title: Role of ultrasonography in diagnosing early rheumatoid arthritis and remission of rheumatoid arthritis--a systematic review of the literature.
abstract: BACKGROUND
  Ultrasonography (US) might have an added value to clinical examination in diagnosing early rheumatoid arthritis (RA) and assessing remission of RA. We aimed to clarify the added value of US in RA in these situations performing a systematic review.
  
  
  METHODS
  A systematic literature search was performed for RA, US, diagnosis and remission. Methodological quality was assessed; the wide variability in the design of studies prohibited pooling of results.
  
  
  RESULTS
  Six papers on the added value of US diagnosing early RA were found, in which at least bilateral metacarpophalangeal (MCP), wrists and metatarsophalangeal (MTP) joints were scanned. Compared to clinical examination, US was superior with regard to detecting synovitis and predicting progression to persistent arthritis or RA. Eleven papers on assessing remission were identified, in which at least the wrist and the MCP joints of the dominant hand were scanned. Often US detected inflammation in patients clinically in remission, irrespective of the remission criteria used. Power Doppler signs of synovitis predicted X-ray progression and future flare in patients clinically in remission.
  
  
  CONCLUSIONS
  US appears to have added value to clinical examination for diagnosing of RA when scanning at least MCP, wrist and MTP joints, and, when evaluating remission of RA, scanning at least wrist and MCP joints of the dominant hand. For both purposes primarily power Doppler US might be used since its results are less equivocal than those of greyscale US.
authors.forename: David F
authors.initials: DF
authors.lastname: Ten Cate
authors.forename: Jolanda J
authors.initials: JJ
authors.lastname: Luime
authors.forename: Nanno
authors.initials: N
authors.lastname: Swen
authors.forename: Andreas H
authors.initials: AH
authors.lastname: Gerards
authors.forename: Mike H
authors.initials: MH
authors.lastname: De Jager
authors.forename: Natalja M
authors.initials: NM
authors.lastname: Basoski
authors.forename: Johanna M W
authors.initials: JM
authors.lastname: Hazes
authors.forename: Cees J
authors.initials: CJ
authors.lastname: Haagsma
authors.forename: Johannes W G
authors.initials: JW
authors.lastname: Jacobs
mesh_terms: D018501:Antirheumatic Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D006801:Humans; D012074:Remission Induction; D018608:Ultrasonography, Doppler
chemical_list: D018501:Antirheumatic Agents