Sensitivity, specificity and responsiveness of magnetic resonance imaging and ultrasound in rheumatoid arthritis diagnosis

Rheumatoid arthritis is associated with numerous fiscal and morbidity considerations, which has been shown to be alleviated with earlier diagnosis. The aim of this report is to develop recommendations, backed by an evidence-based search, on the use of specific imaging modalities in the clinical environment of rheumatoid arthritis diagnosis. Three key questions were gener ated, looking specifically at whether the sensitivity, specificity and responsiveness of magnet resonance imaging (MRI) and ultrasound (US) showed any advantage over clinical examination and conventional radiography in the early detection and response to treatment of rheumatoid arthritis. A systematic PubMed search was performed in October 2013 identifying 5986 results, with exclusion and keyword criteria applied; a total of 65 papers were considered for this review, upon which 5 recommendations have been made. These recommendations encompass an evaluation of the MRI outcome measures in rheumatology (OMERACT) methodology with specific attention applied to the joints assessed and the time constraints. A further assessment of the automated MRI volume of the enhanced inflammatory tissue methodology, paying particular attention to specificity of the automated method, and in power-Doppler US a clarification of the non-pathological reading of joint vascularization. Also identified in this report is the need to further assess the capabilities in both staffing and training levels of staff and its cost-effectiveness in both the MRI and US clinical setting.