The reason for this change is that modern therapy relies on early diagnosis and treatment with disease-modifying antirheumatic drugs (DMARDs), and radiographs are painfully insensitive in this setting (~70% of patients with early disease have normal radiographs).
MRI or ultrasound are much more sensitive, but the guidelines limit their use to confirmation of the clinical findings after clinical classification of a patient.
Radiography still has a role in excluding other joint diseases (e.g., osteoarthritis) and to assess joint damage in established cases of rheumatoid arthritis.
- Aletaha D, Neogi T, Silman AJ, et al. 2010 rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Ann Rheum Dis. 2010 Sep;69(9):1580-8. Erratum in: Ann Rheum Dis. 2010 Oct;69(10):1892.
- Rowbotham EL, Grainger AJ. Rheumatoid arthritis: ultrasound versus MRI. AJR Am J Roentgenol. 2011 Sep;197(3):541-6.
- Tan YK, Conaghan PG. Imaging in rheumatoid arthritis. Best Pract Res Clin Rheumatol. 2011 Aug;25(4):569-84.