Role of Radiography in Diagnosis of Rheumatoid Arthritis

The most recent guidelines by the American College of Rheumatology and European League Against Rheumatism have dropped radiography from their diagnostic criteria and instead rely on physical examination findings and laboratory data.

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.

References

• 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.