Evidence-based recommendations on the use of imaging in the management of symptomatic, peripheral joint osteoarthritis have been developed by a European League Against Rheumatism (EULAR) task force for clinicians who treat patients with the condition in their clinical practice.
The EULAR task force included rheumatologists, radiologists, methodologists, primary care physicians, and patients from 9 countries who defined 10 questions on the role of imaging in OA to support a systematic literature review; 17,011 references were identified from which 390 studies were included.
The knee, hip, hand, and foot were joints of interest. Imaging modalities included conventional radiography, MRI, ultrasonography, CT, and nuclear medicine.
Recommendations were developed to cover various areas in the routine management of osteoarthritis, including the lack of need for diagnostic imaging in patients with typical symptoms, the role of imaging in differential diagnosis, and the lack of benefit in monitoring when no therapeutic modification is related.
The task force offered the following overview:
• The recommendations pertain only to symptomatic osteoarthritis.
• Imaging abnormalities of osteoarthritis are seen frequently, especially with increasing age.
• Joint symptoms are common and increase with age. Symptoms are not always causally related to imaging abnormalities.
• A full history and examination are always needed before the need for investigations, including imaging, is considered.
• Modern imaging modalities provide the capability to detect a wide range of soft tissue, bony, and cartilage pathology in osteoarthritis, but the increased information provided has not yet had any influence on clinical decision-making with respect to management.
Following are the 7 osteoarthritis imaging recommendations with findings:
1. Imaging is not required to make the diagnosis in patients with a typical presentation of osteoarthritis.
Studies in which imaging was applied in addition to clinical findings to evaluate its additional impact on the certainty of diagnosis were lacking.
Sakellariou G, Conaghan PG, Zhang W, et al. “EULAR recommendations for the use of imaging in the clinical management of peripheral joint osteoarthritis.” Ann Rheum Dis. 2017;76:1484-1494. doi: 10.1136/annrheumdis-2016-210815. Epub 2017 Apr 7.