title: Novel algorithms for the pragmatic use of ultrasound in the management of patients with rheumatoid arthritis: from diagnosis to remission.
abstract: The absence of specific guidance on how to use ultrasound (US) to diagnose and manage patients with inflammatory arthritis, especially with rheumatoid arthritis (RA) has hindered the optimal utilisation of US in clinical practice, potentially limiting its benefits for patient outcomes. In view of this, a group of musculoskeletal US experts formed a working group to consider how this unmet need could be satisfied and to produce guidance (additional to European League against Rheumatism (EULAR) imaging recommendations) to support clinicians in their daily clinical work. This paper describes this process and its outcome, namely five novel algorithms, which identify when US could be used. They are designed to aid diagnosis, to inform assessment of treatment response/disease monitoring and to evaluate stable disease state or remission in patients with suspected or established RA, by providing a pragmatic template for using US at certain time points of the RA management. A research agenda has also been defined for answering unmet clinical needs.
authors.affiliation: Rheumatology Department, APHP, Hôpital Ambroise Paré, Boulogne-Billancourt, France INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University, Saint-Quentin en Yvelines, France Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, Leeds, UK.
authors.forename: Maria Antonietta
authors.initials: MA
authors.lastname: D'Agostino
authors.affiliation: Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Lene
authors.initials: L
authors.lastname: Terslev
authors.affiliation: Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, Leeds, UK NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Wakefield
authors.affiliation: Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Mikkel
authors.initials: M
authors.lastname: Østergaard
authors.affiliation: Third Rheumatology Department, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary.
authors.forename: Peter
authors.initials: P
authors.lastname: Balint
authors.affiliation: Department of Rheumatology, Hospital General Universitario Gregorio Marañón and Universidad Complutense, Madrid, Spain.
authors.forename: Esperanza
authors.initials: E
authors.lastname: Naredo
authors.affiliation: Ultrasound Unit, Rheumatology Department, Sapienza Università di Roma, Rome, Italy.
authors.forename: Annamaria
authors.initials: A
authors.lastname: Iagnocco
authors.affiliation: Department of Internal Medicine, Rheumatology and Clinical Immunology Academic Hospital of the Charité Berlin, Park-Klinik Weissensee Berlin, Berlin, Germany.
authors.forename: Marina
authors.initials: M
authors.lastname: Backhaus
authors.affiliation: Clinica Reumatologica-Scuola di Specializzazione in Reumatologia Università Politecnica delle Marche, Ancona, Italy.
authors.forename: Walter
authors.initials: W
authors.lastname: Grassi
authors.affiliation: Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, Leeds, UK NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: Emery
mesh_terms: D000465:Algorithms; D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging*; D019468:Disease Management; D006801:Humans; D012074:Remission Induction; D014463:Ultrasonography / Q000379:methods*
keywords: Rheumatoid Arthritis; Synovitis; Ultrasonography