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Overuse of radiologic procedures in patients with RA ‘unlikely’
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Patients with rheumatoid arthritis undergo more radiologic procedures than patients without the disease, and despite some guidelines, routine hand and wrist radiographs were not obtained with regularity, making overuse unlikely, according to researchers from the Mayo Clinic.
Researchers studied 650 patients with rheumatoid arthritis (RA) and 650 patients of similar demographics without RA from the Rochester Epidemiology Project medical record linkage system. Data on radiographic procedures performed were collected electronically using billing data from the Mayo Clinic and Olmsted Medical Center and their affiliated hospitals in Olmsted County, Wisconsin.
A total of 27,088 radiographic procedures were performed, which included conventional radiographs of the ankle, chest, elbow, feet, hand, hip, shoulder, spine and wrist, along with CT and MRI scans of the head and upper and lower extremities, radionuclide bone imaging, mammograms and dual-energy X-ray absorptiometry (DXA) scanning.
Patients with RA had significantly more chest radiographs compared with those without RA, according to the researchers. Radiographs of the upper and lower extremities were also more common in patients with RA, as were bone radionuclide and DXA imaging. Additionally, significantly more conventional radiographs of the hip, pelvis, sacroiliac joints and spine were obtained in patients with RA.
Radiographic procedures were performed more frequently in women, both with and without RA in similar proportions, and in patients with positive rheumatoid factor.
An increase in radiographic procedures overall was observed in patients without RA between 1998 and 2007, compared with index dates between 1988 and 1997, but the increase was not observed in patients with RA. MRI and CT scans of the upper and lower extremities also increased in patients with RA between the two time indices, according to the researchers.
Hand and wrist radiographs were obtained within 1 year of diagnosis from 57% of patients with RA, which dropped to 42% between 1 and 3 years following diagnosis. From 3 to 5 years after diagnosis, only 32% obtained hand and wrist radiographs, and that number plateaued at 28% after 5 years. – by Shirley Pulawski
Disclosures: The authors report no relevant financial disclosures.
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