 2. Gabriel SE, Michaud K. Epidemiological studies in incidence, prevalence, mortality, and comorbidity of the rheumatic diseases. Arthritis Res Ther 2009;11:229. |
Observational-Dx |
N/A |
Toexamine a decade of progress on the descriptive epidemiology (incidence, prevalence, and survival) associated with the major rheumatic diseases. |
No results stated in abstract. |
4 |
| 3. Zhu Y, Pandya BJ, Choi HK. Prevalence of gout and hyperuricemia in the US general population: the National Health and Nutrition Examination Survey 2007-2008. Arthritis Rheum 2011;63:3136-41. |
Review/Other-Dx |
5,707 participants in NHANES 2007-2008 |
To estimate the prevalence of gout and hyperuricemia based on the latest nationally representative sample of US men and women (National Health and Nutrition Examination Survey [NHANES] 2007-2008). |
The prevalence of gout among US adults in 2007-2008 was 3.9% (8.3 million individuals). The prevalence among men was 5.9% (6.1 million), and the prevalence among women was 2.0% (2.2 million). The mean serum urate levels were 6.14 mg/dl among men and 4.87 mg/dl among women, corresponding to hyperuricemia prevalences of 21.2% and 21.6%, respectively. These estimates were higher than those in NHANES-III, with differences of 1.2% in the prevalence of gout (95% confidence interval [95% CI] 0.6, 1.9), 0.15 mg/dl in the serum urate level (95% CI 0.07, 0.24), and 3.2% in the prevalence of hyperuricemia (95% CI 1.2, 5.2). |
4 |
| 4. Czuczman GJ, Mandell JC, Wessell DE, et al. ACR Appropriateness Criteria® Inflammatory Back Pain: Known or Suspected Axial Spondyloarthritis: 2021 Update. J Am Coll Radiol 2021;18:S340-S60. |
Review/Other-Dx |
N/A |
Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for inflammatory back pain: known or suspected axial spondyloarthritis. |
No results stated in abstract. |
4 |
| 5. American College of Radiology. ACR Appropriateness Criteria®: Suspected Osteomyelitis, Septic Arthritis, or Soft Tissue Infection (Excluding Spine and Diabetic Foot). Available at: https://acsearch.acr.org/docs/3094201/Narrative/. |
Review/Other-Dx |
N/A |
Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for a specific clinical condition. |
No abstract available. |
4 |
| 6. Guggi V, Calame L, Gerster JC. Contribution of digit joint aspiration to the diagnosis of rheumatic diseases. Joint, Bone, Spine: Revue du Rhumatisme. 69(1):58-61, 2002 Jan. |
Observational-Dx |
71 patients |
To assess the diagnostic usefulness of digit joint aspiration in patients with involvement of one or more digit joints. |
Digit aspiration yielded a diagnosis of crystal deposition arthropathy in 20 (29%) of the 71 patients (gout, N = 14; calcium pyrophosphate dihydrate crystal deposition disease, N = 6). In 28 patients, the amount of fluid was too small to allow analysis. The leukocyte count indicated inflammatory disease in eight of the remaining 23 patients and mechanical disease in 15. |
2 |
| 7. Zamudio-Cuevas Y, Martinez-Nava GA, Martinez-Flores K, et al. Synovial fluid analysis for the enhanced clinical diagnosis of crystal arthropathies in a tertiary care institution. Clin Rheumatol 2021;40:3239-46. |
Observational-Dx |
264 SF analyses |
To assess the consistency between the clinical referring diagnosis and the identification of crystals, such as monosodium urate (MSU) and calcium pyrophosphate (CPP), in the synovial fluid (SF) of patients from a Mexican tertiary care institution. |
The prevalence of MSU crystals in SF was noted in 89.1% of gout cases and 9.09% of cases of calcium pyrophosphate disease (CPPD). CPP crystals were present in 54.5% of CPPD cases, 42.9% of osteoarthritis (OA) cases, and 7.27% of gout cases. Calcium hydroxyapatite (HA) crystals were identified in 5.45% of gout cases, 33.3% of rheumatoid arthritis (RA) cases, 57.1% of OA cases, and 63.6% of CPPD cases. Cholesterol and lipid crystals were present in small proportions in RA cases. Glucocorticoid crystals were observed in 1.85% of gout cases, 44.4% of RA cases, and 42.9% of OA cases. We observed an association of MSU identification with clinical suspicion of gout (P = 0.08), CPP with OA (P = 0.26) and CPPD (P = 0.50). An association was noted between HA and the diagnosis of CPPD (P = 0.84) and OA (P > 0.99). The number of initial diagnoses that changed upon SF analysis was 14.3%. |
3 |
| 8. Aoki T, Fujii M, Yamashita Y, et al. Tomosynthesis of the wrist and hand in patients with rheumatoid arthritis: comparison with radiography and MRI. AJR Am J Roentgenol. 202(2):386-90, 2014 Feb. |
Observational-Dx |
20 patients with established diagnosis of RA and 5 controls |
Tocompare tomosynthesis with radiography and MRI of the wrist and hand for evaluating bone erosion in patients with rheumatoid arthritis (RA). |
The detection rates of bone erosion for radiography, tomosynthesis, and MRI were 26.5%, 36.1%, and 36.7%, respectively. Significantly more bone erosions were revealed with tomosynthesis and MRI than with radiography (p < 0.01). When MRI was used as the reference standard, the sensitivity, specificity, and accuracy were 68.1%, 97.5%, and 86.7%, respectively, for radiography and 94.8%, 97.8%, and 96.7%, respectively, for tomosynthesis. Interobserver agreement (kappa value) for bone erosion was good to excellent on tomosynthesis and MRI for all joints (0.65-1.00 and 0.68-1.00, respectively), whereas it was slight to fair on radiography for some carpal bones and bases of metacarpal bones (0.22-0.56). |
3 |
| 9. Backhaus M, Kamradt T, Sandrock D, et al. Arthritis of the finger joints: a comprehensive approach comparing conventional radiography, scintigraphy, ultrasound, and contrast-enhanced magnetic resonance imaging. Arthritis Rheum 1999;42:1232-45. |
Experimental-Dx |
60 patients |
To compare conventional radiography, 3-phase bone scintigraphy, ultrasound, and magnetic resonance imaging (MRI) with precontrast and dynamic postcontrast examinations in patients with various forms of arthritis including rheumatoid arthritis (RA), spondyl-arthropathy, and arthritis associated with connective tissue disease. |
Clinical evaluation, scintigraphy, MRI, and ultrasound were each more sensitive than conventional radiography in detecting inflammatory soft tissue lesions as well as destructive joint processes in arthritis patients in group 1. All differences were statistically significant. We found ultrasound to be even more sensitive than MRI in the detection of synovitis. MRI detected erosions in 92 finger joints (20%; 26 patients) in group 1 that had not been detected by conventional radiography. |
1 |
| 10. Baillet A, Gaujoux-Viala C, Mouterde G, et al. Comparison of the efficacy of sonography, magnetic resonance imaging and conventional radiography for the detection of bone erosions in rheumatoid arthritis patients: a systematic review and meta-analysis. [Review]. Rheumatology (Oxford). 50(6):1137-47, 2011 Jun. |
Meta-analysis |
21 studies including 913 patients |
To evaluate the reproducibility of US and to compare its efficacy with that of MRI and conventional radiography (CR) for the detection of bone erosion in RA patients. |
Intraobserver and interobserver reproducibility of US for erosion detection was good. US and MRI efficacies were comparable at both joint (OR = 1.19, P = 0.45; seven studies, 869 joints) and patient (OR = 1.76, P = 0.22; nine studies, 338 patients) levels. US detected significantly more erosion than CR at both joint (OR = 0.30, P < 0.00001; 4047 joints studied) and patient (OR = 0.31, P < 0.00001; 592 studied patients) levels. The number of patients to screen in order to detect an additional patient with an erosion in comparison with CR was 4, 95% CI (2.4, 5.9). |
M |
| 11. Dohn UM, Ejbjerg BJ, Court-Payen M, et al. Are bone erosions detected by magnetic resonance imaging and ultrasonography true erosions? A comparison with computed tomography in rheumatoid arthritis metacarpophalangeal joints. Arthritis Research & Therapy. 8(4):R110, 2006. |
Observational-Dx |
17 patients. |
To determine the sensitivity, specificity and accuracy of MRI, US and radiography in detecting bone erosions in RA MCP joints. |
The sensitivity, specificity and accuracy, respectively, for detecting bone erosions (with CT as the reference method) were 19%, 100% and 81% for radiography; 68%, 96% and 89% for MRI; and 42%, 91% and 80% for US. When the 16 quadrants with radiographic erosions were excluded from the analysis, similar values for MRI (65%, 96% and 90%) and US (30%, 92% and 80%) were obtained. CT and MRI detected at least one erosion in all patients but none in control individuals. US detected at least one erosion in 15 patients, however, erosion-like changes were seen on US in all control individuals. Nine patients had no erosions on radiography. In conclusion, with CT as the reference method, MRI and US exhibited high specificities (96% and 91%, respectively) in detecting bone erosions in RA MCP joints, even in the radiographically non-erosive joints (96% and 92%). The moderate sensitivities indicate that even more erosions than are seen on MRI and, particularly, US are present. Radiography exhibited high specificity (100%) but low sensitivity (19%). |
2 |
| 12. Wakefield RJ, Gibbon WW, Conaghan PG, et al. The value of sonography in the detection of bone erosions in patients with rheumatoid arthritis: a comparison with conventional radiography. Arthritis Rheum. 43(12):2762-70, 2000 Dec. |
Experimental-Dx |
100 RA patients and 20 asymptomatic control subjects |
To compare sonography, a modern imaging technique, with conventional radiography for the detection of erosions in the metacarpophalangeal (MCP) joints of patients with RA. |
Sonography detected 127 definite erosions in 56 of 100 RA patients, compared with radiographic detection of 32 erosions (26 [81%] of which coincided with sonographic erosions) in 17 of 100 patients (P < 0.0001). In early disease, sonography detected 6.5-fold more erosions than did radiography, in 7.5-fold the number of patients. In late disease, these differences were 3.4-fold and 2.7-fold, respectively. On MRI, all sonographic erosions not visible on radiography (n = 12) corresponded by site to MRI abnormalities. The Cohen-kappa values for intra- and interobserver reliability of sonography were 0.75 and 0.76, respectively. |
1 |
| 13. Colebatch AN, Edwards CJ, Ostergaard M, et al. EULAR recommendations for the use of imaging of the joints in the clinical management of rheumatoid arthritis. Ann Rheum Dis. 72(6):804-14, 2013 Jun. |
Review/Other-Dx |
199 studies |
To develop evidence-based recommendations on the use of imaging of the joints in the clinical management of rheumatoid arthritis (RA). |
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. |
4 |
| 14. McQueen FM.. Imaging in early rheumatoid arthritis. [Review]. Baillieres Best Pract Res Clin Rheumatol. 27(4):499-522, 2013 Aug. |
Review/Other-Dx |
N/A |
To summarize the latest imaging advances in the field of early RA, including the role played by each modality, firstly in diagnosis and secondly in monitoring disease activity and damage. |
No results stated. |
4 |
| 15. Gandikota G, Fakuda T, Finzel S. Computed tomography in rheumatology - From DECT to high-resolution peripheral quantitative CT. [Review]. Baillieres Best Pract Res Clin Rheumatol. 34(6):101641, 2020 12. |
Review/Other-Dx |
N/A |
To discuss current updates and applications of Dual Energy Computed Tomography (DECT), iodine-DECT mapping, and high-resolution peripheral quantitative CT (HR-pQCT) in rheumatology. |
No results stated in abstract. |
4 |
| 16. Kubota K, Ito K, Morooka M, et al. FDG PET for rheumatoid arthritis: basic considerations and whole-body PET/CT. Ann N Y Acad Sci. 2011;1228:29-38. |
Review/Other-Dx |
N/A |
Review the use of FDG PET for patients with RA. |
FDG PET/computed tomography (CT) enables the detailed evaluation of disease in large joints throughout the whole body, which is a unique advantage of PET/CT. FDG PET/CT can also be used to detect high-risk disease complications, such as atlanto-axial joint involvement, at an early stage. The possible contribution of FDG PET to the management of patients with RA remains to be studied in detail. |
4 |
| 17. van der Krogt JMA, van Binsbergen WH, van der Laken CJ, Tas SW. Novel positron emission tomography tracers for imaging of rheumatoid arthritis. [Review]. Autoimmun Rev. 20(3):102764, 2021 Mar. |
Review/Other-Dx |
N/A |
To provide an overview of PET tracers, investigated in pre-clinical or clinical studies in RA, that specifically visualize immune targets (i.e. macrophages, monocytes, dendritic cells, B-/T lymphocytes, and neutrophils) or stromal targets (i.e. endothelial cells, fibroblasts). |
No results stated in abstract. |
4 |
| 18. Tan YK, Ostergaard M, Bird P, Conaghan PG. Ultrasound versus high field magnetic resonance imaging in rheumatoid arthritis. [Review]. Clin Exp Rheumatol. 32(1 Suppl 80):S99-105, 2014 Jan-Feb. |
Review/Other-Dx |
N/A |
To compare the usefulness of US and MRI in RA diagnosis, prognosis and outcome assessment. |
No results stated in abstract. |
4 |
| 19. Nakashima Y, Tamai M, Kita J, et al. Magnetic Resonance Imaging Bone Edema at Enrollment Predicts Rapid Radiographic Progression in Patients with Early RA: Results from the Nagasaki University Early Arthritis Cohort. J Rheumatol. 43(7):1278-84, 2016 07. |
Observational-Dx |
76 patients with early-stage RA. |
To clarify whether magnetic resonance imaging (MRI) bone edema predicts the development of rapid radiographic progression (RRP) in the Nagasaki University Early Arthritis Cohort of patients with early-stage rheumatoid arthritis (RA). |
RRP was found in 12 of the 76 patients at 1 year. A univariate analysis revealed that matrix metalloprotease-3, RAMRIS bone edema score, and RAMRIS bone erosion score were associated with RRP. Multivariate logistic regression analyses demonstrated that the RAMRIS bone edema score at enrollment (5-point increase, OR 2.18, 95% CI 1.32-3.59, p = 0.002) was the only independent predictor of the development of RRP at 1 year. A receiver-operating characteristic analysis identified the best cutoff value for RAMRIS bone edema score as 5. RRP was significantly rare among the patients with a RAMRIS bone edema score < 5 at enrollment (2 from 50 patients). |
3 |
| 20. Nieuwenhuis WP, van Steenbergen HW, Stomp W, et al. The Course of Bone Marrow Edema in Early Undifferentiated Arthritis and Rheumatoid Arthritis: A Longitudinal Magnetic Resonance Imaging Study at Bone Level. Arthritis rheumatol.. 68(5):1080-8, 2016 05. |
Observational-Dx |
59 patients. |
To determine the association of BME and synovitis with the development of erosions in the same bone longitudinally. |
Of the bones showing BME at baseline (n = 203), BME persisted in 56%, disappeared in 39%, and disappeared and then reappeared in 5%. Stratified analyses at baseline revealed that BME was associated with erosive progression both in the presence and in the absence of local synovitis, with odds ratios (ORs) of 7.5 (95% confidence interval [95% CI] 3.8-14.9) and 6.9 (95% CI 1.9-25.6), respectively. However, local synovitis was not associated with erosive progression in the presence or in the absence of BME (ORs of 2.0 [95% CI 0.6-7.0] and 1.9 [95% CI 0.8-4.1], respectively). In multivariable generalized estimating equation analyses, persistent BME was strongly associated with erosive progression (OR 60.5 [95% CI 16.8-218.1]) in contrast to persistent synovitis (OR 1.3 [95% CI 0.4-4.4]). |
3 |
| 21. Navalho M, Resende C, Rodrigues AM, et al. Bilateral MR imaging of the hand and wrist in early and very early inflammatory arthritis: tenosynovitis is associated with progression to rheumatoid arthritis. Radiology. 264(3):823-33, 2012 Sep. |
Experimental-Dx |
32 women and 3 men |
To identify bilateral hand and wrist findings of synovial inflammation associated with progression to rheumatoid arthritis (RA) in very-early-RA cohort (VERA) (duration, <3 months) and early-RA cohort (ERA) (duration, <12 but >3 months), to test tenosynovitis as a magnetic resonance (MR) imaging additional parameter for improving diagnostic accuracy of the 2010 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) RA classification criteria, and to evaluate the symmetry of joint and tendon involvement. |
Tenosynovitis of the extensor carpi ulnaris (odds ratio, 3.21) and flexor tendons of the second finger (odds ratio, 14.61) in VERA group and synovitis of the radioulnar joint (odds ratio, 8.79) and tenosynovitis of flexor tendons of the second finger (odds ratio, 9.60) in ERA group were significantly associated with progression to RA (P < .05). Consideration of tenosynovitis improved areas under the receiver operating characteristic curve of ACR/EULAR criteria performance for the diagnosis of RA from 0.942 (P < .0001; sensitivity, 52%; specificity, 100%) to 0.972 (P < .0001; sensitivity, 76%; specificity, 100%), with cutoff score of 6 or greater. Asymmetry was found in 80.0% (62 of 77) (VERA patients) and 69.3% (106 of 153) (ERA patients) of joint or tendon pairs (P < .05). |
2 |
| 22. Ostergaard M, Conaghan PG, O'Connor P, et al. Reducing invasiveness, duration, and cost of magnetic resonance imaging in rheumatoid arthritis by omitting intravenous contrast injection -- Does it change the assessment of inflammatory and destructive joint changes by the OMERACT RAMRIS? J Rheumatol. 2009;36(8):1806-1810. |
Observational-Dx |
86 patients and 5 controls |
We explored to what extent RA joint pathologies in wrists and metacarpophalangeal (MCP) joints can be reliably assessed by unenhanced MRI images compared with Gd-enhanced MRI as the reference method. |
Gd contrast injection appeared unimportant to MRI scores of bone erosions and bone edema in RA wrist and MCP joints. However, when post-Gd MRI was considered the standard reference, MRI without Gd provided only moderate to high agreement concerning assessment of synovitis, and omitting the post-Gd acquisitions increased the interreader variation on synovitis scores. Low-field (0.2 T) E-MRI in these exercises provided a lower sensitivity of unenhanced imaging for synovitis than MRI using higher-field strengths. |
2 |
| 23. Stomp W, Krabben A, van der Heijde D, et al. Aiming for a simpler early arthritis MRI protocol: can Gd contrast administration be eliminated? Eur Radiol. 2015;25(5):1520-1527. |
Observational-Dx |
93 patients |
To evaluate whether intravenous gadolinium (Gd) contrast administration can be eliminated when evaluating synovitis and tenosynovitis in early arthritis patients, thereby decreasing imaging time, cost, and invasiveness. |
At the individual joint/tendon level, sensitivity to detect synovitis without Gd contrast was 91 % and 72 % for the two readers, respectively, with a specificity of 51 % and 81 %. For tenosynovitis, the sensitivity was 67 % and 54 %, respectively, with a specificity of 87 % and 91 %. Pooled data analysis revealed an overall sensitivity of 81 % and specificity of 50 % for evaluation of synovitis. Variations in tenosynovitis scoring systems hindered pooled analyses. |
3 |
| 24. Spira D, Kotter I, Henes J, et al. MRI findings in psoriatic arthritis of the hands. AJR Am J Roentgenol 2010;195:1187-93. |
Review/Other-Dx |
N/A |
To provide a practical review of the spectrum of morphologic and functional MRI findings in psoriatic arthritis of the hand joints. |
The MRI findings of psoriatic arthritis include enthesitis, bone marrow edema, and periostitis accompanying articular or flexor tendon sheath synovitis in the early stage accompanied by destructive and proliferative bony changes, subluxation, and ankylosis in the late stage. |
4 |
| 25. Taniguchi Y, Kumon Y, Takata T, et al. Imaging assessment of enthesitis in spondyloarthritis. Ann Nucl Med 2013;27:105-11. |
Review/Other-Dx |
N/A |
To review imaging of enthesitis in spondyloarthritis. |
New imaging techniques including magnetic resonance imaging (MRI), ultrasonography, and positron emission tomography with computed tomography using 18F-fluorodeoxyglucose capable of detecting morphological and metabolic abnormalities and monitoring disease activity have improved the assessment and management of enthesitis of SpA. |
4 |
| 26. Sundin U, Ostergaard M, Glinatsi D, et al. Validity and Responsiveness of Combined Inflammation and Combined Joint Damage Scores Based on the OMERACT Rheumatoid Arthritis MRI Scoring System (RAMRIS). J Rheumatol. 46(9):1222-1227, 2019 09. |
Observational-Dx |
Data from 194 patients from the ARCTIC trial (derivation cohort), and 195 patients from CIMESTRA and OPERA (validation cohort). |
To investigate methods to combine the RAMRIS features into valid and responsive scores for inflammation and joint damage. |
Inflammation scores combined by normalized and weighted summation had significantly higher responsiveness in comparison to unweighted summation, with SRM (95% CI) for unweighted summation 0.62 (0.51-0.73), normalized summation 0.73 (0.63-0.83), and weighted summation 0.74 (0.64-0.84). |
3 |
| 27. Boeters DM, Nieuwenhuis WP, van Steenbergen HW, Reijnierse M, Landewe RBM, van der Helm-van Mil AHM. Are MRI-detected erosions specific for RA? A large explorative cross-sectional study. Annals of the Rheumatic Diseases. 77(6):861-868, 2018 06. |
Observational-Dx |
589 newly-presenting early arthritis patients and 193 symptom-free controls. |
To compare MRI-detected erosions of RA-patients with healthy controls and with other arthritides. |
Grade =2 erosions and MTP5-erosions were specific for RA (specificity 98-100% and 90-98% for different age-groups). MTP1-erosions were only specific if aged<40 (specificity 98%) and erosions with inflammation if aged<60 (specificity 91-100%). =1 of the mentioned erosions characteristics were present in 29% of RA-patients. Comparing RA-patients with other arthritides revealed that grade =2 erosions and MTP5-erosions remained specific for RA (specificity =89%) as well as MTP1-erosions if aged<40 (specificity 93%), in contrast to erosions combined with inflammation (specificity 49-85%). |
1 |
| 28. Eshed I, Krabbe S, Ostergaard M, et al. Influence of field strength, coil type and image resolution on assessment of synovitis by unenhanced MRI--a comparison with contrast-enhanced MRI. Eur Radiol 2015;25:1059-67. |
Observational-Dx |
41 RA patients and 12 healthy controls. |
To explore if the reliability of synovitis assessment by unenhanced MRI is influenced by different MRI field-strengths, coil types and image resolutions in RA patients. |
Fair-good agreement (ICC=0.38--0.72) between the standard reference and the different STIR protocols (best agreement with extremity coil and small voxel size at 1.5 T). The accuracy for presence/absence of synovitis was very high per person (0.80--1.0), and moderate-high per joint (0.63--0.85), whereas exact agreements on scores were moderate (0.50--0.66). The intrareader agreement (15 patients and 3 controls) on presence/absence of synovitis was very high (0.87--1.0). |
3 |
| 29. Finzel S, Ohrndorf S, Englbrecht M, et al. A detailed comparative study of high-resolution ultrasound and micro-computed tomography for detection of arthritic bone erosions. Arthritis Rheum. 63(5):1231-6, 2011 May. |
Experimental-Dx |
26 subjects (14 with rheumatoid arthritis, 6 with psoriatic arthritis, and 6 healthy controls) |
To test whether bony lesions appearing on ultrasound (US) imaging are cortical breaks detectable by micro-computed tomography (micro-CT). |
Overall there was a good correlation between the severity of erosions as assessed by US and by micro-CT (r = 0.463, P < 0.0001). False-negative results (US negative/micro-CT positive) were obtained in only 9.9% of the joint regions and were mostly due to small erosive lesions at the dorsal sides of the MCP joints. False-positive results (US positive/micro-CT negative) were more frequent (28.6%) and were primarily based on vascular bone channels at the palmar sides of the MCP joints as well pseudo-erosions created by osteophytes. |
2 |
| 30. Zayat AS, Ellegaard K, Conaghan PG, et al. The specificity of ultrasound-detected bone erosions for rheumatoid arthritis. Ann Rheum Dis. 74(5):897-903, 2015 May. |
Observational-Dx |
250 patients and 60 healthy volunteers |
To determine the specificity of ultrasound (US)-detected bone erosions (including their size) in the classical 'target' joints for RA. |
310 subjects were recruited. The inter-reader and intrareader agreements were good to excellent. US-detected bone erosions were more frequent but not specific for RA (specificity 32.9% and sensitivity 91.4%). The presence of erosions with semiquantitative score >/=2 in four target joints (2nd, 5rd MCP, 5th MTP joints and distal ulna) was highly specific for RA (specificity 97.9% and sensitivity 41.4%). Size of erosion was found to be associated with RA. Erosions of any size in the 5th MTP joint were both specific and sensitive for RA (specificity 85.4% and sensitivity 68.6%). |
2 |
| 31. Fujikawa K, Kawashiri SY, Endo Y, et al. Diagnostic efficacy of ultrasound detection of enthesitis in peripheral spondyloarthritis. Mod Rheumatol. 30(6):1060-1066, 2020 Nov. |
Observational-Dx |
136 patients. |
To investigate the diagnostic efficacy of power Doppler ultrasound (PDUS) to detect enthesitis in Japanese patients with peripheral spondyloarthritis (SpA). |
A definite diagnosis was obtained in 111 patients, including 72 with SpA and 39 non-SpA. Among the patients with SpA, PDUS demonstrated articular synovitis in 40 of the 72 patients (56%), tenosynovitis or peritendinitis in 48 (67%), and enthesitis in 63 (88%). Considering PDUS alone, enthesitis in at least one site was the most useful means of differentiating SpA from non-SpA (sensitivity 87.5%; specificity 82.1%; accuracy 85.6%; positive likelihood ratio 4.88). Combining that finding along with fulfillment of Amor, European Spondyloarthropathy Study Group, or Assessment of SpondyloArthritis international Society criteria for peripheral SpA increased the specificity of the diagnosis (92.5%, 92.3%, and 97.4%, respectively). |
3 |
| 32. Sapundzhieva T, Karalilova R, Batalov A. Hand ultrasound patterns in rheumatoid and psoriatic arthritis: the role of ultrasound in the differential diagnosis. Rheumatol Int. 40(6):837-848, 2020 Jun. |
Review/Other-Dx |
16 studies |
To focus on the literature evidence regarding the added value of ultrasound (US) of the hand in the differential diagnosis between RA and PsA. |
Overall, there was heterogeneity with regard to the pathology examined. Based on the included studies analysis, hand US patterns have several basic features to be considered-location of gray scale (GS) inflammatory findings, involvement of periarticular soft tissue, distribution and extent of Doppler signal (intra- and peri-articular), bone reaction, shape and location of erosions, involvement of tendons without synovial sheath, involvement of enthesis and nail abnormalities. Future research could focus on determining the sensitivity and specificity of the different US detected hand patterns in patients with early arthritis. |
4 |
| 33. Zabotti A, Salvin S, Quartuccio L, De Vita S. Differentiation between early rheumatoid and early psoriatic arthritis by the ultrasonographic study of the synovio-entheseal complex of the small joints of the hands. Clin Exp Rheumatol. 34(3):459-65, 2016 May-Jun. |
Observational-Dx |
34 early rheumatoid and 26 early psoriatic arthritis patients. |
To determine whether ultrasonographic findings of the synovio-entheseal complex of the hand small joints could be used to differentiate between early rheumatoid and early psoriatic arthritis. |
Synovitis was significantly more frequently detected in early rheumatoid arthritis compared to early psoriatic arthritis patients (p=0.0001), in 91.1% joints of the former and in 59.6% joints of the latter. At metacarpohalangeal joint, the presence of peritendon extensor digitorum tendon inflammation was observed in 2.5% of the joints in the early rheumatoid arthritis group and in 54.1% of the joints in the early psoriatic arthritis group (p=0.0001). At PIP joints, central slip enthesitis was exclusively observed in EPsA (p=0.0045). When considering the most clinically involved finger per patient, soft tissue oedema was detected almost exclusively in psoriatic arthritis (p=0.0002). |
3 |
| 34. Sandobal C, Carbo E, Iribas J, Roverano S, Paira S. Ultrasound nail imaging on patients with psoriasis and psoriatic arthritis compared with rheumatoid arthritis and control subjects. J Clin Rheumatol 2014;20:21-4. |
Observational-Dx |
35 patients with PsA, 20 with cutaneous psoriasis, and control groups (28 control subjects and 27 patients with rheumatoid arthritis) |
To show findings at finger nails level revealed by high-frequency gray-scale ultrasound (US) and power Doppler in patients with psoriatic arthritis (PsA),and cutaneous psoriasis compared with rheumatoid arthritis and control subjects. |
All patients and control subjects presented abnormalities in the US imaging. Those with psoriatic arthritis and cutaneous psoriasis showed a higher number of compromised nails. When classifying those abnormalities using the typology of Wortsman et al, patients with psoriatic arthritis showed loosening of the borders of the ventral plate (type II), whereas patients with cutaneous psoriasis showed focal hyperechoic involvement of the ventral plate without involvement of the dorsal plate (type I). Patients of the control group could not be classified, although 31 of 55 showed thinning of the ventral plate without hyperechoic deposits. Nineteen of 35 patients with psoriatic arthritis, and 10 of 20 patients with cutaneous psoriasis did not show any nail clinical alterations. Nevertheless, the US detected type II alterations in the first group and type I in the second group. Patients with psoriatic arthropathy had power Doppler increases in distal interphalangeal joints and nail beds in a statistically significant form (P = 0.0001).When measuring the distance between the ventral plate and the bone margin of the distal phalanx, there was homogeneity among samples in patients and control subjects. A receiver operating characteristic curve analysis determined that a cut point of 2 mm clearly defined these 2 groups. There was a significant difference (P < 0.0001) between the mean distance ventral plate-osseous margin of the distal phalanx in psoriatic arthritis patients (P = 0.001) and patients with cutaneous psoriasis (P = 0.005) versus rheumatoid arthritis patients (P = 0.548). |
3 |
| 35. Takase-Minegishi K, Horita N, Kobayashi K, et al. Diagnostic test accuracy of ultrasound for synovitis in rheumatoid arthritis: systematic review and meta-analysis. [Review]. Rheumatology. 57(1):49-58, 2018 01 01. |
Meta-analysis |
14 studies |
To evaluate diagnostic test accuracy of US compared with MRI for the detection of synovitis in RA patients. |
The diagnostic odds ratio was 11.6 (95% CI 5.6, 24; I2 = 0%), 28 (95% CI 12, 66; I2 = 11%), 23 (95% CI 6.5, 84; I2 = 19%) and 5.3 (95% CI 0.60, 48; I2 = 0%) and the AUC was 0.81, 0.91, 0.91 and 0.61 for wrist, MCP, PIP and knee joints, respectively. The summary estimates of sensitivity and specificity were 0.73 (95% CI 0.51, 0.87)/0.78 (95% CI 0.46, 0.94), 0.64 (95% CI 0.43, 0.81)/0.93 (95% CI 0.88, 0.97), 0.71 (95% CI 0.33, 0.93)/0.94 (95% CI 0.89, 0.97) and 0.91 (95% CI 0.56, 0.99)/0.60 (95% CI 0.20, 0.90) for wrist, MCP, PIP and knee joints, respectively. |
Not Assessed |
| 36. Tan YK, Li H, Allen JC Jr, Thumboo J. Ultrasound power Doppler and gray scale joint inflammation: What they reveal in rheumatoid arthritis. Int J Rheum Dis. 22(9):1719-1723, 2019 Sep. |
Observational-Dx |
30 patients |
To gain further insight into ultrasound PD and GS joint inflammation by studying their association with Disease Activity Score of 28 joints (DAS28) (a disease activity measure) and ultrasound-detected bone erosion (a structural damage measure). |
PD scores correlated with DAS28 (r = 0.46, P = 0.0104) but not with ultrasound erosion scores; GS scores correlated with ultrasound erosion (r = 0.64, P = 0.0001) but not with DAS28 scores. Simple linear regression revealed PD as predictive of DAS28 (P = 0.0104) and GS as predictive of ultrasound-detected bone erosion (P = 0.0001). |
3 |
| 37. Moller B, Aletaha D, Andor M, et al. Synovitis in rheumatoid arthritis detected by grey scale ultrasound predicts the development of erosions over the next three years. Rheumatology (Oxford). 59(7):1556-1565, 2020 07 01. |
Observational-Dx |
259 PDUS and 287 GSUS patients. |
To evaluate grey scale US (GSUS) and power Doppler US synovitis (PDUS), separately or in combination (CombUS), to predict joint damage progression in RA. |
After a median of 35 months, 69 of 250 patients with CombUS (28%), 73 of 259 patients with PDUS (28%) and 75 of 287 patients with available GSUS data (26%) demonstrated joint damage progression. PDUS beyond upper limit of normal (1/54), GSUS and CombUS each at their 50th (9/54 and 10/54) and their 75th percentiles (14/54 and 15/54) were significantly associated with ?Xray in crude and adjusted models. In subgroup analyses, GSUS beyond 14/54 and CombUS higher than 15/54 remained significantly associated with ?Xray in patients on biological DMARDs, while clinical disease activity measures had no significant prognostic power in this subgroup. |
3 |
| 38. Taylor PC, Steuer A, Gruber J, et al. Comparison of ultrasonographic assessment of synovitis and joint vascularity with radiographic evaluation in a randomized, placebo-controlled study of infliximab therapy in early rheumatoid arthritis. Arthritis Rheum 2004;50:1107-16. |
Observational-Dx |
24 patients |
To confirm the clinical and structural benefits of infliximab + MTX therapy in patients with early RA. |
Using changes in the total vdH-Sharp score over 54 weeks and changes in synovial thickening and joint vascularity at 18 weeks, we were able to distinguish those patients receiving infusions of infliximab + MTX from those receiving placebo + MTX. Sonographic measurements of synovial thickening and vascularity at baseline in the placebo + MTX group demonstrated clear relationships with the magnitude of radiologic joint damage at week 54. Infliximab + MTX treatment abolished these relationships. |
1 |
| 39. Zhao C, Wang Q, Tao X, et al. Multimodal photoacoustic/ultrasonic imaging system: a promising imaging method for the evaluation of disease activity in rheumatoid arthritis. Eur Radiol. 31(5):3542-3552, 2021 May. |
Observational-Dx |
31 patients |
To assess the clinical value of multimodal photoacoustic/ultrasound (PA/US) articular imaging scores, a novel imaging method which can reflect the micro-vessels and oxygenation level of inflamed joints of rheumatoid arthritis (RA). |
The PA-sum had high positive correlations with the standard clinical scores of RA (DAS28 [ESR] ? = 0.754, DAS28 [CRP] ? = 0.796, SDAI ? = 0.836, CDAI ? = 0.837, p < 0.001), which were superior to the PD-sum (DAS28 [ESR] ? = 0.651, DAS28 [CRP] ? = 0.676, SDAI ? = 0.716, CDAI ? = 0.709, p < 0.001). For the patients with high PA-sum scores, significant differences between hypoxia and hyperoxia were identified in pain visual analog score (p = 0.020) and patient's global assessment (p = 0.026). The PA+SO2 patterns presented moderate and high correlation with PGA (? = 0.477, p = 0.0077) and VAS pain score (? = 0.717, p < 0.001). |
2 |
| 40. Zhao C, Wang Q, Wang M, et al. Ultra-microangiography in evaluating the disease activity of rheumatoid arthritis and enhancing the efficacy of ultrasonography: A preliminary study. Eur J Radiol. 137:109567, 2021 Apr. |
Observational-Dx |
52 patients |
To investigate the feasibility of UMA in assessing disease activity and identify the clinical value of the UMA feature for evaluating rheumatoid arthritis (RA). |
Synovial blood vessel signals were detected for 68 by PDUS and for 93 by UMA (display rate of blood vessel signals: 18.68 % VS 25.55 %). UMA presented better display capability of blood vessels within the inflamed regions than that of PDUS in overall. Significant differences were detected in clinical scores (P < 0.0001 for DAS28 [ESR], DAS28 [CRP], SDAI, CDAI, CRP P = 0.0303, SJC P = 0.0059, and TJC P = 0.0423) between Group 2 and 3. Significant correlations between the groups and clinical parameters were also observed (DAS28 [ESR] ?=0.750; DAS28 [CRP] ?=0.762; SDAI ?=0.778; CDAI ?=0.773; CRP ?= 0.524; SJC ?=0.742; TJC ?=0.693, P < 0.0001), indicating that the UMA feature was related to high disease activity. |
2 |
| 41. Witt M, Mueller F, Nigg A, et al. Relevance of grade 1 gray-scale ultrasound findings in wrists and small joints to the assessment of subclinical synovitis in rheumatoid arthritis. Arthritis Rheum. 65(7):1694-701, 2013 Jul. |
Observational-Dx |
100 patients with early or established RA and 30 healthy controls |
To investigate the clinical relevance of grade 1 findings on gray-scale ultrasound (GSUS) of the joints in patients with rheumatoid arthritis (RA). |
Grade 1 results represented the majority of all GSUS findings in patients with RA and were also frequently recorded in healthy controls. Grade 1 GSUS findings were not associated with tenderness, swelling, or positive results on PDUS. In comparison to joints with grade 2 and grade 3 findings on GSUS, joints with grade 1 findings were less likely to respond to treatment. |
3 |
| 42. Witt MN, Mueller F, Weinert P, et al. Ultrasound of synovitis in rheumatoid arthritis: advantages of the dorsal over the palmar approach to finger joints. J Rheumatol. 41(3):422-8, 2014 Mar. |
Observational-Dx |
70 patients |
To compare the dorsal and palmar ultrasound (US) examination of finger joints in early rheumatoid arthritis (RA) with regard to the concurrence of greyscale (GSUS) and power Doppler (PDUS) positivity, and to correlate both approaches with clinical variables. |
With 44.6% versus 32.2% positive findings, palmar GSUS identified significantly more joints with synovitis than did dorsal GSUS. With 22.1% versus 8.9%, PDUS abnormalities were detected significantly more often from the dorsal side. With 71.2% versus 21.8% for the MCP and 57.5% versus 17.4% for the PIP joints, significantly more GSUS and PDUS double-positive joints were found with the dorsal as opposed to the palmar approach. These differences remained significant at Month 6. Both palmar and dorsal GSUS and PDUS correlated with comparable strength with clinical variables such as the Disease Activity Score 28, Clinical Disease Activity Index, and Simple Disease Activity Index. |
2 |
| 43. Backhaus M, Ohrndorf S, Kellner H, et al. Evaluation of a novel 7-joint ultrasound score in daily rheumatologic practice: a pilot project. Arthritis Rheum. 61(9):1194-201, 2009 Sep 15. |
Observational-Dx |
120 patients |
To introduce a new standardized ultrasound score based on 7 joints of the clinically dominant hand and foot (German US7 score) implemented in daily rheumatologic practice. |
One hundred twenty patients (76% women) with rheumatoid arthritis (91%) and psoriatic arthritis (9%) were enrolled. In 52 cases (43%), erosions were seen in radiography at baseline. Patients received DMARDs (41%), DMARDs plus TNFalpha inhibitors (41%), or TNFalpha inhibitor monotherapy (18%). At baseline, the mean DAS28 was 5.0 and the synovitis scores were 8.1 in GS ultrasound and 3.3 in PD ultrasound. After 6 months of therapy, the DAS28 significantly decreased to 3.6 (Delta = 1.4), and the GS and PD ultrasound scores significantly decreased to 5.5 (-32%) and 2.0 (-39%), respectively. |
2 |
| 44. Ohrndorf S, Halbauer B, Martus P, et al. Detailed Joint Region Analysis of the 7-Joint Ultrasound Score: Evaluation of an Arthritis Patient Cohort over One Year. Int J Rheumatol. 2013;2013:493848. |
Observational-Dx |
45 patients |
The main objective of this study was to evaluate the 7-joint ultrasound (US7) score by detailed joint region analysis of an arthritis patient cohort. |
The joint region analysis performed at baseline disclosed synovitis in 95.6% of affected wrists in the dorsal aspect by greyscale (GS) US where Grade 2 (moderate) was most often (48.9%) detected. Palmar wrist regions presented Grade 1 (minor) capsule elevation in 40% and Grade 2 (moderate synovitis) in 37.8%. Tenosynovitis of the extensor carpi ulnaris (ECU) tendon was found in 40%, with PD activity in 6.6%. Most of the erosions in MCP II were detected in the radial (68.9%), followed by the dorsal (48.9%) and palmar (44.4%) aspects. In MTP V, erosions were seen in 75.6% from lateral. |
3 |
| 45. Rosa J, Ruta S, Saucedo C, et al. Does a Simplified 6-Joint Ultrasound Index Correlate Well Enough With the 28-Joint Disease Activity Score to Be Used in Clinical Practice?. J. clin. rheumatol.. 22(4):179-83, 2016 Jun. |
Observational-Dx |
60 patients |
We compared 3 US indices (with different numbers of joints) with disease activity measured by the 28-Joint Disease Activity Score (DAS28) in order to find the most parsimonious index still useful in clinical practice. |
All 3 US indices were significantly higher in patients with active disease versus inactive disease (P < 0.05 for all 3). Ultrasound index C showed the best correlation with DAS28 (rho = 0.5020, P < 0.0001) and a very good discriminative value for moderate to high disease activity (DAS28 >3.2) and for absence of remission (DAS28 >2.6) (areas under receiver operating characteristic curve = 0.75 and 0.80, respectively). A cutoff value of 3 in US index C showed sensitivity of 88.89% and specificity of 66.67% for absence of remission. Correlation between the 3 US indices was excellent. |
1 |
| 46. Kuo D, Morris NT, Kaeley GS, et al. Sentinel joint scoring in rheumatoid arthritis: an individualized power Doppler assessment strategy. Clin Rheumatol. 40(3):1077-1084, 2021 Mar. |
Review/Other-Dx |
54 RA patients |
To evaluate a novel patient-centered method for constructing a longitudinal ultrasound score in RA patients. |
At baseline, 1236/1829 joints scanned (67.5%) did not have PDUS signal. The proportion of "flipped" joints at 24 weeks was 5.6% for = 1, 2.9% for = 2, and 1.0% for = 3 PD. tPDUS and SJS scores were highly correlated (r = 0.91 to 0.97). Overall the effect sizes for tPDUS, SJS, and US7 increased over 24 weeks, where SJS was the highest (SJS 1.00 4-week, 1.07 12-week, 1.26 24-week) and tPDUS and US7 were comparable (tPDUS 0.32 4-week, 0.52 12-week, 0.84 24-week; US7 0.23 4-week, 0.52 12-week, 0.74 24-week). |
4 |
| 47. Gamala M, Jacobs JWG, van Laar JM. The diagnostic performance of dual energy CT for diagnosing gout: a systematic literature review and meta-analysis. Rheumatology (Oxford). 58(12):2117-2121, 2019 12 01. |
Meta-analysis |
Ten studies. |
This study aimed to assess the utility of dual energy CT (DECT) for diagnosing gout. |
In person-based evaluations, the pooled (95% CI) sensitivity and specificity were 0.81 (0.77, 0.86) and 0.91 (0.85, 0.95), respectively. In joint-based evaluations, they were 0.83 (0.79, 0.86) and 0.88 (0.83, 0.92), respectively. At short disease duration (?6 weeks), the pooled (95% CI) sensitivity and specificity at the joint level were 0.55 (0.46, 0.64) and 0.89 (0.84, 0.94), respectively. |
Good |
| 48. Lee YH, Song GG. Diagnostic accuracy of dual-energy computed tomography in patients with gout: A meta-analysis. [Review]. Semin Arthritis Rheum. 47(1):95-101, 2017 08. |
Meta-analysis |
Eight studies including 510 patients with gout and 268 controls. |
To evaluate the diagnostic performance of dual-energy computed tomography (DECT) for patients with gout. |
The pooled sensitivity and specificity of DECT were 84.7% (95% confidence interval [CI]: 81.3-87.7) and 93.7% (93.0-96.3), respectively. The positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were 9.882 (6.122-15.95), 0.163 (0.097-0.272), and 78.10 (31.14-195.84), respectively. The area under the curve of DECT was 0.956 and the Q* index was 0.889, indicating a high diagnostic accuracy. Some between-study heterogeneity was found in the meta-analyses. However, there was no evidence of a threshold effect (Spearman correlation coefficient = 0.419; p = 0.035). |
Good |
| 49. Yu Z, Mao T, Xu Y, et al. Diagnostic accuracy of dual-energy CT in gout: a systematic review and meta-analysis. [Review]. Skeletal Radiol. 47(12):1587-1593, 2018 Dec. |
Meta-analysis |
Seven studies. |
To evaluate the accuracy of DECT in the diagnosis of gout. |
The analysis results presented the pooled sensitivity was 88% (95% CI 84-90%) and specificity was 90% (95% CI 85-93%). Then, we figured out that the pooled PLR was 8.48 (95% CI 5.89-12.22) and NLR was 0.10 (95% CI 0.04-0.24) respectively. In addition, Cochran-Q was 0.90 and AUC was 0.9565 in sROC curve. |
Good |
| 50. Sivera F, Andres M, Falzon L, van der Heijde DM, Carmona L. Diagnostic value of clinical, laboratory, and imaging findings in patients with a clinical suspicion of gout: a systematic literature review. J Rheumatol Suppl. 2014;92:3-8. |
Review/Other-Dx |
19 studies |
To analyze the diagnostic utility of clinical, laboratory, and imaging items for gout. |
Nineteen studies were included in the review; 4 used the identification of monosodium urate (MSU) crystals as the reference standard (RS) and the rest used expert opinion or the ACR preliminary criteria. Most features were evaluated in a single study. Evidence for diagnostic utility, using MSU crystals as RS, of over 50 individual clinical, laboratory, and radiographic features was retrieved. Most items showed a positive likelihood ratio (LR+) < 3, except for the following: response of arthritis to colchicine (LR+ 4.3); presence of tophi on physical examination (LR+ 15.6-30.9); identification of the double-contour sign in ultrasound (US) (LR+ 13.6); and detection of urate deposits by dual-energy computed tomography (DECT) (LR+ 9.5) |
4 |
| 51. Klauser AS, Halpern EJ, Strobl S, et al. Gout of hand and wrist: the value of US as compared with DECT. Eur Radiol. 28(10):4174-4181, 2018 Oct. |
Observational-Dx |
180 patients |
To compare findings of ultrasound (US) with dual-energy CT (DECT) in patients presenting with suspected gouty hand and wrist arthritis. |
The final diagnosis of gout was positive in 97/180 patients (53.9%) by DECT, an alternative diagnosis confirmed in 83 patients. US showed a sensitivity of 70.1% (extra-articular: 42.5%, p < 0.0001; intra-articular: 80.3%, p = 0.14) and specificity of 51%. The double contour sign (DCS) was present in 58/61 patients with a positive US study for intra-articular gout (95.1%). |
1 |
| 52. Wang Y, Deng X, Xu Y, Ji L, Zhang Z. Detection of uric acid crystal deposition by ultrasonography and dual-energy computed tomography: A cross-sectional study in patients with clinically diagnosed gout. Medicine (Baltimore). 97(42):e12834, 2018 Oct. |
Observational-Dx |
60 patients |
To compare the performance of ultrasonography (US) and dual-energy computed tomography (DECT) in detecting the crystal deposition at lower extremity joints in patients with gout. |
We found that US can detect significantly more patients with crystal deposition than DECT (81.7% vs 56.7%, by US and DECT, respectively, P < .001). The frequency of urate crystal deposition detected by US at MTP1, knee, and ankle joints regions was 56.7%, 63.3%, and 51.7%, respectively. The percentage of positivity of double contour sign on US was 33.3%, 48.3%, and 41.7% at the joints mentioned above, respectively. There was a good correlation between ultrasound and synovial fluid analysis in detecting crystal deposition (? = 0.87, P = .001), while the agreement between DECT and synovial fluid analysis was just fair (? = 0.28, P = .02). |
1 |
| 53. Zou Z, Yang M, Wang Y, Zhang B. Gout of ankle and foot: DECT versus US for crystal detection. Clin Rheumatol. 40(4):1533-1537, 2021 Apr. |
Observational-Dx |
50 patients |
To compare dual-energy computed tomography (DECT) and ultrasound (US) in detecting monosodium urate (MSU) crystals in the ankle and foot in patients with acute gouty arthritis. |
At the patient level, the overall positivity of crystal deposition detected by DECT was higher than that by US (92% vs 68%, P = 0.005). The agreement of detecting crystal deposition between DECT and US was not very strong (? = 0.44, P = 0.003). At different joint/area levels, there were significant differences between the two examinations in the area of the dorsum (36% vs 12%, P = 0.009) and metatarsal bone (34% vs 12%, P = 0.017), but the sensitivity of DECT and US was similar in the first metatarsophalangeal joint (MTP) and ankle areas (P>0.05). Agreement between the two examinations in the ankle and first MTP was very strong (? = 0.86, P < 0.001; ? = 0.79, P < 0.001, respectively). |
2 |
| 54. Araujo EG, Bayat S, Petsch C, et al. Tophus resolution with pegloticase: a prospective dual-energy CT study. RMD Open. 1(1):e000075, 2015. |
Observational-Tx |
10 patients with refractory gout and baseline mean SUA level of 8.1 mg/dL |
To investigate the effect of intensive lowering of serum uric acid (SUA) levels by pegloticase on the resolution of tophi in patients with refractory gout. |
Patients were treated for a mean of 13.3 weeks. Pegloticase effectively reduced tophi in all patients showing a decrease in volume by 71.4%. Responders, showing reduction of SUA level below 6 mg/dL during at least 80% of the treatment time, were virtually cleared from tophi (-94.8%). Dependent on their anatomical localisation, resolution of tophi showed different dynamics, with articular tophi showing fast, and tendon tophi slow, resolution. |
1 |
| 55. Richette P, Doherty M, Pascual E, et al. 2018 updated European League Against Rheumatism evidence-based recommendations for the diagnosis of gout. Ann Rheum Dis. 79(1):31-38, 2020 01. |
Review/Other-Dx |
N/A |
To update the 2006 EULAR recommendations for the diagnosis of gout. |
No results stated in abstract. |
4 |
| 56. Wallace SL, Robinson H, Masi AT, Decker JL, McCarty DJ, Yu TF. Preliminary criteria for the classification of the acute arthritis of primary gout. Arthritis Rheum 1977;20:895-900. |
Review/Other-Dx |
706 patients |
To develop criteria for classifying a patient as having gout. |
Criteria for classifying a patient as having gout were a) the presence of characteristic urate crystals in the joint fluid, and/or b) a topus proved to contain urate crystals by chemical or polarized light microscopic means, and/or c) the presence of six of the twelve clinical, laboratory, and X-ray phenomena listed in Table 5. |
4 |
| 57. McQueen FM, Doyle A, Reeves Q, et al. Bone erosions in patients with chronic gouty arthropathy are associated with tophi but not bone oedema or synovitis: new insights from a 3 T MRI study. Rheumatology (Oxford). 2014;53(1):95-103. |
Experimental-Dx |
40 gout patients |
To use MRI scans to explore associations between bone erosion, bone oedema, synovitis and tophi in gout with a view to clarifying the processes underlying bone erosion and joint damage. |
Interreader reliability was high for erosions and tophi [intraclass correlation coefficients (ICCs) 0.77 (95% CI 0.71, 0.87) and 0.71 (95% CI 0.52, 0.83)] and moderate for bone oedema [ICC = 0.60 (95% CI 0.36, 0.77)]. Compared with DECT, MRI had a specificity of 0.98 (95% CI 0.93, 0.99) and sensitivity of 0.63 (95% CI 0.48, 0.76) for tophi. Erosions were detected in 63% of patients and were strongly associated with tophi [odds ratio (OR) = 13.0 (95% CI 1.5, 113)]. In contrast, no association was found between erosions and bone oedema. Using concordant data, bone oedema was scored at 6/548 (1%) sites in 5/40 patients (12.5%) and was very mild (median carpal score = 1, maximum = 45). In logistic regression analysis across all joints nested within individuals, tophus, but not synovitis, was independently associated with erosion [OR = 156.5 (21.2, >999.9), P < 0.0001]. |
1 |
| 58. Gutierrez M, Schmidt WA, Thiele RG, et al. International Consensus for ultrasound lesions in gout: results of Delphi process and web-reliability exercise. Rheumatology (Oxford) 2015;54:1797-805. |
Observational-Dx |
32 participants |
To produce consensus-based definitions of the US elementary lesions in gout and to test their reliability in a web-based exercise. |
A total of 32 participants responded to the questionnaires. Good agreement (>80%) was obtained for US definitions on DC, tophus, aggregates and erosion in the Delphi exercise after three rounds. The reliability on images showed inter-reader ? values for DC, tophus, aggregates, erosion findings of 0.98, 0.71, 0.54 and 0.85, respectively. The mean intra-reader ? values were also acceptable: 0.93, 0.78, 0.65 and 0.78, respectively. |
3 |
| 59. Christiansen SN, Ostergaard M, Slot O, Fana V, Terslev L. Ultrasound for the diagnosis of gout-the value of gout lesions as defined by the Outcome Measures in Rheumatology ultrasound group. Rheumatology (Oxford). 60(1):239-249, 2021 01 05. |
Observational-Dx |
82 patients. |
To evaluate ultrasound for diagnosing gout using consensus-based Outcome Measures in Rheumatology ultrasound definitions of gout lesions. |
Eighty-two patients (70 men), mean age 62.4 (range 19-88) years, were included. Fifty-seven patients were MSU-positive whereas 25 patients were MSU-negative (no MSU crystals: 23; aspiration unsuccessful: 2). Of these 25 patients, three patients were classified as ACR/EULAR-positive (i.e. totally 60 ACR/EULAR-positive patients). All ultrasound lesions had high sensitivities for gout (0.77-0.95). DC and tophus showed high specificities (0.88-0.95), positive predictive values (0.94-0.98) and accuracies (0.82-0.84) when both reference standards were used. In contrast, low specificities were found for aggregates and erosions (0.32-0.59). |
3 |
| 60. Ogdie A, Taylor WJ, Weatherall M, et al. Imaging modalities for the classification of gout: systematic literature review and meta-analysis. Ann Rheum Dis. 2014. |
Meta-analysis |
11 studies (9 manuscripts and 2 meeting abstracts) |
To examine the usefulness of imaging modalities in the classification of gout when compared to monosodium urate (MSU) crystal confirmation as the gold standard, in order to inform development of new gout classification criteria. |
All studies were set in secondary care, with mean gout disease duration of at least 7 years. Three features were examined in more than one study: the double contour sign (DCS) on US, tophus on US, and MSU crystal deposition on DECT. The pooled (95% CI) sensitivity and specificity of US DCS were 0.83 (0.72 to 0.91) and 0.76 (0.68 to 0.83), respectively; of US tophus, were 0.65 (0.34 to 0.87) and 0.80 (0.38 to 0.96), respectively; and of DECT, were 0.87 (0.79 to 0.93) and 0.84 (0.75 to 0.90), respectively. |
M |
| 61. Cazenave T, Martire V, Reginato AM, et al. Reliability of OMERACT ultrasound elementary lesions in gout: results from a multicenter exercise. Rheumatol Int. 39(4):707-713, 2019 04. |
Observational-Dx |
16 patients; 63 sonographers |
To evaluate the reliability of the outcome measures in rheumatology (OMERACT) definitions for ultrasound (US) elementary lesions in gout through an image reading exercise. |
Participants were stratified according to their level of experience. In the first exercise, inter-reader kappa values were 0.45 for aggregates, 0.57 for tophus, 0.69 for erosions, and 0.90 for double contour (DC). Intra-reader kappa values were 0.86, 0.76, 0.80, and 0.90, respectively. The web-based exercise showed inter-reader kappa values for aggregates, tophus, erosions, and DC of 0.42, 0.49, 0.69, and 0.79, respectively. The intra-reader kappa values were 0.62, 0.69, 0.77, and 0.85, respectively. Reliability was not influenced by the sonographer's level of experience |
3 |
| 62. Chowalloor PV, Keen HI. A systematic review of ultrasonography in gout and asymptomatic hyperuricaemia. Ann Rheum Dis. 2013;72(5):638-645. |
Review/Other-Dx |
N/A |
To undertake a systematic review evaluating US as an outcome tool in gout and asymptomatic hyperuricaemia. |
US was less sensitive than MRI to cortical erosions in gout, but better than conventional radiography. Interobserver reliability when assessed ranged from fair to substantial agreement for soft tissue changes and was very good for assessing tophi, double contour and erosions. US is a promising tool which could be used in the diagnosis and management of gout. More studies are needed to assess responsiveness, reliability and feasibility. |
4 |
| 63. Zhang B, Yang M, Wang H. Diagnostic value of ultrasound versus dual-energy computed tomography in patients with different stages of acute gouty arthritis. Clin Rheumatol. 39(5):1649-1653, 2020 May. |
Observational-Dx |
41 patients |
To compare the diagnostic value of US and DECT in patients with different stages of acute gouty arthritis. |
In the early-stage group, the sensitivity of US was significantly higher than DECT in identifying MSU deposition (66.7% vs 26.6%, p < 0.05), while in the middle- and late-stage groups, the sensitivity of US and DECT was similar. In the early-stage group, the US results in nine joints were positive (four with double contour sign, four with snowstorm sign, and one with both double contour sign and snowstorm sign), while DECT did not show any urate crystal deposits. |
2 |
| 64. Ebstein E, Forien M, Norkuviene E, et al. Ultrasound evaluation in follow-up of urate-lowering therapy in gout: the USEFUL study. Rheumatology (Oxford). 58(3):410-417, 2019 03 01. |
Observational-Dx |
79 patients. |
To determine the ability of ultrasonography (US) to show disappearance of urate deposits in gouty patients requiring urate-lowering therapy (ULT). |
We included 79 gouty patients (mean ± s.d., age 61.8 (14) years, 91% males, disease duration 6.3 (6.1) years). Baseline SU level was 530 ± 97 µmol/l (i.e. 8.9 mg/dl ± 1.6mg/dl). At least one US tophus and double contour sign was observed in 74 (94%) and 68 (86%) patients, respectively. Among the 67 completers at M6, 18 and 39 achieved a very low and low SU level, respectively. We found a significant decrease in US features of gout among patients with the lowest SU level (P < 0.001). Final M6 SU level was positively correlated with decreased size of tophus (r = 0.54 [95% CI: 0.34, 0.70], P < 0.0001), and inversely correlated with proportion of double contour sign disappearance (r=-0.59 [-0.74, -0.40]). |
3 |
| 65. Hammer HB, Karoliussen L, Terslev L, Haavardsholm EA, Kvien TK, Uhlig T. Ultrasound shows rapid reduction of crystal depositions during a treat-to-target approach in gout patients: 12-month results from the NOR-Gout study. Ann Rheum Dis. 79(11):1500-1505, 2020 11. |
Observational-Dx |
209 patients |
To explore the main locations for depositions and the extent of dissolution of depositions during a treat-to-target approach with urate lowering treatment (ULT) in patients with gout. |
The serum urate levels decreased from baseline to 12 months (mean (SD) 500 (77) to 312 (49) µmol/L) (p<0.001)). The first metatarsophalangeal joint was the most frequent location for all the elementary lesions and erosions were associated with higher levels of crystal depositions. From baseline to 12 months, mean sum scores decreased for DC (4.3 to 1.3), tophi (6.5 to 3.8) and aggregates (9.3 to 6.7) (p<0.001 for all), with DC being most sensitive to change. The intrarater reliability (SD) was 0.96 (0.11) and 0.88 (0.11) for the two sonographers, while the inter-rater reliability was 0.89 (0.11) in the first round and 0.81 (0.11) in the second round. The intra-rater close agreement was 100% for both sonographers and the inter-rater close agreement was 98.7% in the first round and 96.2% in the second round. |
2 |
| 66. Zhang W, Doherty M, Bardin T, et al. European League Against Rheumatism recommendations for calcium pyrophosphate deposition. Part I: terminology and diagnosis. Ann Rheum Dis. 70(4):563-70, 2011 Apr. |
Review/Other-Dx |
N/A |
To agree terminology and to develop recommendations for the diagnosis of calcium pyrophosphate deposition (CPPD). |
It was agreed that 'CPPD' should be the umbrella term that includes acute calcium pyrophosphate (CPP) crystal arthritis, osteoarthritis (OA) with CPPD and chronic CPP crystal inflammatory arthritis. Chondrocalcinosis (CC) defines cartilage calcification, most commonly due to CPPD and detected by imaging or histological examination. A total of 11 key recommendations were generated on the topics of clinical features, synovial fluid (SF) examination, imaging, comorbidities and risk factors. Definitive diagnosis of CPPD relies on identification of SF CPP crystals. Rapid onset inflammatory symptoms and signs are suggestive but not definitive for acute CPP crystal arthritis. Radiographic CC is not highly sensitive or specific, whereas ultrasonography appears more useful (LR=24.2, 95% CI 3.51 to 168.01) for peripheral joints. Recognised risk factors for CPPD include ageing, OA and metabolic conditions such as primary hyperparathyroidism, haemochromatosis and hypomagnesaemia; familial forms are rare. SORs varied from 53 to 99 (maximum 100). |
4 |
| 67. Ramonda R, Musacchio E, Perissinotto E, et al. Prevalence of chondrocalcinosis in Italian subjects from northeastern Italy. The Pro.V.A. (PROgetto Veneto Anziani) study. Clin Exp Rheumatol 2009;27:981-4. |
Review/Other-Dx |
1629 subjects |
To undertake an epidemiological survey of the prevalence of radiological chondrocalcinosis (CC) of the lower limbs in the elderly Italian population of the Pro.V.A. study. |
Chondrocalcinosis (CC) was found in 169 (mean age 78.2 + or - 8.0 yrs) out of the 1629 subjects studied (10.4%). After adjusting for the sex and age structure of the target population, the prevalence was 10.0%. CC was more often observed in women than in men (M: 7.0%; F: 12.8%, p=0.0002), and increased in occurrence with age, rising from 7.8% in subjects aged 65-74 yrs, to 9.4% in those aged 75-84 yrs, and to 21.1% in subjects older than 85 yrs. The knee was the most prevalent location since it was affected in 94.1% of all the subjects with CC, in particular the right limb. Knee CC was bilateral in 71.7% of the affected patients. The occurrence of rheumatic disorders did not differ significantly between the subjects with CC and those without (rheumatoid arthritis 0.59% vs. 0.48%, p=ns). |
4 |
| 68. Filippou G, Adinolfi A, Cimmino MA, et al. Diagnostic accuracy of ultrasound, conventional radiography and synovial fluid analysis in the diagnosis of calcium pyrophosphate dihydrate crystal deposition disease. Clin Exp Rheumatol. 34(2):254-60, 2016 Mar-Apr. |
Observational-Dx |
42 patients |
To assess the diagnostic performance of ultrasound (US), x-rays, and microscopic analysis of synovial fluid (SF) for calcium pyrophosphate dihydrate crystal deposition disease (CPPD) using histology as a reference standard. |
25 patients (59.5%) were positive for CPP at US, 15 (44.1%) at X-ray and 14 (43.7%) at SF. Sensitivity and specificity values were 96% and 87% for US, 75% and 93% for radiography and 77% and 100% for SF respectively. |
3 |
| 69. McQueen FM, Doyle A, Dalbeth N. Imaging in the crystal arthropathies. Rheum Dis Clin North Am 2014;40:231-49. |
Review/Other-Dx |
N/A |
To review the use of imaging techniques in the crystal arthropathies, with an emphasis on recent advances in this field and evolving clinical applications. |
No results stated in abstract. |
4 |
| 70. Budzik JF, Marzin C, Legrand J, Norberciak L, Becce F, Pascart T. Can Dual-Energy Computed Tomography Be Used to Identify Early Calcium Crystal Deposition in the Knees of Patients With Calcium Pyrophosphate Deposition?. Arthritis rheumatol.. 73(4):687-692, 2021 04. |
Observational-Dx |
132 knee DECT scans from patients with suspected crystal-associated arthropathy |
To assess the ability of dual-energy computed tomography (DECT) in identifying early calcium crystal deposition in menisci and articular cartilage of the knee, depending on the presence/absence of chondrocalcinosis seen on conventional CT. |
In both menisci and articular cartilage, and for all 5 DECT attenuation parameters, calcified ROIs in CPPD patients showed significantly higher values than ROIs in controls (P = 0.036). Conversely, noncalcified ROIs in CPPD patients were comparable with those in controls (P = 0.09). While specific DECT parameters yielded good accuracy (area under the curve [AUC] 0.87-0.88) in differentiating calcified ROIs in CPPD patients from ROIs in controls, DECT failed to distinguish between noncalcified ROIs in CPPD patients and controls (AUC 0.58-0.59). |
3 |
| 71. Tanikawa H, Ogawa R, Okuma K, et al. Detection of calcium pyrophosphate dihydrate crystals in knee meniscus by dual-energy computed tomography. J. ORTHOP. SURG.. 13(1):73, 2018 Apr 05. |
Observational-Dx |
26 patients |
To investigate the efficacy of a dual-energy computed tomography (DECT) for detecting CPPD crystals in knee meniscus. |
CPPD crystals in synovial fluid were observed in 9 (36%) patients. The sensitivity and specificity of DECT in the detection of CPPD crystals, against microscopic identification, were 77.8 and 93.8%, respectively. The sensitivity and specificity of conventional radiography in the detection of CPPD crystals were 44.4 and 100%, respectively. |
2 |
| 72. Sullivan J, Pillinger MH, Toprover M. Chondrocalcinosis: Advances in Diagnostic Imaging. [Review]. Curr Rheumatol Rep. 23(10):77, 2021 10 08. |
Review/Other-Dx |
N/A |
To highlight recent updates in the imaging of CPPD. |
No results stated in abstract. |
4 |
| 73. Gutierrez M, Di Geso L, Salaffi F, et al. Ultrasound detection of cartilage calcification at knee level in calcium pyrophosphate deposition disease. Arthritis Care Res (Hoboken). 2014;66(1):69-73. |
Observational-Dx |
74 CPDD patients and 83 controls |
To determine the sensitivity, specificity, and accuracy of ultrasound (US) in the detection of cartilage calcification at knee level in patients with calcium pyrophosphate deposition disease (CPDD) and to assess the interobserver reliability. |
A total of 314 knees in 157 patients (74 with CPDD, 19 with rheumatoid arthritis, 17 with spondyloarthritis, 32 with osteoarthritis, and 15 with gout) were assessed. In the 74 patients with CPDD, hyaline cartilage spots were detected by US in at least 1 knee in 44 patients (59.5%), whereas radiography detected hyaline cartilage spots in 34 patients (45.9%) (P < 0.001). Meniscal fibrocartilage calcifications were detected by US in 67 of the 74 CPDD patients (90.5%), whereas conventional radiography detected calcifications in 62 patients (83.7%) (P = 0.011). The criterion validity expressed as percentage of sensitivity, specificity, and accuracy of US in the detection of articular cartilage calcification was high. Both kappa values and overall agreement percentages showed moderate to excellent agreement. |
2 |
| 74. Lee KA, Lee SH, Kim HR. Diagnostic value of ultrasound in calcium pyrophosphate deposition disease of the knee joint. Osteoarthritis Cartilage. 27(5):781-787, 2019 05. |
Observational-Dx |
43 patients with CPPD and 131 controls. |
To assess the diagnostic performance of ultrasound (US) for calcium pyrophosphate deposition (CPPD) at the level of menisci, hyaline cartilage (HC), tendons, and synovial fluid (SF) of the knee, and to examine inter- and intra-observer reliability. |
US revealed calcium pyrophosphate (CPP) deposits in menisci, HC, and tendon more frequently in patients with CPPD than in control patients. The presence of US CPP deposits in SF was not significantly different between the two groups. Combined US evaluation of the three components (menisci, HC, and tendon) showed the best diagnostic performance. The sensitivity and specificity for US evaluation of the three components were 74.4% and 77.1%, respectively, while for CR evaluation, the sensitivity and specificity were 44.2% and 96.9%, respectively. Inter- and intra-observer agreement were excellent for medial (? = 0.930, 0.972) and lateral menisci (? = 0.905, 0.942), HC (? = 0.844, 0.957), and SF (? = 0.817, 0.925). Tendon showed fair inter-observer (? = 0.532) and good intra-observer reliability (? = 0.788). |
2 |
| 75. Filippou G, Scanu A, Adinolfi A, et al. Criterion validity of ultrasound in the identification of calcium pyrophosphate crystal deposits at the knee: an OMERACT ultrasound study. Ann Rheum Dis. 80(2):261-267, 2021 02. |
Observational-Dx |
68 patients. |
To evaluate the discriminatory ability of ultrasound in calcium pyrophosphate deposition disease (CPPD), using microscopic analysis of menisci and knee hyaline cartilage (HC) as reference standard. |
Of 101 enrolled patients, 68 were included in the analysis. In 38 patients, the surgical specimens were insufficient. The overall diagnostic accuracy of ultrasound for CPPD was of 75%-sensitivity of 91% (range 71%-87% in single sites) and specificity of 59% (range 68%-92%). The best sensitivity and specificity were obtained by assessing in combination by ultrasound the medial meniscus and the medial condyle HC (88% and 76%, respectively). |
1 |
| 76. Wittoek R, Jans L, Lambrecht V, Carron P, Verstraete K, Verbruggen G. Reliability and construct validity of ultrasonography of soft tissue and destructive changes in erosive osteoarthritis of the interphalangeal finger joints: a comparison with MRI. Ann Rheum Dis. 70(2):278-83, 2011 Feb. |
Experimental-Dx |
252 joints |
To study the reliability and construct validity of ultrasound in interphalangeal finger joints affected by erosive osteoarthritis (EOA) and non-EOA with MRI as the reference method. |
Ultrasound and MRI were found to be more sensitive in detecting erosions than conventional radiography in EOA. A high agreement between ultrasound and MRI in the assessment of bone erosions (77.7%), osteophytes (75.9%) and synovitis (86.5%) was present. A high percentage of inflammatory changes was found in EOA, and in smaller amount in non-EOA, both confirmed by MRI. Good interobserver reliability of ultrasound was obtained for all variables (all median kappa > 0.8). |
1 |
| 77. American College of Radiology. ACR Appropriateness Criteria® Radiation Dose Assessment Introduction. Available at: https://www.acr.org/-/media/ACR/Files/Appropriateness-Criteria/RadiationDoseAssessmentIntro.pdf. |
Review/Other-Dx |
N/A |
To provide evidence-based guidelines on exposure of patients to ionizing radiation. |
No abstract available. |
4 |
