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Open Access Highly Accessed Research article

Role of ultrasonography in diagnosing early rheumatoid arthritis and remission of rheumatoid arthritis - a systematic review of the literature

David F Ten Cate1*, Jolanda J Luime1, Nanno Swen2, Andreas H Gerards3, Mike H De Jager4, Natalja M Basoski5, Johanna MW Hazes1, Cees J Haagsma6 and Johannes WG Jacobs7

Author Affiliations

1 Rheumatology, Erasmus Medical Center Rotterdam, Dr. Molewaterplein 50-60, Rotterdam, 3015 GE, The Netherlands

2 Rheumatology, Medical Center Alkmaar, Wilhelminalaan 12, Alkmaar, 1815 JD, The Netherlands

3 Rheumatology, Vlietland Hospital Schiedam, Vlietlandplein 2, Schiedam, 3118 JH, The Netherlands

4 Rheumatology, Albert Schweitzer Hospital, Albert Schweitzerplaats 25, Dordrecht, 3318 AT, The Netherlands

5 Rheumatology, Maasstad Hospital, Maasstadweg 21, Rotterdam, 3079 DZ, The Netherlands

6 Rheumatology, Hospital Group Twente, Zilvermeeuw 1, Almelo, 7609 PP, The Netherlands

7 Rheumatology & Clinical Immunology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, 3584 CX, The Netherlands

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Arthritis Research & Therapy 2013, 15:R4  doi:10.1186/ar4132

Published: 8 January 2013

Abstract

Introduction

Ultrasonography (US) might have an added value to clinical examination in diagnosing early rheumatoid arthritis (RA) and assessing remission of RA. We aimed to clarify the added value of US in RA in these situations performing a systematic review.

Methods

A systematic literature search was performed for RA, US, diagnosis and remission. Methodological quality was assessed; the wide variability in the design of studies prohibited pooling of results.

Results

Six papers on the added value of US diagnosing early RA were found, in which at least bilateral metacarpophalangeal (MCP), wrists and metatarsophalangeal (MTP) joints were scanned. Compared to clinical examination, US was superior with regard to detecting synovitis and predicting progression to persistent arthritis or RA. Eleven papers on assessing remission were identified, in which at least the wrist and the MCP joints of the dominant hand were scanned. Often US detected inflammation in patients clinically in remission, irrespective of the remission criteria used. Power Doppler signs of synovitis predicted X-ray progression and future flare in patients clinically in remission.

Conclusions

US appears to have added value to clinical examination for diagnosing of RA when scanning at least MCP, wrist and MTP joints, and, when evaluating remission of RA, scanning at least wrist and MCP joints of the dominant hand. For both purposes primarily power Doppler US might be used since its results are less equivocal than those of greyscale US.