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VBCR - April 2015, Volume 4, No 2 - In the News

Although patients with rheumatoid arthritis (RA) undergo radiological evaluations, the actual use of radiological imaging in RA has not been adequately reported. A population-based study evaluated the use of radiological procedures in patients with RA compared with patients without RA. Study results indicate that radiological procedures are performed more frequently in patients with RA than in those without RA; however, overuse is not likely.

“The utilization of radiography is likely a reflection of overall disease burden,” wrote the authors. Radiological findings can help in disease diagnosis and in assessment of disease progression, and these continue to be an important part of patient management. Some guidelines suggest that hand/wrist radiographs be obtained every 2 years after initial diagnosis in patients with RA, but the researchers report that these were not performed with any regularity. They found that clinicians do not consistently follow suggestions regarding obtaining baseline and follow-up hand/wrist radiographs.

The study reviewed population-based cohorts from Olmsted County, Minnesota. Patients who fulfilled American College of Rheumatology criteria for RA between 1988 and 2007 and age- and sex-mated comparator subjects were evaluated. The study included 650 RA patients and 650 comparator subjects without RA. Mean age was 55.8 years, and 69% were female.

Radiographs were significantly more common in RA patients compared with non-RA subjects as follows: chest, upper extremity, lower extremity, spine, and hip, pelvis, or sacroiliac joints. Bone radionuclide and dual-energy x-ray absorptiometry imaging were also more common among patients with RA. The likelihood of undergoing radiological procedures was increased among RA patients with a positive rheumatoid factor, and women were more likely to undergo imaging than men.

Hand/wrist radiographs were obtained in 57% of patients within the first year of RA diagnosis, but in the subsequent 1 to 3 years following diagnosis only 42% had had radiographs, and the percentage dropped to 32% during the 3 to 5 years following diagnosis. Only about 28% had hand/wrist radiographs every 2 years, as recommended by some organizations.

No significant difference was found between the periods of 1988-1997 and 1998-2007 in the number of radiological studies performed among patients with RA.

The authors state that the role of various imaging modalities is in flux, and in the future the need for radiographs maybe be superseded by low-cost ultrasonographic joint evaluation. At present, patients with stable hand radiographs after 2 years may not need further routine radiographs of the hands. Venegas-Pont M, et al. J Clin Rheumatol. 2015;21(1):15-18.

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Last modified: May 21, 2015
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