title: Structural evaluation in the management of patients with rheumatoid arthritis: development of recommendations for clinical practice based on published evidence and expert opinion.
abstract: OBJECTIVE
  To develop French evidence-based recommendations for the structural evaluation of rheumatoid arthritis (RA) in everyday practice.
  
  
  METHODS
  A scientific committee selected 10 questions using the Delphi consensus procedure. Evidence-based responses to each question were sought by searching the PubMed and Ovid databases and the abstract databases for the 2002, 2003, and 2004 annual meetings of the French Society for Rheumatology, the EULAR, and the American College of Rheumatology. The following indexing terms were used: rheumatoid arthritis, arthritis, patient, diagnostic imaging, radiography, joint, erosion, and joint space width. All articles published in French or English prior to May 2004 were identified. The evidence from these articles was reported to a panel of 77 rheumatologists working in hospital or office practice. The panel developed detailed recommendations, filling gaps in evidence with their expert opinion. The strength of each recommendation was determined.
  
  
  RESULTS
  The 10 questions probed the structural evaluation of RA by plain radiography, magnetic resonance imaging (MRI), and ultrasonography, both for diagnostic and monitoring purposes. The literature search retrieved 673 publications, of which 166 were selected and reviewed. The panel developed 10 recommendations, one for each question, which were accepted by consensus.
  
  
  CONCLUSIONS
  Recommendations relative to the diagnosis or monitoring of structural involvement in patients with RA in everyday practice were developed. They should help to improve practice uniformity and, ultimately, to improve the management of RA.
authors.affiliation: Rheumatology Department, Cochin Teaching Hospital, Paris, France.
authors.forename: Laure
authors.initials: L
authors.lastname: Gossec
authors.forename: Bruno
authors.initials: B
authors.lastname: Fautrel
authors.forename: Thao
authors.initials: T
authors.lastname: Pham
authors.forename: Bernard
authors.initials: B
authors.lastname: Combe
authors.forename: René-Marc
authors.initials: RM
authors.lastname: Flipo
authors.forename: Philippe
authors.initials: P
authors.lastname: Goupille
authors.forename: Xavier
authors.initials: X
authors.lastname: Le Loet
authors.forename: Xavier
authors.initials: X
authors.lastname: Mariette
authors.forename: Xavier
authors.initials: X
authors.lastname: Puéchal
authors.forename: Daniel
authors.initials: D
authors.lastname: Wendling
authors.forename: Thierry
authors.initials: T
authors.lastname: Schaeverbeke
authors.forename: Jean
authors.initials: J
authors.lastname: Sibilia
authors.forename: Jacques
authors.initials: J
authors.lastname: Sany
authors.forename: Maxime
authors.initials: M
authors.lastname: Dougados
mesh_terms: D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D032921:Consensus; D019317:Evidence-Based Medicine; D006287:Health Planning Guidelines; D016239:MEDLINE; D012219:Rheumatology / Q000379:methods* / Q000592:standards