Emilio Filippucci

Università Politecnica delle Marche, Ancona, The Marches, Italy

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Publications (224)830.27 Total impact

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    ABSTRACT: Objective: Ultrasonography (US) demonstrated to be a promising tool for the diagnosis of calcium pyrophosphate dihydrate deposition disease (CPPD). The aim of this systematic literature review (SLR) was to collect the definitions for the US elementary lesions and to summarize the available data about US diagnostic accuracy in CPPD. Methods: We systematically reviewed all the studies that considered US as the index test for CPPD diagnosis without restrictions about the reference test or that provided definitions about US identification of CPPD. Sensitivity and specificity were calculated for each study and definitions were extrapolated. Subgroup analyses were planned by anatomical site included in the index text and different reference standards. Results: 37 studies were included in this review. All the studies were eligible for the collection of US findings and all definitions were summarized. US description of elementary lesions appeared heterogeneous among the studies. Regarding US accuracy, 13 articles entered in the meta-analysis. Considering each joint structure, the sensitivity ranged between 0.77 (0.63-0.87) to 0.34 (0.16-0.58) while the specificity varies between 1.00 (0.89-1.00) and 0.92 (0.16-1.00) Considering the reference standards used, the sensibility ranged between 0.34 (0.02-0.65) and 0.87 (0.76-0.99) while specificity ranged between 0.84 (0.52-1.00) and 1.00 (0.99-1.00). Conclusion: US is potentially a useful tool for the diagnosis of CPPD but universally accepted definitions and further testing are necessary in order to assess the role of the technique in the diagnostic process.
    No preview · Article · Jan 2016 · Osteoarthritis and Cartilage
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    ABSTRACT: Objective: Bone erosions in rheumatoid arthritis (RA) have been studied in an increasing amount of research. Both earlier and present classification criteria of RA contain erosions as a significant classification component. Ultrasound (US) can detect bone changes in accessible surfaces. Therefore, the study group performed a systematic literature review of assessment of RA bone erosions with US. Methods: A systematic search of PubMed and Embase was performed. Data on the definitions of RA bone erosions, their size, scoring, relation to synovitis, comparators, and elements of the OMERACT (Outcome Measures in Rheumatology Clinical Trials) filter were collected and analyzed. Results: The selection process identified 58 original research papers. The assessed joints were most frequently metacarpophalangeal (MCP; 41 papers), proximal interphalangeal (19 papers), and metatarsophalangeal joints (MTP; 18 papers). The OMERACT definition of RA bone erosion on US was used most often (17 papers). Second and fifth MCP and fifth MTP were recommended as target joints. Conventional radiography was the most frequently used comparator (27 papers), then magnetic resonance imaging (17 papers) and computed tomography (5 papers). Reliability of assessment was presented in 20 papers and sensitivity to change in 11 papers. Conclusion: This paper presents results of a systematic literature review of bone erosion assessment in RA with US. The survey suggests that US can be a helpful adjunct to the existing methods of imaging bone erosions in RA. It analyzes definitions, scoring systems, used comparators, and elements of the OMERACT filter. It also presents recommendations for a future research agenda based on the results of the review.
    No preview · Article · Dec 2015 · The Journal of Rheumatology
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    ABSTRACT: Objective: To test the reliability of the consensus-based ultrasound (US) definitions of elementary gout lesions in patients. Methods: Eight patients with microscopically proven gout were evaluated by 16 sonographers for signs of double contour (DC), aggregates, erosions, and tophi in the first metatarsophalangeal joint and the knee bilaterally. The patients were examined twice using B-mode US to test agreement and inter- and intraobserver reliability of the elementary components. Results: The prevalence of the lesions were DC 52.8%, tophus 61.1%, aggregates 29.8%, and erosions 32.4%. The intraobserver reliability was good for all lesions except DC, where it was moderate. The best reliability per lesion was seen for tophus (κ 0.73, 95% CI 0.61-0.85) and lowest for DC (κ 0.53, 95% CI 0.38-0.67). The interobserver reliability was good for tophus and erosions, but fair to moderate for aggregates and DC, respectively. The best reliability was seen for erosions (κ 0.74, 95% CI 0.65-0.81) and lowest for aggregates (κ 0.21, 95% CI 0.04-0.37). Conclusion: This is the first step to test consensus-based US definitions on elementary lesions in patients with gout. High intraobserver reliability was found when applying the definition in patients on all elementary lesions while interobserver reliability was moderate to low. Further studies are needed to improve the interobserver reliability, particularly for DC and aggregates.
    Full-text · Article · Oct 2015 · The Journal of Rheumatology
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    ABSTRACT: Objective To produce educational guidelines for the conduct, content and format of theoretical and practical teaching at EULAR musculoskeletal ultrasound (MSUS) Teaching the Teachers (TTT) Courses. Methods A Delphi-based procedure with 24 recommendations covering five main areas (Duration and place of the course; Faculty members; Content of the course; Evaluation of the teaching skills; TTT competency assessment) was distributed among a group of experts involved in MSUS teaching, in addition to an advisory educational expert being present. Consensus for each recommendation was considered achieved when the percentage of agreement was >75%. Results 21 of 24 invited participants responded to the first Delphi questionnaire (88% response rate). All 21 participants also responded to the second round. Agreement on 19 statements was obtained after two rounds. Conclusions This project has led to the development of guidelines for the conduct, content and format of teaching at the EULAR MSUS TTT Courses that are organised annually, with the aim of training future teachers of EULAR MSUS Courses, EULAR Endorsed MSUS Courses, as well as national and local MSUS Courses. The presented work gives indications on how to homogenise the teaching at the MSUS TTT Courses, thus resolving current discrepancies in the field.
    Full-text · Article · Oct 2015
  • Walter Grassi · Tadashi Okano · Luca Di Geso · Emilio Filippucci
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    ABSTRACT: Recent advances in imaging technology are dramatically changing the approach to patients with inflammatory arthritis. Conventional radiography is still the major imaging modality used to evaluate patients with rheumatoid arthritis in daily clinical practice. In the last decade, several investigations have shown the diagnostic ability of MRI and ultrasound to rectify the traditional approach to early diagnosis and disease activity monitoring. This review will summarize the options, uses and optimization of these imaging modalities with a special focus on ultrasound, which is currently the most promising tool to change the paradigms in both early diagnosis and therapy monitoring of rheumatoid arthritis.
    No preview · Article · Sep 2015 · Expert Review of Clinical Immunology
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    ABSTRACT: To investigate intra- and inter-reader agreement of ultrasonography (US) and conventional radiography (CR) for the evaluation of osteophyte presence and size within the tibiofemoral joint. In addition, to correlate these findings with arthroscopic degeneration of the articular cartilage. Forty adult patients with knee pain were enrolled in this study. Knee CR and US scanning of the medial and lateral bone margins were performed on all patients. A novel atlas for the US grading of knee osteophytes was used in the evaluation. The number and size of the osteophytes were evaluated semi-quantitatively in two rounds from both the CR images (four readers) and the US images (14 readers). The Noyes grading system was used for the evaluation of arthroscopic degeneration of the articular cartilage in 26 patients. On average, intra- and inter-reader US and CR agreement was substantial and comparable to each other (κ = 0.60-0.72). US detected more osteophytes than CR at both the medial (65% vs. 48%) and lateral (70% vs. 60%) compartments. A statistically significant correlation between CR- or US-based osteophyte and arthroscopy grades was observed only for US at the medial compartment (rs = 0.747, p < 0.001). The detection of knee osteophytes using the novel US atlas is as reproducible as reading conventional radiographs. US is more sensitive to detect knee osteophytes than CR. Furthermore, osteophytes detected with US correlate significantly with arthroscopic cartilage changes at the medial knee compartment whereas those detected by CR do not.
    No preview · Article · Sep 2015 · Scandinavian journal of rheumatology
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    ABSTRACT: OBJECTIVE: To summarize the work performed by the Outcome Measures in Rheumatology (OMERACT) Ultrasound (US) Working Group on the validation of US as a potential outcome measure in gout. METHODS: Based on the lack of definitions, highlighted in a recent literature review on US as an outcome tool in gout, a series of iterative exercises were carried out to obtain consensus-based definitions on US elementary components in gout using a Delphi exercise and subsequently testing these definitions in static images and in patients with proven gout. Cohen's κ was used to test agreement, and values of 0-0.20 were considered poor, 0.20-0.40 fair, 0.40-0.60 moderate, 0.60-0.80 good, and 0.80-1 excellent. RESULTS: With an agreement of > 80%, consensus-based definitions were obtained for the 4 elementary lesions highlighted in the literature review: tophi, aggregates, erosions, and double contour (DC). In static images interobserver reliability ranged from moderate to almost perfect, and similar results were found for the intrareader reliability. In patients the intraobserver agreement was good for all lesions except DC (moderate). The interobserver agreement was poor for aggregates and DC but moderate for the other components. CONCLUSION: These first steps in evaluating the validity of US as an outcome measure for gout show that the reliability of the definitions ranged from moderate to excellent in static images and somewhat lower in patients, indicating that a standardized scanning technique may be needed, before testing the responsiveness of those definitions in a composite US score.
    Full-text · Article · Sep 2015 · The Journal of Rheumatology
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    ABSTRACT: Background In the last decade, ultrasonography (US) demonstrated to be a useful tool for the diagnosis of calcium pyrophosphate dihydrate deposition disease (CPPD) but the heterogeneity of the criteria used for calcium pyrophosphate crystal (CPP) US detection remains the main limit of this technique regarding reproducibility. Objectives The aim of this study was to define, on the basis of a systematic literature review and experts' opinion, the criteria for US identification of CPP deposits. Methods The first step of this study was the systematic literature review, aimed to identify all the studies regarding US and CPPD and to retrieve the definitions used for the description of the CPP deposits. In the second step, a rheumatologist expert in musculoskeletal ultrasound (MSUS) drew up a first group of definitions for US CPPD identification based on the results of the literature research. In the third step, the propositions were evaluated by a task force composed by 7 members: 4 senior rheumatologists experienced in MSUS, 1 senior rheumatologist expert in imaging, 1 radiologist expert in musculoskeletal imaging and 1 junior rheumatologist with 3 years' experience in MSUS. This step was carried out with the Delphi technique. The consensus was considered obtained for a score greater than or equal to 7. Results Based on the results of the systematic review, we created five groups of definitions. The first four groups were based on the structure under examination: fibrocartilage, hyaline cartilage, tendons and synovial fluid. For each group we defined: echogenity, shape, localization and behavior during dynamic scanning of CPP deposits. The fifth group contained the most important recommendations and tricks for a correct identification of deposits as described in the literature and also based on the experience of the panel of experts. Three Delphi rounds were needed in order to reach a consensus on each preposition Final definitions for US identification of CPP deposits are summarized in the Table 1. Conclusions This is the first attempt, to our knowledge, carried out by a group of experts in order to define US criteria for CPPD identification. The use of these criteria could improve the reproducibility of US among sonographers and promote a greater diffusion of ultrasound as a diagnostic tool for the diagnosis of CPPD. Disclosure of Interest None declared
    No preview · Article · Jun 2015 · Annals of the Rheumatic Diseases
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    ABSTRACT: Background Conventional radiography is the most commonly used imaging modality for assessing osteoarthritis (OA) in daily practice. However, the sensitivity of conventional radiography for detecting early changes of cartilage damage may be relatively low. Ultrasonography (US) is able to visualize large portions of femoral hyaline cartilage directly and to assess osteophytes [1-3]. Objectives The main aim of this study was to compare US with conventional radiography for the assessment of joint damage in knee OA. Methods One hundred sixty-six knees of 84 patients (59 women and 25 men) with primary knee OA were included in this study. The femoral hyaline cartilage of the medial para-patellar aspect and osteophytes of both medial and lateral femoral condyle were scanned. The cartilage involvement and the osteophytes were both quantitatively (grade 0-3) and qualitatively assessed. An US global grade for knee joint damage was developed merging the US cartilage damage and osteophyte grades (grade 0-3). The US findings were compared with those obtained by conventional radiography using the Kellgren and Lawrence (K/L) grading system (grade 0-3). Results There was a moderate agreement between US cartilage damage grade and K/L grade assessments (weighted κ=0.466: 95% CI 0.361-0.572) and fair agreement between US osteophyte grade and K/L grade assessments (weighted κ =0.306: 95% CI 0.208-0.405). A fair agreement was found also between the US global grade and K/L grade assessments (weighted κ =0.396: 95% CI 0.289-0.504). In 31 knees with K/L grade 1, US grade higher than 1 were found in 6 knees for cartilage damage and 14 knees for osteophytes. Ninety-two percent of knees that had less than 1 mm cartilage thickness were classified as severe OA in radiographs. Conclusions The present study provides evidence supporting the concurrent validity of US in the assessment of knee joint damage due to OA through its agreement with conventional radiography. However, such a correlation was moderate. A possible reason explaining the discrepancy between radiographic and US assessment may be related to the fact that US allows a direct visualization of femoral cartilage while joint space width assessed by conventional radiography is the result of cartilage thinning and/or meniscal degeneration and protrusion. References Disclosure of Interest None declared
    No preview · Article · Jun 2015 · Annals of the Rheumatic Diseases
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    ABSTRACT: Background Ultrasound (US) is a promising diagnostic tool for the diagnosis of calcium pyrophosphate deposition disease (CPPD) but, to our knowledge, in the literature are not available data regarding the reliability between operators in the detection of calcium pyrophosphate (CPP) deposits. Objectives The aim of this study is to evaluate the agreement between sonographers in the CPP deposits detection and to understand the main causes of discordance. Methods Six sonographers participated to this study: 4 senior rheumatologists experienced in musculoskeletal ultrasound (MSUS), 1 radiologist expert in musculoskeletal imaging and 1 junior rheumatologist with 3 years' experience in MSUS. This study included 3 steps. In the first the participants defined the criteria for US detection of CPP deposits (this step was extensively described in another abstract). In the second phase the sonographers voted for the presence/absence of CPP deposits in a set of 120 images previously acquired (20 images by each participant) from patients affected or not by CPPD. During the third step the operators performed right knee US examination of eight patients and for each one gave a dichotomous score (presence/absence of CPP crystals). In the second phase the main objective was to test the validity of the criteria, while in the third step the purpose was to evaluate the effectiveness of criteria in a “real life” setting and to understand how the technical approach could affect the reliability. During the second and the third phases, the dichotomous score was severally provided for menisci, hyaline cartilage, patellar tendon and synovial fluid. All the operators were blinded to patients' disease and to other operator's reports. Results The overall agreement was good both for static images (k=0.6366) and dynamic scans (k=0.6190). The k value differs greatly between the structures assessed. It appears higher and homogenous for menisci (respectively 0.65 and 0.61 in static and dynamic images) while greater discordance was found at the level of patellar tendon (0,1675 for static images and 0.0505 for dynamic scans). Substantial difference was noted at the level of the hyaline cartilage, in fact for the static images the value of k was of 0.7728 while for the US examination it decreased to 0.1944 Conclusions US detection of CPP deposits appears easier at the level of fibrocartilage while the agreement decreased dramatically for the patellar tendon. This could be due to an absence of clear criteria for the identification of these deposits. The technical approach appeared very important in regards to CPP detection at the level of hyaline cartilage. In conclusion, the overall agreement in US identification of CPP crystals appears good but could be improved with the revision of US criteria and the standardization of the technical approach as regards to the CPP identification at the level of the hyaline cartilage. Disclosure of Interest None declared
    No preview · Article · Jun 2015 · Annals of the Rheumatic Diseases
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    ABSTRACT: To produce consensus-based definitions of the US elementary lesions in gout and to test their reliability in a web-based exercise. The process consisted of two steps. In the first step a written Delphi questionnaire was developed from a systematic literature review and expert international consensus. This collated information resulted in four statements defining US elementary lesions: double contour (DC), tophus, aggregates and erosion. The Delphi questionnaire was sent to 35 rheumatology experts in US, asking them to rate their level of agreement or disagreement with each statement. The second step tested the reliability by a web-exercise. US images of both normal and gouty elementary lesions were collected by the participants. A facilitator then constructed an electronic database of 110 images. The database was sent to the participants, who evaluated the presence/absence of US elementary lesions. A group of 20 images was displayed twice to evaluate intra-reader reliability. A total of 32 participants responded to the questionnaires. Good agreement (>80%) was obtained for US definitions on DC, tophus, aggregates and erosion in the Delphi exercise after three rounds. The reliability on images showed inter-reader κ values for DC, tophus, aggregates, erosion findings of 0.98, 0.71, 0.54 and 0.85, respectively. The mean intra-reader κ values were also acceptable: 0.93, 0.78, 0.65 and 0.78, respectively. This, the first consensus-based US definition of elementary lesions in gout, demonstrated good reliability overall. It constitutes an essential step in developing a core outcome measurement that permits a higher degree of homogeneity and comparability between multicentre studies. © The Author 2015. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.
    Full-text · Article · May 2015 · Rheumatology (Oxford, England)
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    ABSTRACT: A taskforce comprised of an expert group of 21 rheumatologists, radiologists and methodologists from 11 countries developed evidence-based recommendations on the use of imaging in the clinical management of both axial and peripheral spondyloarthritis (SpA). Twelve key questions on the role of imaging in SpA were generated using a process of discussion and consensus. Imaging modalities included conventional radiography, ultrasound, magnetic resonance imaging, computed tomography (CT), positron emission tomography, single photon emission CT, dual-emission x-ray absorptiometry and scintigraphy. Experts applied research evidence obtained from systematic literature reviews using MEDLINE and EMBASE to develop a set of 10 recommendations. The strength of recommendations (SOR) was assessed by taskforce members using a visual analogue scale. A total of 7550 references were identified in the search process, from which 158 studies were included in the systematic review. Ten recommendations were produced using research-based evidence and expert opinion encompassing the role of imaging in making a diagnosis of axial SpA or peripheral SpA, monitoring inflammation and damage, predicting outcome, response to treatment, and detecting spinal fractures and osteoporosis. The SOR for each recommendation was generally very high (range 8.9-9.5). These are the first recommendations which encompass the entire spectrum of SpA and evaluate the full role of all commonly used imaging modalities. We aimed to produce recommendations that are practical and valuable in daily practice for rheumatologists, radiologists and general practitioners. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
    Full-text · Article · Apr 2015 · Annals of the rheumatic diseases
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    ABSTRACT: A taskforce comprised of an expert group of 21 rheumatologists, radiologists and methodologists from 11 countries developed evidence-based recommendations on the use of imaging in the clinical management of both axial and peripheral spondyloarthritis (SpA). Twelve key questions on the role of imaging in SpA were generated using a process of discussion and consensus. Imaging modalities included conventional radiography, ultrasound, magnetic resonance imaging, computed tomography (CT), positron emission tomography, single photon emission CT, dual-emission x-ray absorptiometry and scintigraphy. Experts applied research evidence obtained from systematic literature reviews using MEDLINE and EMBASE to develop a set of 10 recommendations. The strength of recommendations (SOR) was assessed by taskforce members using a visual analogue scale. A total of 7550 references were identified in the search process, from which 158 studies were included in the systematic review. Ten recommendations were produced using research-based evidence and expert opinion encompassing the role of imaging in making a diagnosis of axial SpA or peripheral SpA, monitoring inflammation and damage, predicting outcome, response to treatment, and detecting spinal fractures and osteoporosis. The SOR for each recommendation was generally very high (range 8.9-9.5). These are the first recommendations which encompass the entire spectrum of SpA and evaluate the full role of all commonly used imaging modalities. We aimed to produce recommendations that are practical and valuable in daily practice for rheumatologists, radiologists and general practitioners.
    Full-text · Article · Apr 2015 · Annals of the Rheumatic Diseases
  • Walter Grassi · Tadashi Okano · Emilio Filippucci
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    ABSTRACT: In the latest recommendations for the diagnosis and management of gout and calcium pyrophosphate dihydrate (CPPD) crystal deposition disease, the diagnostic potential of ultrasound has been recognized. This review highlights the recent advances of research on ultrasound in gout and CPPD crystal deposition disease. Ultrasound allows highly sensitive, noninvasive and quick detection of microcrystal aggregates in multiple anatomic areas. Ultrasound can be used as a safe and reliable guide to aspirate even minimal fluid collections suitable for microscopic analysis, and as a tool for monitoring monosodium urate crystal dissolution induced by urate-lowering therapy. The first metatarsophalangeal joint and the knee should be regarded as the anatomic regions with the highest probability of being respectively positive for monosodium urate and CPPD crystal aggregates. The detection of highly evocative signs in patients with equivocal clinical findings may have a deep impact on the clinical decision-making process, narrowing the differential diagnostic spectrum and avoiding time-consuming and expensive diagnostic procedures. Ultrasound differential diagnosis between gout and CPPD crystal deposition disease is based on the characteristics of crystal aggregates and their preferential localization in different anatomical areas.
    No preview · Article · Mar 2015 · Current Opinion in Rheumatology
  • Emilio Filippucci · Luca Di Geso · Walter Grassi

    No preview · Article · Jan 2015 · Nature Reviews Rheumatology
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    ABSTRACT: Objective Ultrasonography is sensitive for the evaluation of cartilage pathology and degree of osteophytes in patients with hand osteoarthritis (OA). High consistency of assessments is essential, and the OMERACT (Outcome Measures in Rheumatology) ultrasonography group took the initiative to explore the reliability of a global ultrasonography score in patients with hand OA using semiquantitative ultrasonography score of cartilage and osteophytes in finger joints. Methods Ten patients with hand OA were examined by 10 experienced sonographers over the course of two days. Semiquantitative scoring (0–3) was performed on osteophytes (carpo-metacarpal 1, metacarpo-phalangeal (MCP) 1–5, proximal interphalangeal 1–5 and distal interphalangeal 2–5 joints bilaterally with an ultrasonography atlas as reference) and cartilage pathology (MCP 2–5 bilaterally). A web-based exercise on static cartilage images was performed a month later. Reliability was assessed by use of weighted κ analyses. Results Osteophyte scores were evenly distributed, and the intraobserver and interobserver reliabilities were substantial to excellent (κ range 0.68–0.89 and mean κ 0.65 (day 1) and 0.67 (day 2), respectively). Cartilage scores were unevenly distributed, and the intraobserver and interobserver reliability was fair to moderate (κ range 0.46–0.66 and mean κ 0.39 (day 1) and 0.33 (day 2), respectively). The web-based exercise showed acceptable agreement for cartilage being normal (κ 0.47) or with complete loss (κ 0.68), but poor for the intermediate scores (κ 0.22–0.30). Conclusions Use of the present semiquantitative ultrasonography scoring system for cartilage pathology in hand OA is not recommended (while normal or total loss of cartilage may be assessed). However, the OMERACT ultrasonography group will endorse the use of semiquantitative scoring of osteophytes with the ultrasonography atlas as reference.
    No preview · Article · Dec 2014 · Annals of the Rheumatic Diseases
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    ABSTRACT: Enthesitis represents a characteristic features of spondyloarthritis (SpA) and, in the context of the early management of the disease, its reliable assessment has emerged as a central issue. Musculoskeletal ultrasonography (US) has proven to be of value in the assessment of peripheral entheses. Our aim was to systematically review the literature from 2010 to 2013 in order to summarise the evidence on the evaluation of entheses by US in patients with diagnosed or suspected SpA. PubMed and Embase were searched developing a search strategy based on terms related to SpA and US. The target population were patients with SpA or suspected SpA, the intervention was entheseal US, the outcomes were the prevalence of US abnormalities, the reliability, the diagnostic accuracy, the sensitivity to change. The possible comparators were clinical evaluation and other imaging techniques. Cohort studies (cross-sectional or longitudinal), case-control studies, diagnostic accuracy studies, systematic literature reviews and meta-analyses were eligible for inclusion. Out of 3368 retrieved references, 34 papers were finally included. 22 of which reported information on the prevalence of US findings, yielding highly variable results. US was sufficiently reliable, as reported in 6 papers. A minority of studies reported data on sensitivity to change, which was good, and on the application of US for differential diagnosis and diagnosis of SpA, thus demonstrating the value of US also in this context. US confirms its validity and reliability in the assessment of entheseal involvement in patients with SpA. Further application in the help of diagnosis will be provided by future research.
    No preview · Article · Nov 2014 · Clinical and experimental rheumatology

  • No preview · Article · Oct 2014
  • Emilio Filippucci · Luca Di Geso · Walter Grassi
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    ABSTRACT: For decades, diagnostic imaging in rheumatology has used conventional radiography. Over the past 10 years, MRI and ultrasonography have clearly shown their potential in diagnostic imaging in rheumatology and their use is revolutionizing the management of chronic arthritis, revealing subclinical inflammation and predicting progression of joint damage. Although validation processes for these imaging modalities are still ongoing, several investigations have now established the positive correlation between subclinical synovitis and radiographic progression of joint damage. Despite the available evidence and the diagnostic potential, there remains a substantial proportion of rheumatologists for whom MRI and ultrasonography findings do not influence their clinical decision-making. This Perspectives will discuss the key issues related to diagnostic imaging in patients with chronic arthritis, outlining how new imaging techniques have evolved over the past two decades and presenting the most attractive technological advances in this field.
    No preview · Article · Sep 2014 · Nature Reviews Rheumatology
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    ABSTRACT: Objectives To develop evidence-based recommendations on the use of imaging in the clinical management of both axial and peripheral spondyloarthritis. Methods The task force comprised an expert group of 21 rheumatologists, radiologists and methodologists from 11 countries. Twelve key questions on the role of imaging in SpA were generated using a process of discussion and consensus. Imaging modalities included conventional radiography (CR), ultrasound (US), magnetic resonance imaging (MRI), computed-, positron emission- and single photon emission computed tomography, dual-emission x-ray absorptiometry (DXA) and scintigraphy. Experts used research evidence obtained from a systematic literature review using MEDLINE and EMBASE to develop a set of 10 recommendations. The strength of recommendation (SOR) was assessed by the group members using a visual analogue scale. Quality assessment of the included studies was performed using the QUADAS-2 tool. Results A total of 7550 references were identified in the search process, from which 157 studies were included in the systematic review. Ten recommendations were produced encompassing the role of imaging in making a diagnosis of axial SpA or peripheral SpA, monitoring inflammation and damage, predicting outcome, response to treatment, and detecting spinal fractures and osteoporosis (OP). The SOR for each proposition varied, but was generally very high (mean 8.9-9.5). Selected aspects of the recommendations are given below (NOT all recommendations and NOT the exact wording, due to space constraints): CR of the sacroiliac joint (SIJ) is recommended as the first imaging method to diagnose sacroiliitis as part of axial SpA, while MRI is an alternative first imaging method in certain cases. US or MRI may be used to detect peripheral arthritis, tenosynovitis, bursitis and particularly peripheral enthesitis, which may support the diagnosis of SpA. MRI of the SIJ and/or spine may be used to assess and monitor disease activity, while CR of the SIJ and/or spine may be used for long-term monitoring of structural damage, particularly new bone formation in axial SpA. In patients with AS (not nonradiographic axial SpA), initial CRs of the lumbar and cervical spine are recommended to detect syndesmophytes, which are predictive of development of new syndesmophytes. MRI (vertebral corner inflammatory lesion) may also be used to predict development of new radiographic syndesmophytes. When spinal fracture in axial SpA is suspected, CR is the recommended initial imaging method. In axial SpA without radiographic syndesmophytes in the lumbar spine, OP should be assessed by hip and AP-spine DXA. Conclusions Ten recommendations for the role of imaging in the clinical management of SpA were developed using research-based evidence and expert opinion. Disclosure of Interest P. Mandl: None declared, V. Navarro-Compán: None declared, L. Terslev: None declared, P. Aegerter: None declared, D. van der Heijde: None declared, M.-A. d'Agostino: None declared, X. Baraliakos: None declared, S. Juhl Pedersen: None declared, A. G. Jurik: None declared, E. Naredo Grant/research support: MSD, Spanish Foundation of Rheumatology, Speakers bureau: Abbvie, Roche Pharma, BMS, Pfizer, UCB, GE, ESAOTE, C. Schueller-Weidekamm: None declared, U. Weber Consultant for: AbbVie, M. Wick: None declared, E. Filippucci: None declared, P. Conaghan: None declared, M. Rudwaleit Consultant for: Roche, MSD, Pfizer, Novartis, UCB, Speakers bureau: AbbVIe, BMS, Chugai, G. Schett: None declared, J. Sieper: None declared, S. Tarp: None declared, H. Marzo-Ortega Speakers bureau: AbbVie, MSD, Janssen, Pfizer, UCB, M. Østergaard: None declared DOI 10.1136/annrheumdis-2014-eular.2204
    No preview · Conference Paper · Jun 2014