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Czuczman GJ, Mandell JC, Wessell DE, Lenchik L, Ahlawat S, Baker JC, Cassidy RC, Demertzis JL, Garner HW, Klitzke A, Maynard JR, Pierce JL, Reitman C, Thiele R, Yost WJ, Beaman FD. ACR Appropriateness Criteria® Inflammatory Back Pain: Known or Suspected Axial Spondyloarthritis: 2021 Update. J Am Coll Radiol 2021; 18:S340-S360. [PMID: 34794593 DOI: 10.1016/j.jacr.2021.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 08/26/2021] [Indexed: 02/07/2023]
Abstract
Inflammatory back pain is a hallmark feature of axial spondyloarthritis, a heterogeneous group of inflammatory disorders which affects the sacroiliac joints and spine. Imaging plays a key role in diagnosis of this disease and in facilitating appropriate treatment. This document provides evidence-based recommendations on the appropriate use of imaging studies during multiple stages of the clinical evaluation of patients with suspected or known axial spondyloarthritis. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | - Jacob C Mandell
- Research Author, Brigham & Women's Hospital & Harvard Medical School, Boston, Massachusetts
| | | | - Leon Lenchik
- Panel Vice-Chair, Wake Forest University School of Medicine, Winston Salem, North Carolina
| | - Shivani Ahlawat
- Musculoskeletal Fellowship Director; and Chair, REiNS Whole Body MRI Committee, Johns Hopkins Hospital, Baltimore, Maryland
| | - Jonathan C Baker
- Mallinckrodt Institute of Radiology Washington University School of Medicine, Saint Louis, Missouri
| | - R Carter Cassidy
- UK Healthcare Spine and Total Joint Service, Lexington, Kentucky; Executive Board, Kentucky Orthopaedic Society; and American Academy of Orthopaedic Surgeons
| | | | | | - Alan Klitzke
- Roswell Park Comprehensive Cancer Center, Buffalo, New York; Board of Directors, American College of Nuclear Medicine; Board of Directors, SNMMI Correlative Imaging Council; and Delegate, American Medical Association House of Delegates
| | - Jennifer R Maynard
- Program Director Sports Medicine Fellowship, Mayo Clinic Florida, Jacksonville, Florida; Primary care physician; Medical Advisor Women's Tennis Association; Vice-Chair, Jacksonville Sports Medicine Program Executive Board; Chair, Florida High School Athletic Association Sports; and Medicine Advisory Committee
| | | | - Charles Reitman
- Medical University of South Carolina, Charleston, South Carolina; and Board of Directors, North American Spine Society
| | - Ralf Thiele
- University of Rochester School of Medicine and Dentistry, Rochester, New York, American College of Rheumatology
| | - William J Yost
- UnityPoint Health, Des Moines, Iowa, American College of Physicians
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Falsetti P, Conticini E, Mazzei MA, Baldi C, Sota J, Bardelli M, Gentileschi S, D'Alessandro R, Al Khayyat SG, Acciai C, Cantarini L, Frediani B. Power and spectral Doppler ultrasound in suspected active sacroiliitis: a comparison with magnetic resonance imaging as gold standard. Rheumatology (Oxford) 2021; 60:1338-1345. [PMID: 32944757 DOI: 10.1093/rheumatology/keaa546] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 07/21/2020] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES The objectives of this study were to study with Power Doppler US (PDUS) the SI joints (SIJs) of patients with suspected active sacroiliitis, to describe SIJ flows with spectral wave analysis (SWA) on Doppler US, and to correlate US data with both clinical characteristics and presence of SIJ bone marrow oedema (BME) in subsequent MRI. METHODS A total of 42 patients (32 females and 10 males, mean age 46.8 years) with recent onset of inflammatory back pain (IBP) were included. Every patient underwent US examination with a convex 1-8 MHz probe [scoring PDUS signals with a three-point scale and describing flows in SWA calculating the mean Resistive Index (RI)] and subsequent MRI of the SIJs. RESULTS PDUS signals were detected in 34 patients and 62 SIJs. In 29 patients and 56 SIJs, MRI revealed BME. A definite diagnosis of SpA was made in 32 patients. PDUS signals were more frequent (P < 0.0001) in patients with a final diagnosis of SpA, yielding a higher PDUS score (P = 0.0304). PDUS grading correlated with both BME grading (r = 0.740, P = 0.0001) and AS DAS (ASDAS) (r = 0.6257, P = 0.0004), but not with inflammatory reactants nor anthropometric data. Mean RI were, respectively, 0.60 and 0.73 (P < 0.0001) in patients with or without diagnosis of active sacroiliitis. The most inclusive RI cut-off resulted <0.70 [positive predictive value (PPV) 94%, accuracy 90%, P = 0.0001]. The best Likelihood Ratio (5.471) for RI to detect pathologic cases was obtained with a cut-off of <0.60 (PPV 96%). CONCLUSIONS PDUS and SWA of SIJs demonstrate good diagnostic accuracy for active sacroiliitis compared with MRI.
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Affiliation(s)
- Paolo Falsetti
- Department of Medical, Surgical and Neurosciences, Rheumatology Unit, Arezzo, Italy
| | - Edoardo Conticini
- Department of Medical, Surgical and Neurosciences, Rheumatology Unit, Arezzo, Italy
| | - Maria Antonietta Mazzei
- Department of Medical, Surgical and Neurosciences, Diagnostic Imaging, University of Siena, Arezzo, Italy
| | - Caterina Baldi
- Department of Medical, Surgical and Neurosciences, Rheumatology Unit, Arezzo, Italy
| | - Jurgen Sota
- Department of Medical, Surgical and Neurosciences, Rheumatology Unit, Arezzo, Italy
| | - Marco Bardelli
- Department of Medical, Surgical and Neurosciences, Rheumatology Unit, Arezzo, Italy
| | - Stefano Gentileschi
- Department of Medical, Surgical and Neurosciences, Rheumatology Unit, Arezzo, Italy
| | - Roberto D'Alessandro
- Department of Medical, Surgical and Neurosciences, Rheumatology Unit, Arezzo, Italy
| | | | | | - Luca Cantarini
- Department of Medical, Surgical and Neurosciences, Rheumatology Unit, Arezzo, Italy
| | - Bruno Frediani
- Department of Medical, Surgical and Neurosciences, Rheumatology Unit, Arezzo, Italy
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4
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Rosa JE, Ruta S, Bravo M, Pompermayer L, Marin J, Ferreyra-Garrot L, García-Mónaco R, Soriano ER. Value of Color Doppler Ultrasound Assessment of Sacroiliac Joints in Patients with Inflammatory Low Back Pain. J Rheumatol 2018; 46:694-700. [PMID: 30554153 DOI: 10.3899/jrheum.180550] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2018] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To evaluate the diagnostic value of color Doppler ultrasound (CDUS) for the detection of sacroiliitis, in patients with inflammatory back pain (IBP). METHODS Consecutive patients with IBP and suspected axial spondyloarthritis (SpA), but without a definitive diagnosis, were included. Consecutive patients with defined SpA and axial involvement were included as a control group. All patients underwent clinical evaluation, magnetic resonance imaging (MRI), and CDUS of sacroiliac joints (SIJ) within the same week. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for the diagnosis of sacroiliitis by CDUS were calculated, using MRI as the gold standard. RESULTS There were 198 SIJ evaluated in 99 patients (36 with previous SpA). There were 61 men (61.6%), with a mean age of 39.8 years (SD 11.3) and median disease duration of 24 months (IQR 12-84). At the patient level, CDUS had a sensitivity of 63% (95% CI 48.7-75.7%) and a specificity of 89% (95% CI 76-96%). The PPV was 87.2% (95% CI 72.6-95.7%) and the NPV was 66.7% (95% CI 53.3-78.3%). At joint level, CDUS had a sensitivity of 60% (95% CI 49-70%) and a specificity of 93% (95% CI 88-98%). The PPV was 83% (95% CI 78-95%) and the NPV was 43% (95% CI 33-56%). The sensitivity of CDUS for the diagnosis of axial SpA was 54% (95% CI 36.6-71.2%), specificity was 82% (95% CI 63.1-93.9%), PPV was 79% (95% CI 57.8-92.9%), and NPV was 59% (95% CI 42.1-74.4%). CONCLUSION CDUS showed adequate diagnostic properties for detection of sacroiliitis and is a useful tool in patients with IBP.
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Affiliation(s)
- Javier E Rosa
- From the Rheumatology Unit, Internal Medicine Department, and the Radiology Department, Hospital Italiano de Buenos Aires; University Institute Hospital Italiano de Buenos Aires; Fundación Dr. Pedro M. Catoggio para el Progreso de la Reumatología, Buenos Aires, Argentina. .,J.E. Rosa, MD, Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires; S. Ruta, MD, Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires; M. Bravo, MD, Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires; L. Pompermayer, MD, Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires; J. Marin, MD, Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires; L. Ferreyra-Garrot, MD, Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires; R. García-Mónaco, MD, Radiology Department, Hospital Italiano de Buenos Aires; E.R. Soriano, PhD, Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires, and Fundación Dr. Pedro M. Catoggio para el Progreso de la Reumatología.
| | - Santiago Ruta
- From the Rheumatology Unit, Internal Medicine Department, and the Radiology Department, Hospital Italiano de Buenos Aires; University Institute Hospital Italiano de Buenos Aires; Fundación Dr. Pedro M. Catoggio para el Progreso de la Reumatología, Buenos Aires, Argentina.,J.E. Rosa, MD, Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires; S. Ruta, MD, Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires; M. Bravo, MD, Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires; L. Pompermayer, MD, Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires; J. Marin, MD, Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires; L. Ferreyra-Garrot, MD, Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires; R. García-Mónaco, MD, Radiology Department, Hospital Italiano de Buenos Aires; E.R. Soriano, PhD, Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires, and Fundación Dr. Pedro M. Catoggio para el Progreso de la Reumatología
| | - Maximiliano Bravo
- From the Rheumatology Unit, Internal Medicine Department, and the Radiology Department, Hospital Italiano de Buenos Aires; University Institute Hospital Italiano de Buenos Aires; Fundación Dr. Pedro M. Catoggio para el Progreso de la Reumatología, Buenos Aires, Argentina.,J.E. Rosa, MD, Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires; S. Ruta, MD, Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires; M. Bravo, MD, Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires; L. Pompermayer, MD, Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires; J. Marin, MD, Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires; L. Ferreyra-Garrot, MD, Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires; R. García-Mónaco, MD, Radiology Department, Hospital Italiano de Buenos Aires; E.R. Soriano, PhD, Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires, and Fundación Dr. Pedro M. Catoggio para el Progreso de la Reumatología
| | - Luciano Pompermayer
- From the Rheumatology Unit, Internal Medicine Department, and the Radiology Department, Hospital Italiano de Buenos Aires; University Institute Hospital Italiano de Buenos Aires; Fundación Dr. Pedro M. Catoggio para el Progreso de la Reumatología, Buenos Aires, Argentina.,J.E. Rosa, MD, Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires; S. Ruta, MD, Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires; M. Bravo, MD, Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires; L. Pompermayer, MD, Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires; J. Marin, MD, Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires; L. Ferreyra-Garrot, MD, Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires; R. García-Mónaco, MD, Radiology Department, Hospital Italiano de Buenos Aires; E.R. Soriano, PhD, Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires, and Fundación Dr. Pedro M. Catoggio para el Progreso de la Reumatología
| | - Josefina Marin
- From the Rheumatology Unit, Internal Medicine Department, and the Radiology Department, Hospital Italiano de Buenos Aires; University Institute Hospital Italiano de Buenos Aires; Fundación Dr. Pedro M. Catoggio para el Progreso de la Reumatología, Buenos Aires, Argentina.,J.E. Rosa, MD, Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires; S. Ruta, MD, Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires; M. Bravo, MD, Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires; L. Pompermayer, MD, Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires; J. Marin, MD, Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires; L. Ferreyra-Garrot, MD, Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires; R. García-Mónaco, MD, Radiology Department, Hospital Italiano de Buenos Aires; E.R. Soriano, PhD, Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires, and Fundación Dr. Pedro M. Catoggio para el Progreso de la Reumatología
| | - Leandro Ferreyra-Garrot
- From the Rheumatology Unit, Internal Medicine Department, and the Radiology Department, Hospital Italiano de Buenos Aires; University Institute Hospital Italiano de Buenos Aires; Fundación Dr. Pedro M. Catoggio para el Progreso de la Reumatología, Buenos Aires, Argentina.,J.E. Rosa, MD, Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires; S. Ruta, MD, Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires; M. Bravo, MD, Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires; L. Pompermayer, MD, Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires; J. Marin, MD, Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires; L. Ferreyra-Garrot, MD, Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires; R. García-Mónaco, MD, Radiology Department, Hospital Italiano de Buenos Aires; E.R. Soriano, PhD, Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires, and Fundación Dr. Pedro M. Catoggio para el Progreso de la Reumatología
| | - Ricardo García-Mónaco
- From the Rheumatology Unit, Internal Medicine Department, and the Radiology Department, Hospital Italiano de Buenos Aires; University Institute Hospital Italiano de Buenos Aires; Fundación Dr. Pedro M. Catoggio para el Progreso de la Reumatología, Buenos Aires, Argentina.,J.E. Rosa, MD, Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires; S. Ruta, MD, Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires; M. Bravo, MD, Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires; L. Pompermayer, MD, Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires; J. Marin, MD, Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires; L. Ferreyra-Garrot, MD, Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires; R. García-Mónaco, MD, Radiology Department, Hospital Italiano de Buenos Aires; E.R. Soriano, PhD, Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires, and Fundación Dr. Pedro M. Catoggio para el Progreso de la Reumatología
| | - Enrique R Soriano
- From the Rheumatology Unit, Internal Medicine Department, and the Radiology Department, Hospital Italiano de Buenos Aires; University Institute Hospital Italiano de Buenos Aires; Fundación Dr. Pedro M. Catoggio para el Progreso de la Reumatología, Buenos Aires, Argentina.,J.E. Rosa, MD, Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires; S. Ruta, MD, Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires; M. Bravo, MD, Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires; L. Pompermayer, MD, Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires; J. Marin, MD, Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires; L. Ferreyra-Garrot, MD, Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires; R. García-Mónaco, MD, Radiology Department, Hospital Italiano de Buenos Aires; E.R. Soriano, PhD, Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires, and Fundación Dr. Pedro M. Catoggio para el Progreso de la Reumatología
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7
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Uson J, Loza E, Möller I, Acebes C, Andreu JL, Batlle E, Bueno Á, Collado P, Fernández-Gallardo JM, González C, Jiménez Palop M, Lisbona MP, Macarrón P, Maymó J, Narváez JA, Navarro-Compán V, Sanz J, Rosario MP, Vicente E, Naredo E. Recommendations for the Use of Ultrasound and Magnetic Resonance in Patients With Spondyloarthritis, Including Psoriatic Arthritis, and Patients With Juvenile Idiopathic Arthritis. ACTA ACUST UNITED AC 2017; 14:27-35. [PMID: 28277255 DOI: 10.1016/j.reuma.2016.08.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 08/10/2016] [Accepted: 08/13/2016] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To develop evidence-based recommendations on the use of ultrasound (US) and magnetic resonance imaging in patients with spondyloarthritis, including psoriatic arthritis, and juvenile idiopathic arthritis. METHODS Recommendations were generated following a nominal group technique. A panel of experts (15 rheumatologists and 3 radiologists) was established in the first panel meeting to define the scope and purpose of the consensus document, as well as chapters, potential recommendations and systematic literature reviews (we used and updated those from previous EULAR documents). A first draft of recommendations and text was generated. Then, an electronic Delphi process (2 rounds) was carried out. Recommendations were voted from 1 (total disagreement) to 10 (total agreement). We defined agreement if at least 70% of participants voted≥7. The level of evidence and grade or recommendation was assessed using the Oxford Centre for Evidence Based Medicine levels of evidence. The full text was circulated and reviewed by the panel. The consensus was coordinated by an expert methodologist. RESULTS A total of 12 recommendations were proposed for each disease. They include, along with explanations of the validity of US and magnetic resonance imaging regarding inflammation and damage detection, diagnosis, prediction (structural damage progression, flare, treatment response, etc.), monitoring and the use of US guided injections/biopsies. CONCLUSIONS These recommendations will help clinicians use US and magnetic resonance imaging in patients with spondyloarthritis and juvenile idiopathic arthritis.
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Affiliation(s)
- Jacqueline Uson
- Servicio de Reumatología, Hospital Universitario de Móstoles, Móstoles, Madrid, España
| | | | - Ingrid Möller
- Servicio de Reumatología, Instituto Poal de Reumatología, Barcelona, España
| | - Carlos Acebes
- Servicio de Reumatología, Hospital General de Villalba, Collado Villalba, Madrid, España
| | - Jose Luis Andreu
- Servicio de Reumatología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | - Enrique Batlle
- Servicio de Reumatología, Hospital Universitario Sant Joan d'Alacant, Sant Joan d'Alacant, Alicante, España
| | - Ángel Bueno
- Servicio de Radiología, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
| | - Paz Collado
- Servicio de Reumatología, Hospital Universitario Severo Ochoa, Leganés, Madrid, España
| | | | - Carlos González
- Servicio de Reumatología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - Mercedes Jiménez Palop
- Servicio de Reumatología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | | | - Pilar Macarrón
- Servicio de Reumatología, Hospital Universitario Clínico San Carlos, Madrid, España
| | - Joan Maymó
- Servicio de Reumatología, Hospital del Mar, Barcelona, España
| | - Jose Antonio Narváez
- Servicio de Radiodiagnóstico, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | | | - Jesús Sanz
- Servicio de Reumatología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | | | - Esther Vicente
- Servicio de Reumatología, Hospital Universitario de La Princesa, Madrid, España
| | - Esperanza Naredo
- Servicio de Reumatología, Hospital General Universitario Gregorio Marañón, Madrid, España
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