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EULAR recommendations: Imaging not required for typical presentation of OA
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EULAR has published imaging recommendations for the management of patients with osteoarthritis, which stated imaging is not required for typical presentation of the disease, according to a recently published report.
“The extensive literature review and expert opinion should provide a sensible guide to imaging and osteoarthritis,” Philip G. Conaghan, MD, Professor of Musculoskeletal Medicine at the University of Leeds, told Healio Rheumatology. “Imaging may be required where differential diagnosis is unclear and does have a role in guiding difficult joint aspirations or in delivering more difficult joint injections, for example, in the hip.”
The recommendation group included rheumatologists, radiologists, methodologists, primary care doctors and patients from nine countries. To support a literature review of 390 studies, they defined 10 questions on the role of imaging in osteoarthritis (OA), which included the knee, hip, hand and foot. Imaging methods included conventional radiography (CR), MR, ultrasonography (US), CT and nuclear medicine. After EMBASE and PubMed were searched, the evidence was presented to the group who made the following seven recommendations:
- Imaging is not required to make a diagnosis in patients with a “typical presentation”— which includes usage-related pain, short-duration morning stiffness, age older than 40 years and symptoms that impact one or a few joints;
- For atypical presentations, imaging is recommended to confirm diagnosis or to determine alternative or additional diagnoses;
- Routine imaging in follow-up is not recommended, but is recommended if there is an unexpected rapid progression of symptoms or a change in clinical characteristics;
- If imaging is required, CR should be used first and for additional diagnoses, soft tissues are best imaged by US or MRI and bone by CT or MRI;
- Physicians should consider radiographic views and weight-bearing, and patellofemoral views are recommended for the knee;
- Imaging is not recommended for the prediction of non-surgical treatment response; and
- Imaging may improve the accuracy of intra-articular injection, which depends on the joint and the skills of the practitioner, and imaging is recommended for joints that are difficult to access.
“A number of important research recommendations were made in this publication,” Conaghan said. “It will be interesting to see if the increased knowledge we have gained about osteoarthritis pathologies from imaging research will eventually translate into targeted therapies aimed at synovitis or bone.” – by Will Offit
Disclosures: The researchers report funding by EULAR. Conaghan reports support by the National Institute for Health Research Leeds Musculoskeletal Biomedical Research Unit.
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